Running head: THE NURSING SHORTAGE

The Nursing Shortage

Jason Conk
Ferris State University

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Abstract
The nursing shortage is currently a very large problem in the US and world in general which
results in many adverse patient outcomes, errors, and preventable deaths every day. The
situation is increasing at a rapid rate and is quickly set to become problem of epidemic
proportions. This paper examines how the nursing shortage began, how big of a problem it is,
and how large the problem could become in the near future. An analysis of the problem will be
conducted with recommendations of how to resolve the issue. Interventions and
recommendations will relate to the American Nurses Associations (ANA) standards of
professional practice along with Quality and Safety Education for Nurses (QSEN) competencies.
Nursing and non-nursing theories will also be implemented to help guide recommendations.

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The Nursing Shortage

Nurses are an integral part of the healthcare system and are at the very foundation of all
health care delivered. Nurses comprise the largest portion of the entire healthcare system with
over three million registered nurses in the US. Nurses easily outnumber physicians at a rate of
10 to 3 according to the Bureau of Labor Statistics (BLS) (2014) and are the primary healthcare
providers for many people. Nurses have also been consistently rated as the most trusted
profession for years by numerous polls. The services nurses provide cannot be underestimated
and the quality of care they deliver is what allows the entire healthcare system to function. Since
nurses are at the forefront of all health care delivered, everything must be done to preserve this
profession and allow it to grow.
The US and the world as a whole are currently experiencing a shortage of Registered
Nurses (RN). According to the American Nurses Association as of 2012 the US was already
experiencing a shortage of nearly 150,000 nurses and the shortage is estimated to increase to
potentially over a half-million or over 20% by 2022 (Duvall, 2014). This is a significant
shortfall in the number of qualified nurses needed to care for the population as a whole. Nurses
are a crucial part of the healthcare system and with a significant shortage it will equate to lower
quality of care, extended stays, increased readmits, increased errors, and more patient deaths.
The problem is dire and it must be addressed and corrected before the health of all patients
begins to suffer. The problem is widespread and there is no one stop fix to the problem, it is
multifaceted and has many dynamics that must be addressed in order to correct and resolve the
impending threat to quality care for all patients.

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Theory Base

Jean Watson
Jean Watson is an American nursing theorist that is world renowned and
respected for her contributions to advancing the nursing profession. She created the Theory of
Human Caring in 1988. This theory was developed because Watson believed in order to
provide optimal care for all patients that the nurse must recognize the significance of each and
every individual and must treat them as humans. Watson (2014) states that a human is
A valued person in and of him or herself to be cared for, respected, nurtured,
understood and assisted; in general a philosophical view of a person as a fully functional
integrated self. Human is viewed as greater than and different from the sum of his or her
parts (para. 2).
Watson believed that nurses must be afforded the time to bond with their patients and get to
know them on a personal level and that they must be treated with dignity and respect. Without
developing a bond and a level of respect the nurse will not be able to properly care for a patient.
She believes this bond allows patients to be more receptive of the nurses treatments and more
likely to adhere to education about their condition. Having adequate time to spend with each
client also allows the nurse to properly assess their patient and be more in tune with any changes
in their condition.
The increasing nursing shortage is forcing nurses to care for more patients thus reducing
the amount of time they can spend with them. With inadequate time to spend with each patient
the nurse will not be able to develop a functional relationship with their patients. The nurse will
not have time to bond and treat each and every client with the respect and dignity they deserve.

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The nurse may appear as uncaring and bothered by the interaction they have with the patients if
they are overworked and short on time. The patient will perceive a lack of quality time spent
with them as uncaring and unprofessional. The patient may not accept the care they are
receiving and not listen to the education the nurse gives them. Lack of quality time will not
allow the nurse to properly assess their patient, lead to more errors, and create a lack of patient
adherence to treatment regimens. The Theory of Human Caring utterly cannot be sustained as
nurses are forced to care for more patients and spend less time with each one. In order for this
theory to be utilized effectively and implemented across the board, more nurses must be trained
and brought into the healthcare system.
Ludwig von Bertalanffy
Ludwig von Bertalanffy is a world renowned biologist that created the General System
Theory in 1936. This theory was created as a framework to guide many different disciplines.
The General System Theory postulates that disciplines can be broken down to individual
components that all work together to create the sum of the whole. Bertalanffy argues that by
breaking things down it allows for differentiation and specialization and allows for a natural
order of progression. He thought that most disciplines were too vast for any one person to
specialize in and be able to perform efficiently at. The very essence of the system is to
differentiate and categorize subsets of skills to work at achieving an overall goal such as a
Banking System, Political System, School System, Family System, or a Healthcare System.
The healthcare system is a great example of Bertalanffys theory at work. At the time of
the creation of the General System Theory, there were mostly only nurses and doctors that cared
for patients without much specialization. Without having differentiation and specialization this

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created a tremendous burden on all healthcare members as they were required to have vast
amounts of knowledge and skills about all dynamics of healthcare. Through the use of
systemization the healthcare field has been broken down and differentiated into countless
specialties and sub-specialties. By creating a vast system of healthcare providers the entire
system works much more effectively and efficiently as everyone can focus all of their effort on
mastering one particular skillset instead of having a very general knowledge about many areas
without any particular strong points.
The general system theory has allowed for the field of nursing to differentiate and create
numerous specialties all within one field which all work together to create the healthcare system.
The nursing shortage is putting a strain on the healthcare system as a whole. Nurses are the
backbone of the entire healthcare system comprising over three million members. Without
adequate nursing staff all patients will begin to suffer. Regardless who the patient is or what
specialty of treatment they require, nurses at some point will be responsible for their care.
Nurses specialize in all areas of care from neonates to geriatrics and hospice care, their work is
an integral part of everyones care and without them the entire healthcare system will begin to
crumble.
Assessment of the Healthcare Environment
There are many factors that have led to the current nursing shortage and factors that are
only going to exacerbate the situation. The main reasons for the nursing shortage include: babyboomers, retirees, increase in chronic diseases, lack of nursing educators, and the implementation
of the Affordable Care Act. An aging population and the drastic increase in people that now
have health insurance are not factors that can be changed, but they must be accounted for

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nonetheless. Decreasing the number of chronic diseases is a controllable factor but not one that
can be implemented immediately nor can it directly solve the current nursing shortage. The one
factor that is controllable and changed is having a lack of qualified nursing educators to train
new nurses.
Baby-Boomers/ Retirees
The population born between 1946 and 1964 aka the Baby-Boomers are the largest factor
that must accounted for when dealing with the nursing shortage. According to the ANA (2014)
from January first 2012 through December 31 2030 an average of 10,000 people will be retiring
every single day in the US. Thats over 63 million people that will begin to require many more
nursing services as the elderly consume a large percentage of all healthcare services. With
millions of people reaching retirement age, beginning to tap into needed healthcare services, the
demand for nurses is going to skyrocket.
The baby-boomers are creating another dynamic to the nursing shortage situation as
many of the current nurses themselves are a part of that generation. According to the American
Association of Colleges of Nursing (AACN) (2014) over 55% of the current RNs in America are
over the age of 50. That means over 1.5 million nursing positions are going to need to be filled
at the same time as the largest influx of elderly population the world has ever seen comes to
fruition. The baby-boomers are going to put a huge strain on the entire healthcare system and the
nurses available to care for them is going to decrease by 40% (AACN, 2014).
Nursing Educators
A lack of qualified nursing educators is another important factor contributing to the
nursing shortage. According to Yucha (2014) nearly 80,000 qualified candidates were turned

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away from nursing schools in 2013 due to lack of staffing. Not only are thousands of applicants
being turned away from nursing school but those that do get accepted are waiting an average of
2-4 years (Yucha, 2014). With such a long wait just to enter nursing school many applicants are
turning to other careers as they could possibly graduate with another degree before they could
even start nursing school.
The seriousness of having a lack of educators is only going to get worse in the near
future. Unfortunately, many of the nursing professors nationwide are part of the baby-boomers
generation. According to Kuehn (2007) the average ages of PhD nursing professors, associate
professors, and assistant professors were 58.6 years, 55.8 years, and 51.6 years, respectively (p.
1624). There is currently a severe lack of educators to train enough new nurses to curb the
current nursing shortage. With many of the current educators beginning to retire over the next
10-15 years the situation is only going to deteriorate rapidly.
Other Factors
According the ANA (2014) over 32 million people will begin to receive healthcare
coverage in 2014 under the Affordable Care Act. That is nearly ten percent of the entire US
population that will start using healthcare services regularly that most likely would not have
without insurance coverage. This alone is going to create an instant need of tens of thousands
more nurses. Without an instant influx of new nurses this is only going to create higher patient
loads and increased stress on the current workforce.
With increased stress comes decreased job satisfaction which inevitably leads to higher
rates of burnout and drives many nurses out of the field all together. The ANA states that over
75% of nurses believe that increases patient loads leads to higher stress levels and decreased

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quality of work life (2014). The AACN reported that 13% of new nurses changed their principal
job within the first year of licensure (2014). That same study also found that over 37% have
thought about leaving their jobs. The more stress put on nurses the lower their job satisfaction is
going to be which will inevitably lead to burnout and many nurses leaving the field only adding
to the already huge shortage of nurses.
Inference/Implications/Consequences
The nursing shortage is a very real problem that has dire consequences for everybody in
the US and anywhere in the world that is suffering from a nursing shortage, which is virtually
every country. The nursing shortage will lead to less time being spent assessing patients which
directly affects the care they receive. It will lead to more errors, leading to more adverse
outcomes, longer wait times for medical care, overall reduced quality patient care culminating to
more deaths. The entire healthcare system is in place to treat patients, heal their wounds, and
cure the ailments, without an adequate number of nurses to care for those seeking treatment the
entire system is jeopardized. The nursing shortage will have a direct impact on the quality of
care everybody receives and will cause many more adverse outcomes.
There are varying reports on just how bad the nursing shortage will get, but all credible
sources agree the shortage is getting worse. The lowest estimated numbers show a shortage of
roughly 300,000 nurses (Kuehn, 2014) to a high of over 500,000 (AACN, 2014) by 2025. A
shortage of even 260,000 would be twice that of the crisis in the 1960s a shortage of 500,000
would be four times that number. Even a shortage of the lowest estimates places healthcare
recipients at substantially greater rates of errors and adverse events. Having fewer nurses is not
only a serious concern to patients but to the nurses themselves as they will be forced to try and

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pick up the slack. The ANA states, nurses working long hours under stressful conditions leads to
increased fatigue, injuries, and job dissatisfaction culminating to them seeking new careers
(2014).
The AACN (2014) cites many studies that relate higher patient to nurse rates to decreased
outcomes and lower patient to nurse outcomes to increased patient outcomes. They state that
increased patient to nurse rates attributes to increased rates of surgical infections, urinary tract
infections, ventilator acquired pneumonia, failure to rescue (FTR), and overall increased rate of
death of 6%. The AACN also state that over 42% of all Americans have reported that they or a
family member have experienced a medical error. These studies were all performed in the last
ten years when the nursing shortage has been estimated at 100,000 or less, with potential future
shortage of 300,000-500,000 the number of errors and preventable deaths are going to become
astronomical.
Recommendations for Quality and Safety Improvements
The outlook of the nursing shortage looks bleak and it appears it will only get worse
before it gets better. Every day the nursing shortage continues to grow and patients suffer more
than they should. Despite the bleak outlook it is not too late to act and the situation can be
improved. With 10,000 baby-boomers retiring every day and with nursing staff and nurse
educators being among those retirees the time to act is now. The overall goal is simple, graduate
more nurses from accredited institutions, however, that is much easier said than done and it will
take a multi-faceted approach in order to resolve.
In order for accredited nursing schools to produce more graduates they must hire more
educators. This is a problem for many reasons; they dont have the funds to just hire more, there

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is a lack of qualified candidates and it takes time and money to educate them, schools need more
equipment and facilities, and educators get paid substantially less than what MSN and PhD
prepared nurses could make outside of academia so there is a disincentive to teach. There are
many problems and barriers that are attributing to the nursing shortage but funding is the largest
one. Schools need more funding in order to create and retain more educators in order to prepare
more BSN prepared nurses to work in the clinical setting.
Title VIII is a federal program that was designed in 1965 that addressed the then current
nursing shortage. The bill appropriated millions of dollars to colleges and universities to hire
faculty, build facilities, and acquire training materials. The bill also provided grants and
scholarships for students to attend nursing school. This bill is still active today but has seen an
average of two percent funding decrease over the last 4 years (ANA, 2014). The US is on the
brink of the largest nursing shortage ever seen and funding to schools and students is decreasing.
The healthcare system needs the help of the federal and state government along with
philanthropic groups to create funding for developing educators, building facilities, and
providing scholarships and grants to students in order to halt the growing nursing shortage.
ANA standard 13 dictates that collaboration is needed in order to grow and sustain the
field of nursing. Nurses need to collaborate with each other and become a collective voice in
order to bring notice of this situation. By becoming members of groups such as the ANA or the
AACN or any of the other many well respected and reputable nursing organizations nurses can
fight and vote as a team in order to garner the attention of their state and federal government in
order to increase funding for nursing. QSEN competencies also state that teamwork and
collaboration are one of the keys to effective nursing. Nurses must stand together and become
recognized as one cohesive group that are vital members to the health of the entire nation in

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order to gain support and respect from philanthropists and philanthropic groups so they will
donate money to help curb the dire situation of a national nursing shortage.
The state of Oregon recognized the significance of the impending nursing shortage in the
early 2000s and created the Oregon Consortium for Nursing Education (OCNE). The group was
commissioned to completely overhaul the curriculum and standards of the states nursing
programs and to bring awareness of the issue. The group has taken many measures to
successfully double the number of graduates between 2002 and 2008 (Lewis, 2010). They
created public relations campaigns to bring more men and minorities into the field as the
overwhelming number of RNs are white women. They also started recruitment efforts in high
schools and implemented dual enrollment programs so prerequisites could be completed before
entering college in order to graduate students more quickly. The OCNE was also able to work
with their state congress to pass a bill authorizing loan repayment of $10,000 per year for
advanced nursing degrees to encourage more nurses to achieve advanced degrees in order to
become educators (Lewis, 2010).
ANA standard 4 states that planning is an essential function of the nurses job. Nurses
must plan for the future and take steps to provide the greatest outcomes for the entire filed which
inevitably leads to the best outcomes for the patients. The state of Oregon is taking steps above
and beyond that of most states in order to alleviate the nursing shortage. The nurses there have
created a fantastic organization in order to bring notice of the situation to the public and their
representatives. Their hard work and dedication have paid great dividends as they have been
able to successfully double their annual output of new nurses and have offered great financial
incentives for BSN prepared nurses to further their education. They are actively planning for the
future and are taking steps to create a better future for the nurses of their state and to the

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population as a whole. All states can learn from their experiences and start implementing
programs such as theirs; this will help pave the way to much broader, federally backed programs.
ANA standard 10- Quality of Practice states that RNs must contribute to quality nursing
practices. With nurses being constantly overworked their quality inevitably is diminished.
Overworking nurses leads to job dissatisfaction, lower retention rates, and decreased quality of
care. By overworking the nurses it is almost impossible for them to retain quality practice at all
times. According to Needleman, Buerhaus, Stewart, Zelevinsky, and Mattke (2006) When
there is a decrease in RN staffing, there is an increase in the incidence of pneumonia, urinary
tract infections, gastrointestinal bleeding, and length of stay (p. 207). Nurses are constantly
being forced to work more hours to compensate for the shortage of nursing staff available. More
RNs must be trained and graduated from accredited institutions in order to prevent needless
patient errors and adverse outcomes from happening.
Conclusion
The nursing shortage is a serious problem that has very real and serious consequences for
the health of the entire nation. The problem is only going to intensify as more of the babyboomers begin to retire and consequently many of the current working RNs and nursing
educators also retire. The nursing shortage is going to increase substantially if it is not addressed
and measures taken to correct it on a national level. There is not one easy solution to the
problem as it will require many different approaches in order to slow the progress of the nursing
shortage.
Nurses must come together and act as one unified voice to create the largest impact and
measures can be taken to thwart the growing epidemic. Collectively nurses stand over three

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million strong and their voice cannot be muted on a national level. RNs must let their
representatives and congressman know how dire the situation is so legislation can be introduced
to increase funding. The solution doesnt just lie with government funding. Philanthropists,
corporations, endowments, and partnering with hospitals and medical companies are all great
potential sources for funding. Steps should also be taken to increase the publics awareness of
the issue as it is ultimately the health of everybody that is at stake.
The nursing shortage is not a nursing problem, it is an everyone problem. Everybody in
America requires the professional assisstance nurses provide at some point in their life. The
public must be informed of the impending epidemic and how it relates to them. By bringing this
problem to mainstream attention it will motivate people to take a stand and take action to curb
the problem and develop solutions. There are many steps that can be taken to help alleviate the
situation and the more people are aware of the problem, then the more help that can be garnered
to correct it.

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