Nursing Workforce Initiatives in the US

Healthcare Policy Issue/ Concern

Nurses have historically been at the forefront of revolutionizing healthcare. However, in today’s United States, their potential might not be used to the fullest due to too many challenges faced by the nursing workforce. Buerhaus et al. (2017) state that the dire situation can be broken down into four key issues. As reported by the Organization for Economic Co-operation and Development, the United States has the largest nursing workforce in the world, and yet it does not meet its residents’ demands (Buerhaus et al., 2017). Buerhaus et al. (2017) ascribes such drastic discrepancy to demographic trends, such as the aging of the baby boom generation, which is associated with geriatric care and a surge in age-related diseases. On top of that, a significant number of registered nurses retire, and the shortages are not replenished by young specialists. Lastly, the authors point out the uneven distribution of physicians and the uncertainty of health care reform outcomes.

So far, the US government has attempted to address the workforce issues in a variety of ways, though not always adequately. For instance, nursing assistants have been introduced ubiquitously to lighten nurses’ workload by reassigning some work responsibilities. However, as proven by Duffield et al. (2019), the addition of assistance has been associated with poorer patient outcomes and has not been generally helpful. As for staff shortages, White (2017) reports that undergraduate nursing education in the United States receives funding through two streams. These are Title IV of the Higher Education Act of 1965 and Nursing Workforce Development Programs under Title VIII of the Public Health Service Act of 1944.

Yet, the government does not have a workforce planning capacity due to its complicated, decentralized, mixed public-private structures. The situation became even more unfavorable after 2016 presidential elections when President Trump advocated against the Affordable Care Act and proposed the elimination of $400 million in nursing training programs. The American Nursing Association (n.d.) emphasizes the need for a health reform that would empower individual nurses to become leaders within their organizations through the provision of better educational and career paths.

Significance to Nursing/Patient Care

Nursing workforce initiatives translate into the quality of patient outcomes and care accessibility. The conversation about nursing workforce challenges cannot leave out one of the most profound healthcare reforms of the last decade, the Affordable Care Act (commonly referred to as the ACA). Carthon et al. (2015) report that, thanks to the ACA, 11 million Americans became insured and accessed healthcare services. In 2015, it was projected that each year 15-24, more Americans would be able to enjoy accessibility and expanded coverage (Carthon et al., 2015). As much as these figures indicate a positive dynamic, there is a risk that the new demand will not be met with supply. Indeed, even if an individual has medical insurance that covers all the necessary services, receiving them on time and in close proximity might still be an issue due to the high workload and understaffing.

Statistics show that certain social determinants of health are at play in the current situation. For instance, every fifth American (20%), or 60 million people in total, lives in rural areas (Centers for Disease Control and Prevention [CDC], 2017). The most recent census also shows that it is older people who typically reside in the countryside. A person’s age and place of residence largely determine their access to healthcare. CDC (2017) shares that the population-to-practitioner rations in rural areas may be as large as 2,000:1. Because of the inefficient support of the nursing workforce, both nurses and patients are under a physical and psychological strain.

Synthesis of Literature

Literature research has helped to identify three common themes: growing pressure, nursing education, and financial difficulties. As mentioned before, like other developed countries, the United States is undergoing a demographic shift. Advanced medicine has increased the average life expectancy, but it resulted in a bigger share of the senior population. Aside from that, the enforcement of the ACA resulted in millions more people trying to access healthcare (Carthon et al., 2015). As for nursing education, recent research pays a lot of attention to its accessibility, funding opportunities, and career tracks. Lastly, Carthon et al. (2015) and White (2017) point out the uncertainty of funding prospects for many initiatives, which compromises their viability.

Comparing the US and UK healthcare systems, White (2017) shows that the UK prioritized centralization over flexibility, even though both models have their advantages and disadvantages. Having made this decision, the UK facilitated an easier transition to the bachelor’s degree as a prerequisite to enter practice. The US could learn from the UK experience because the promotion of bachelor’s degrees is one of the objectives set by IOM’s Future of Nursing Report (American Nursing Association, 2018).

Like the ANA, the CDC, and the United States Department of Health and Human Services, the IOM is one of the key stakeholders when it comes to the present healthcare concern. While the IOM acknowledges the power of state and nationwide intervention, such as funding programs mentioned, it also emphasizes the role of nurses in managing change. In particular, the report seeks to promote continuing education in the nursing workforce and diversity of roles. According to the IOM, nurses can and should make their contribution by working on interdisciplinary teams and carrying out independent research.

A Compelling Story

Recent data suggests that the current nursing workforce initiatives have yet to yield the results that they are aiming for. Haddad et al. (2020) estimate the projected nursing workforce shortage at 11 million. At the same time, the demand for nurses is only growing: according to Haddad et al. (2020), every year, the number of job openings increases by 5%. The US funding initiatives also do not reach out to all students as only 75% of them rely on grants and scholarships (White, 2017). When nurses enter the workforce, they face even more challenges, such as high workload, long hours, and inadequate leadership. As reported by Haddad et al. (2020), depending on the specialization and geographical location, the turnover rates range between 9% and 37%.


Currently, the United States has the largest nursing workforce in the world, and the demand for nurses is still on the rise. Unlocking the full potential of US nurses is inhibited by serious challenges, such as the aging population, insurance expansion, underwhelming funding, and poor working conditions. This report shows that the US has taken measures to address the problem by funding education and lightening the workload with the introduction of nursing assistants. Still, the shortages are not replenished, and nurses remain at risk of a burnout, which translates into high turnover rates. The proposed course of action could include hospital investments into nursing education to expand enrollments. In the workplace, nurses could benefit from more flexibility and autonomy, which would put them in control of their careers.


American Nursing Association. (n.d. a). IOM future of nursing report. Web.

American Nursing Association. (n.d. b). Nursing workforce. Web.

Buerhaus, P. I., Skinner, L. E., Auerbach, D. I., & Staiger, D. O. (2017). Four challenges facing the nursing workforce in the United States. Journal of Nursing Regulation, 8(2), 40-46. Web.

Carthon, J. M. B., Barnes, H., & Altares Sarik, D. (2015). Federal policies influence access to primary care and nurse practitioner workforce. The Journal for Nurse Practitioners, 11(5), 526-530. Web.

Centers for Disease Control and Prevention. (2017). About rural health. Web.

Duffield, C., Twigg, D., Roche, M., Williams, A., & Wise, S. (2019). Uncovering the disconnect between nursing workforce policy intentions, implementation, and outcomes: Lessons learned from the addition of a nursing assistant role. Policy, Politics, & Nursing Practice, 20(4), 228-238. Web.

Haddad L.M., Annamaraju P., & Toney-Butler T.J. (2020). Nursing shortage. In: StatPearls [Internet]. StatPearls Publishing.

White, E. (2017). A comparison of nursing education and workforce planning initiatives in the United States and England. Policy, Politics, & Nursing Practice, 18(4), 173-185. Web.