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A Nursing Shortage? Or a Shortage of Nurses Willing to Work Under Current Conditions? (Recruiting, Retaining and Recouping)

While many commentators talk of a "nursing shortage," the truth is that most or all of the current nursing shortage could be solved if working conditions improved. In this sense, the data suggest that the most successful staffing strategies must go beyond recruitment and retention to focus on recouping those RNs who have dropped out of the hospital workforce but remain available to work. In 2000, nearly 500,000 registered nurses in the United States were not working in nursing. Of these, 36,000 were seeking employment as nurses. An additional 136,000 were working in non-nursing occupations, and 323,000 were not employed at all. There is reason to believe that many of the 136,000 nurses working outside the profession they trained for might return to nursing work if conditions on the job were improved. More than 40 percent of this group are employed in health occupations other than nursing, suggesting that they retain an interest in the field.

Even more telling, the reasons these nurses left nursing work have primarily to do with deteriorating conditions on the job. Nearly half (44.9 percent) of these employees stated that they left nursing to find an occupation that is more professionally rewarding; more than one-third (35.4 percent) left for a better salary; 45.7 percent cited more convenient hours in their new job; 19.7 percent were concerned about workplace safety in nursing; and 8.4 percent (or more than 11,000 RNs) reported that they left the profession because they felt they were unable to practice nursing on a professional level.64

Even among those who are not working at all, there is good reason to believe that many of these individuals might return to nursing if the job were made more attractive. While nearly half of unemployed RNs are over the age of 60, this still leaves tens of thousands of RNs in their prime working years who are choosing to remain at home rather than work in their profession. In 2000, 115,000 registered nurses in the country were under the age of 60 (13,000 under 40; 40,000 aged 40–49; 62,000 aged 50–59) and had no children under the age of 6, but were choosing to remain unemployed rather than work as nurses. If we assume that, in addition to this group, perhaps half of those with young children at home and perhaps 10 percent of those aged 60 and older, might return to work under the proper conditions, the pool of currently unemployed but potentially available RNs rises to almost 144,000.65

Taking these two groups together — unemployed RNs and RNs working outside nursing — it is clear that a very substantial share of the current "shortage" could be solved if working conditions improved for RNs on the job. Even after subtracting those with out-of-date nursing skills or disability or illness, more than 102,000 working RNs could potentially be drawn back into nursing. Similarly, as shown in the table at right, combining this number with the total number of unemployed RNs who are under age 60 and have no young children at home (118,200) would yield more than 220,000 potentially available RNs. If we add a percentage of those with young children and a small share of those over age 60, the supply of potentially available RNs rises to nearly 250,000.

 

 Registered Nurses Not Working in Nursing, 2000

 RNs employed in non-nursing occupations  135,696
      Nursing skills out of date  -23,578 
      Disability/illness  -9,438
 Employed in other occupations but potentially available  102,680 
      As percent of 126,000 vacant RN positions  81.5%
      As percent of 153,000 vacant RN positions  67.1%
 Unemployed RNs  323,453 
 Unemployed but potentially available    
     100 percent of those under age 60, no young children  118,210
     10 percent of those over age 60  +10,210
     50 percent of those with young children   +15,206
 Total unemployed but potentially available  143,626
 Total potentially available RNs   246,306  
     As percent of 126,000 vacant RN positions  195%
     As percent of 153,000 vacant RN positions   161%
 Source: Author’s calculations based on The Registered Nurse Population, March 2000,
Tables 33–34, pp. 71–72.
 Note: Employed RNs with out-of-date nursing skills and those with disability or illness
may overlap. For the sake of conservative estimates, they are counted here as if there is
no overlap.

   
Compared to the national total of vacant RN positions (estimated at between 126,000 and 153,000), the number of licensed RNs who are potentially available to work but currently choosing to avoid nursing work is equal to between 67 percent and 195 percent of the positions needed, depending on the assumptions one makes. In other words, at the most conservative possible estimate — assuming 126,000 positions must be filled and the only realistically available RNs are those currently working in other occupations who are not disabled and have up-to-date nursing skills — if nursing were made more attractive as an occupation, the country could immediately fill four-fifths of the needed positions. Under very realistic scenarios, an improvement in working conditions for hospital RNs would, in and of itself, enable hospitals to fill every one of the vacant nursing positions in the country more or less immediately.

In summary, no evidence of a true nursing shortage exists. There is no shortage of nurses; there is a shortage of nurses willing to take the jobs under the conditions now being offered. The health care industry has created its own Catch-22: As working conditions worsen, more nurses opt out of the profession, creating shortages on hospital floors and resulting in even greater speedups, stress, safety worries and other conditions that further drive nurses out of the industry.

As long as work conditions do not improve, the industry will fail to retain qualified RNs. On the other hand, if conditions improve, enough RNs in the country are qualified and most likely prepared to return to work that the so-called "shortage" could evaporate in little time.

The centrality of recouping strategies is dramatically evident in the situation faced by the California hospital industry under the state's new staffing mandate. It is estimated that hospitals in California will need to find up to 5,000 new nurses to meet the nurse-to-patient ratios required by state law. By contrast, a 1997 survey by the California Board of Registered Nursing found that 7,000 California RNs left the profession because of dissatisfaction but would consider returning if conditions improve. Thus, the state's entire demand for new nurses — and then some — could be met by encouraging trained RNs to return to work in their chosen profession.66

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