Globally, the healthcare system depends significantly on the nursing profession for care delivery. However, in the US, this sector has been experiencing shortages of nurses in recent years. Therefore, this paper aims to explore the factors that cause these shortages, including a shift of focus to the increasing number of senior patients, lack of sufficient nursing educators, and healthcare reforms. With different countries leveraging technological advancement in medical care, people live longer, which increases the demand for healthcare services. Older adults develop severe conditions, such as Alzheimer’s disease, depression, lung disease, and diabetes, that require constant care and attention from nurses. Meanwhile, nurses are also growing older and leaving behind a gap in nursing that needs to be filled.
Additionally, the US experiences reduced enrollment in nursing schools and a lack of quality training, leading to insufficient nurses. Healthcare reforms in the US, such as the Affordable Care Act (ACA), have also negatively impacted nurse staffing. Since most of these new policies have been implemented to ensure people access care equally, they have increased the demand in many organizations, which has stretched the available nurses. As the country is also shifting to home care and specialized services, many nurses are drawn away from hospitals and other care settings, leading to an imbalance in the workforce. This challenge in the nursing profession has severe effects on the healthcare system: poor service quality, medical errors, and treatment delays. The paper concludes that this issue is growing in the US that requires immediate attention.
Nurses’ Shortage in the United States
Nursing is an essential profession making up one of the largest occupations worldwide. As an important profession, the demand for nurses has been high throughout history, encouraging its growth as more individuals embraced education in nursing. However, the field is facing significant challenges in recent years resulting from nurse shortages. The nursing workforce has declined due to various reasons. The primary reasons include an increased population of seniors, a lack of nurses’ educators, and the impact of healthcare reforms. The shortage has impacted various sectors of patient healthcare, such as delays in treatment continuity, and medical errors due to fatigue and workplace stress.
Patients have to wait longer to receive healthcare services that are performed within a short time due to poor staffing leading to poor service delivery. According to CBC News, “A man in his 70s dies in the waiting room of the Edmunds on Regional Hospital’s emergency department, when the emergency room had a high level of traffic and long wait times” (CBC News, 2022). The healthcare system must acknowledge the challenge as an urgent crisis and find quick and effective solutions. This essay explores the causes of nurse shortages in the United States, including the increased senior population, lack of nursing educators, and health policy reforms.
Definition of Nursing Shortage
In recent years, the overwhelming demand for nurses has reached a critical point that needs immediate attention. A nursing shortage refers to inadequate nursing professionals for more prolonged periods, affecting many health facilities nationally and leading to severe consequences for patients. According to statistics, the nursing shortage is projected to increase in the coming years if the situation is not addressed sooner (Rosseter, 2020). The United States has experienced nurse shortages periodically throughout history due to various factors that have not been addressed to date. Therefore, it is necessary to search the cause, which may help health practitioners and scholars find effective mitigation measures and restoration of quality services to the public.
Increased Population of Seniors
One of the causes of nurse shortages is the increased number of senior citizens in the nation. The most prominent citizen population in the United States is the aging generation consisting of baby boomers. The aged population continues to grow, and it is predicted that people will reach more than 70 years old by 2030 (Tamata & Mohammadnezhad, 2022). The increased number of senior citizens has strained medical facilities due to a higher demand for care services. With medical advances in the modern era, people can live longer than 70 years and require constant care to live healthy lives.
At the same time, the aged population is inclined to suffer numerous chronic illnesses which require medical attention. According to Tamata and Mohammadnezhad (2022), five out of eight of America’s senior population have morethan one chronicdisease.The chronic ailments include depression, lung disease, stress, diabetes, and Alzheimer’s, which need constant and quality care to ensure the patient’s well-being.
The number is expected to increase as the population grows, which will demand more nurses leading to a pronounced nursing shortage. Therefore, the healthcare system needs more nurses to cater to the people, creating a shortage in demand and supply. Health facilities are already experiencing nursing shortages due to other factors, such as the increased outpatient population due to the general population increase. Thus, a higher demand to care forolder adults will strain the profession, resulting in nursingshortages in the region.
Consequently, the increased number of senior citizens has affected the number of the nursing workforce. Most of the aged population comprises the existing workforce in nursing and other sectors involving the number of nurses due to retirement. The profession is being drained by senior nurses who have approached retirement age, leaving a considerable gap in staffing. The United States nursing population comprises baby boomers reaching 65 years, the appropriate age for nurse retirement, while the number of those enrolling in the profession is still staggering. According to Haddad et al. (2018), the number of older nurses about to retire soon is increasing and could reach 71% by 2030.
During the Coronavirus pandemic, more senior nurses were given early retirement as hospitals received fewer patients leading to a decline in financial resources. Hence, many medical facilities were forced to reduce staff to sustain the hospitals, which caused the early retirement of older nurses. The move significantly contributed to the nursing shortage when healthcare facilities resumed normal functioning. In addition, an estimated one million registered nurses will retire from the profession in the next five years, leading to more shortages (Daniel & Smith, 2018). Efforts to resolve the issue should be underway to avoid a more severe deficiency, which will significantly influence the health sector. Therefore, the coupled effect of the aging citizen population and nurses has contributed substantially to the nursing shortage, which continues to decline due to the lack of nurse educators in nursing colleges.
A growing numbers of nursing home admission led to nurses’ shortage. Most seniors were placed in a nursing home due to a lower level of cognition and more rapid cognitive decline. Cognitive impairment, especially Alzheimer’s disease, is a major contributor to nursing home admission. Most older people with cognitive decline are unable to care for themselves or perform activities of daily living, including meal preparation, bathing, managing their personal finances, and managing medical appointments. People with these diseases are at increased risk for falls, delirium, and other negative conditions. Long term care manages risk factors for falls and injuries, including on-on-one care, creating medication reminder systems, helping with personal care, and arranging transportation for medical appointments. Nurses are handling higher workloads due to the rising of nursing home admission.
Lack of Nurse Educators
Another cause is inadequate nursing educators, which has directly affected the nation’s nursing shortage and quality nursing. Reduced enrollment in nursing schools and lack of quality training are among the barriers contributing to nurse shortages in the United States. Challenges leading to decreased enrollment include inadequate faculty, budget constraint in nursing colleges, and insufficient space to hold students (Collard et al., 2020). Nursing schools have few faculty nationwide to cater to the rising demand for registered nurses (RN) to fill senior and retiring staff positions.
Although many individuals have applied to enroll in nursing schools, the shortage of nurse educators has limited enrollment limiting student capacity. According to the American Association of Colleges of Nursing (AACN), nursing schools turned away over 91,000 qualified applicants in 2021 due to capacity constraints and inadequacies in nursing educators (Rosseter, 2020). The nursing school reported that the main reason for rejecting the applications is the lack of nursing educators to facilitate training. Nurse educators have become inadequate in schools due to numerous factors, including aging faculty, competition in the job market, lack of qualified professionals, and budget constraints to facilitate the recruitment of more staff. Like senior nurses, many nursing educators are baby boomers who have neared retirement age, leaving a significant occupation gap when they retire.
Competition in the job market has led many educators to join the private sector as it offers luring compensation compared to the public sector. Currently, nursing educators are among the most advertised occupation in public colleges, with a demand of approximately 2000 educators in graduate and baccalaureate programs (Collard et al., 2020). The vacant positions are due to shifts from public colleges as educators to practicing in private clinics, which offer better remuneration.
Further, an additional 200 nurse educators are needed to accommodate the rising students’ demand to enroll in nursing schools to fill the enormous gap left by retirees and those leading the profession for various reasons. Lastly, there are few professionals qualified for nursing educators as the number of individuals enrolling for doctoral and master’s degrees is declining (Haddad et al., 2018). The decline is attributed to a lack of nursing educators in higher education, leading to reduced enrollments, which has affected the enrollment of fresh graduates. Therefore, nursing educators play a vital role in producing quality nurses, and a lack of professionals significantly contributes to the nursing shortage in the nation.
Healthcare Policy Reforms
The nursing profession is highly connected to policy reforms in the public, financial, and health sectors. Recent development in healthcare insurance reforms has affected nurse staffing in numerous health facilities, increasing the demand for nurses. The Affordable Care Act (ACA) is among the reforms that have contributed to nurse shortages in the United States. The act offers subsidies and fair insurance policies to ensure equality in healthcare. Although the move aims at benefiting public health, it means a higher flow of patients in medical facilities. In turn, health centers will require additional registered nurses to match the rising patient demand.
Studies by Marć et al. (2018) reveal that the implementation of ACA will lead to a rise in demand for RNs up to 3.5 million nurses. Making healthcare affordable to all individuals has resulted in many patients in the outpatient sector, which requires more nurses for quality service delivery. Thus, the number of nurses needed in outpatient care and physician offices needs to rise to fill the supply and demand gap.
Besides affordable medication, health insurance policies have capitalized on the ACA reforms to create premium packages for home care and financially able individuals. The policy requires nurses to have additional education and specialization to provide quality services in-home care and private settings. Hospitals that offer poor services and do not meet the demands of the insurance policy do not receive incentives leading to un-proportional remuneration among nurses (Daniel & Smith, 2018). Thus, many young nurses opt for additional education to get specialized skills, guaranteeing higher pay. The shift in nurses from the public and outpatient sectors to homecare and private settings significantly contributes to the nursing shortage as the remaining nurses strain to deliver in public health facilities. Therefore, the healthcare system needs to review its nursing and insurance policies to curb the nursing shortage threatening the nation’s public health.
Conclusion
Nurses’ shortage is a growing crisis in the United States. The main reasons for the situation include an aging population and workforce, healthcare policy reforms, occupational burnout, and inadequate nurse educators. America’s population comprises many aged people who demand nursing care. At the same time, the nursing workforce includes more senior nurses who have reached retirement leaving a significant gap in the profession.
The number of retiring nurses combined with the high demand for registered nurses due to the increased number of outpatients has created concern for the nurse shortage, which requires more individuals to enroll in nursing schools. However, nursing colleges have challenges, including lacking faculty and resources to contain fresh applicants. A shortage of nurse educators means limited trainers and fewer enrollments, which affects the number of nurses entering the industry. From the discussion, the health sector has much to consider in ensuring the nursing gap is filled in public health.
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