NURSING SHORTAGE IN THE UNITED STATES 1

A Review of the Nursing Shortage Found in the United States

Thomas C. Dwinell

Appalachian State University, RC 2001 Section#151

NURSING SHORTAGE IN THE UNITED STATES 2

Abstract:

For several years now nursing shortages have been prevalent across the country. There are

several reasons for this shortage along with several consequences associated with it. The

COVID-19 pandemic drastically changed the demand for nursing, causing many nurses to work

grueling hours and witness many traumatic events. Additionally, during the COVID-19

pandemic, many nurses from the baby boomer generation started retiring, this put extra strain on

the health care system and impacted the staffing in hospitals across the country. In current times,

nurses are overworked and short staffed leading to many issues ranging from compromised

patient care to poor mental health and morale amongst nurses(Needleman & Buerhaus, 2003).

This is a topic that impacts everyone because everyone receives medical care and needs to

receive the best treatment possible. There are several new ways of looking at and combating this

problem. Many of these approaches involve creating a motivating and encouraging environment

in which nurses have the ability to rest, plan, and ultimately treat patients with the best care

possible. Additionally, there is a strong push for legislature and policy change about how many

hours nurses can work, mandatory overtime, and many other questionable practices.

Keywords: nursing, nursing shortage, burnout, pandemic, education, healthcare

NURSING SHORTAGE IN THE UNITED STATES 3

A Review of the Nursing Shortage Found in the United States

Nurses are crucial to the treatment of patients, making up the majority of healthcare

professionals(Haddad et al., 2022). The scope of practice for registered nurses includes

“administering and monitoring medications; developing care plans; taking vital signs and

recognizing abnormalities; caring for wounds; performing basic life support.” (Berg, 2021). This

large scope of practice and responsibility can be harmful for nurses because administrators often

assign large workloads leading to an unequal distribution of work in the healthcare setting. Many

studies have predicted that in the coming years there will be a severe staffing shortage for

hospitals. In the United States, “The US Bureau of Labor Statistics, it predicts more than 275,000

additional nurses are needed from 2020 to 2030. Employment opportunities for nurses are

projected to grow at a faster rate (9%) than all other occupations from 2016 through

2026”(Haddad, 2022). This surge of new positions opening is why there is a nursing shortage

that needs to be addressed and prepared for. Currently there is an even higher demand for nurses

due to the COVID-19 pandemic. The workload drastically increased due to the high number of

patients being admitted to hospitals emergency and critical care units(Ness, 2021). The stress,

physical demand, and dangers related to working with COVID-19 patients has led to many

nurses retiring early to escape. This contributes to the nursing shortage. The nursing shortage in

the United states is a serious problem that affects everyone, there are several things contributing

to this problem.

One area that impacts the nursing profession is that there are simply not enough new

nurses entering the workforce to replace the retiring nurses and to fill new positions created by

hospitals. This can be explained when looking at the number of facilities and schools that teach
NURSING SHORTAGE IN THE UNITED STATES 4

and prepare nurses. In the American Association of colleges of nursing’s report on 2019-2020

Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing, “U.S. nursing

schools turned away 80,407 qualified applications from baccalaureate and graduate nursing

programs in 2019 due to an insufficient number of faculty, clinical sites, classroom space,

clinical preceptors, and budget constraints”(Rosseter, 2019). The lack of schools and facilities

and their ability to graduate larger class sizes drastically decreases the amount of nurses that

could be entering the field. This is a crucial part of the nursing shortage in the United States that

needs to be addressed. Without an adequate amount of students entering nursing schools, there

will never be enough nurses to fulfill nursing requirements nationwide. Another reason that there

are not enough nurses entering the workforce is that there are not enough instructors. This is

occurring for several reasons but one being that educators do not get paid enough. The AACN

found that the average salary of a master's level nurse educator was a mere $79,444 whereas the

average salary of a Nurse practitioner is $110,000.(Rosseter, 2019) Because there is an

opportunity to make a higher salary, many nurses choose not to go into education but stay in the

clinical setting. This has also changed during the pandemic. Hospitals offered drastic pay raises

and bonuses for nurses working during the pandemic, drawing away potential nursing

instructors. Altogether the lack of new nurses entering the workforce is a fundamental reason the

nursing shortage exists and will continue to exist if nothing is changed.

Another reason we are seeing the nursing shortage in the United States is because there is

about to be an immense number of nurses retiring. In a research article titled “Retirements and

succession of nursing faculty in 2016–2025”, Dr. Di Fang writes “Based on historical trends in

faculty retirements, faculty aged 60 or older in 2015, who comprised about one-third of total

faculty population, were considered as those who are likely to retire in the next 10 years. The
NURSING SHORTAGE IN THE UNITED STATES 5

impact of their exodus on the entire faculty workforce will be huge. Although this faculty group

comprised slightly less than one-third of total faculty in 2015, they comprised 44.3% of faculty

with a research-focused doctoral degree, 69.2% of full professors, 44.9% of associate professors,

36.9% of faculty teaching at graduate level, and 36.4% of faculty teaching at both baccalaureate

and graduate levels”. As we can see the aging population of nursing faculty is going to be a

major influence on the nursing shortage. Because there are so many older nurses preparing to

retire in the next 10 years, this wave of retirement demands a large number of new nurses. It is

important to note that the quote above states that 69.2% of full professors are going to retire by

2025. This puts an immense strain on nursing programs nationwide as they are already

scrambling to fill professor and instructor positions in their schools. Altogether, there is going to

be a large amount of faculty retiring which will further exacerbate the shortage nationwide. This

compounding with the fact that many of those retiring are nursing professors and instructors

indicates the immediate need for nurses, educators, and higher incentives for teaching.

Another reason that we are seeing the nursing shortage is due to nurse burnout. Nurse

burnout according to Christinia Maslach and Micheal Leiter, In their book The Truth About

Burnout: how organizations cause personal stress and what to do about it, burnout is“a sustained

response to the chronic work stress comprising of three components: the experience of being

emotionally exhausted (emotional exhaustion), negative feelings and attitudes towards the

recipients of the service (depersonalisation) and feelings of low accomplishment and

professional failure (lack of personal accomplishment)”(Maslach, 1997). As discussed

previously, there is a wide scope of practice, demanding hours and tasks for nurses. This stress

can lead to burnout, which ultimately leads to switching careers or retiring early. There are

several factors influencing burnout, one of which is scheduling. When faced with an inflexible
NURSING SHORTAGE IN THE UNITED STATES 6

schedule it has been proven that this heightens emotional exhaustion in nurses, as well as raises

the potential for higher work demands. Another factor influencing nurse burnout are the physical

and emotional demands. Nurses constantly have to face death, disease, and injury when working.

This is emotionally demanding and can lead to burnout(Gandi et al. 2011). Nurses also work

long hours and have many physically demanding tasks such as lifting patients or doing repetitive

tasks. These physical demands can lead to chronic pain and joint or muscle aches (Kaewpan,

2019), leading to burnout. Altogether burnout occurs when there is a lack of physical and

emotional resources for nurses. With proper precautions burnout can be lowered in the nursing

workforce which will reduce the amount of people leaving the profession which contributes to

the overall nursing shortage problem.

Policy Change

As we can see there is a nursing shortage in the United States, and there are several

factors that contribute to it. Because there are several factors that contribute to the nursing

shortage, there are also several ways that we can minimize the impact of the shortage. These can

include providing incentives for going into nursing education, providing flexible schedule

options, and creating more nursing schools/facilities. All of these are options that do take effort

and money but in the long run it will improve patient care and mental health of nursing faculty.

One major policy that can be enacted is raising the salary for nurse educators. This would

contribute to solving the problem by decreasing the amount of nurses going into private practice

or higher paying clinical jobs(Rosseter, 2020). If there were more nurses and educational faculty

then nursing schools would be able to accept and train more nurses. Graduating larger nursing

classes is crucial to making up for the retiring workforce and the main way to mitigate the
NURSING SHORTAGE IN THE UNITED STATES 7

problem. Altogether raising incentives for teaching would enable schools to admit new nursing

students, leading to an increase in the nursing faculty nationwide.

A second policy change that could affect the nursing shortage is changing the way we

schedule nursing shifts. It is commonly accepted that working time arrangements such as night

shifts, inflexible work schedules, and unpredictable hours constitute serious psychosocial

hazards(Suzanne, et al. 2018). In theory, if managers were flexible in their scheduling, and

allowed nurses to have more of a say in how long and what days they worked, this would lower

stress. The more flexible the scheduling is, the less stress nurses will have(Suzanne, et al.). It is

important that nurses have a say in their work schedules because it can drastically affect morale

in the workplace. If poor morale is present in the workplace and people feel their concerns are

not being heard then it can contribute to burnout, which further increases the shortage of nurses.

Lastly, the nursing shortage can be solved by creating more nursing schools and facilities

to train nurses. This can only be done once the problem of having enough nurse educators is

solved. Without enough nurse educators already, this is a solution that needs to be implemented

down the road. It is commonly agreed upon that in the near future there will be an increase in the

demand for nurses and a decrease in available nurses(Buerhaus, 2021). To combat this issue I

propose that we focus most of our energy on creating more nursing schools so that we can bring

more people into the workforce. Without a drastic increase in people entering the nursing

profession, there will always be a shortage of nurses. Altogether there is a fundamental need for

larger nursing schools to accommodate the needed increased class sizes.

In the healthcare setting there is a crucial need for policy change that can alleviate the

nursing shortage in the United States. The nursing shortage impacts everyone, whether it be
NURSING SHORTAGE IN THE UNITED STATES 8

patients, nurses, doctors, or community members. Inadequate staffing can lead to workplace

injuries and mistakes(Haddad et al., 2022). The shortage of nurses has been brought on by

underpaying educators, not listening to employees, and not having enough facilities to

accommodate for such a large demand of nurses. There are several ways to combat these

problems whether it be paying educators more, changing the way we schedule or manage nurses,

and building or growing nursing programs nationwide. This is a problem that will not go away

unless something is done, and innocent people will face the consequences if it is not fixed.
NURSING SHORTAGE IN THE UNITED STATES 9

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