RNs: The Critical Factor In The U.S. Nursing Workforce

Abstract

Although this book’s title suggests a comprehensive overview of the U.S. nursing workforce, this book has a more narrow focus on the nation’s supply of and demand for registered nurses (RNs). In part, the decision to eliminate consideration of licensed practical nurses (LPNs) and nurse aides (NAs) is based on the availability of data over a sustained period of time to enable accurate and meaningful interpretation. RNs are viewed by the authors as having “a much larger impact on the productivity of the nursing workforce” than LPNs or NAs; they “earn higher wages, and exert a much greater effect on healthcare spending, quality of care, and patient safety.” Readers of this book will not conclude that there is a national “crisis” in regard to the RN workforce. However, the authors describe in great detail a number of harbingers of considerable concern that if ignored could lead to serious compromises in our ability to provide needed health care services, especially in hospitals and skilled nursing facilities. This book is essentially an analysis of basic patterns of “supply” of and “demand” for RNs and the services they provide in the context of the U.S. health care system. The authors offer an analytical approach that is likely to be useful both for classroom applications in health care policy and labor economics and for policymakers and nursing professional advocates. Basically, the authors have updated previous estimates of anticipated shortages of RNs, suggesting that shortages between 2015 and 2020 will be in the range of 285,000 RNs—a figure somewhat lower than initially calculated a few years ago but still nearly three times the size of current shortages. More importantly, they show that the current shortages (measured by the number of vacant RN positions) have persisted since the late 1990s and represent the “longest lasting shortage in over 50 years.” In some respects, at least for RNs in the current labor market, all aspects of this analysis are unlikely to be seen as “bad news.” The authors anticipate that the shortages will result in upward pressure on RNs’ wages, followed by movement toward new educational opportunities for entry into the nursing field and an increase in the popularity of nursing as a career (on the supply side). Such changes will be followed by increased emphasis on alternative types of providers of what have been considered “nursing” tasks by health care organizations (the demand side). Many of these future scenarios are hard to conceptualize and measure precisely, but the general scope of potential change on both sides of the workforce B o o k R e v i e w s