Nursing school enrollment is not growing fast enough to meet the projected demand for RN and APRN services.

Though AACN reported a 3.7% enrollment increase in entry-level baccalaureate programs in nursing in 2018, this increase is not sufficient to meet the projected demand for nursing services, including the need for more nurse faculty, researchers, and primary care providers.

A shortage of nursing school faculty is restricting nursing program enrollments.

• According to AACN’s report on 2018-2019 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing, U.S. nursing schools turned away more than 75,000 qualified applicants from baccalaureate and graduate nursing programs in 2018 due to insufficient number of faculty, clinical sites, classroom space, and clinical preceptors, as well as budget constraints. Almost two-thirds of the nursing schools responding to the survey pointed to a shortage of faculty and/or clinical preceptors as a reason for not accepting all qualified applicants into their programs.

A significant segment of the nursing workforce is nearing retirement age.

• According to a 2018 survey conducted by the National Council of State Boards of Nursing and The Forum of State Nursing Workforce Centers, 50.9% of the RN workforce is age 50 or older.
• The Health Resources and Services Administration projects that more than 1 million registered nurses will reach retirement age within the next 10 to 15 years.

Changing demographics signal a need for more nurses to care for our aging population.

• Issued in May 2014, the U.S. Census Bureau report on An Aging Nation: The Older Population in the United States found that by 2050, the number of US residents age 65 and over is projected to be 83.7 million, almost double its estimated population of 43.1 million in 2012. With larger numbers of older adults, there will be an increased need for geriatric care, including care for individuals with chronic diseases and comorbidities.

Insufficient staffing is raising the stress level of nurses, impacting job satisfaction, and driving many nurses to leave the profession.

• In the July 2017 issue of BMJ Quality & Safety, the international journal of healthcare improvement, Dr. Linda Aiken and her colleagues released findings from a study of acute care hospitals in Belgium, England, Finland, Ireland, Spain, and Switzerland, which found that a greater proportion of professional nurses at the bedside is associated with better outcomes for patients and nurses. Reducing nursing skill mix by adding assistive personnel without professional nurse qualifications may contribute to preventable deaths, erode care quality, and contribute to nurse shortages.
• In the March 2005 issue of Nursing Economic$, Dr. Peter Buerhaus and colleagues found that more than 75% of RNs believe the nursing shortage presents a major problem for the quality of their work life, the quality of patient care, and the amount of time nurses can spend with patients. Looking forward, almost all surveyed nurses see the shortage in the future as a catalyst for increasing stress on nurses (98%), lowering patient care quality (93%) and causing nurses to leave the profession (93%).

High nurse retirement and turnover rates are affecting access to health care.

• In the September 21, 2015 issue of Science Daily, healthcare economist David Auerbach released findings from a new study, which found that almost 40% of RNs are over the age of 50. “The number of nurses leaving the workforce each year has been growing steadily from around 40,000 in 2010 to nearly 80,000 by 2020. Meanwhile, the dramatic growth in nursing school enrollment over the last 15 years has begun to level off.”
• In September 2007, Dr. Christine T. Kovner and colleagues found that 13% of newly licensed RNs had changed principal jobs after one year, and 37% reported that they felt ready to change jobs. These findings were reported in the American Journal of Nursing in the article “Newly Licensed RNs’ Characteristics, Work Attitudes, and Intentions to Work.”

Many scientific studies point to the connection between adequate levels of registered nurse staffing and safe patient care.

• In the February 2014 issue of the Lancet, Linda Aiken and colleagues published findings from a study conducted in European hospitals, which found that an increase in a nurses’ workload by one patient increased the likelihood of dying within 30 days of admission by 7%. The researchers also found that every 10% increase in bachelor’s degree nurses was associated with a decrease in patient mortality by 7%.
• In a study published in the journal BMJ Quality & Safety in May 2013, researcher Heather L. Tubbs-Cooley and colleagues observed that higher patient loads were associated with higher hospital readmission rates. The study found that when more than four patients were assigned to an RN in pediatric hospitals, the likelihood of hospital readmissions increased significantly.
• In the August 2012 issue of the American Journal of Infection Control, Dr. Jeannie Cimiotti and colleagues identified a significant association between high patient-to-nurse ratios and nurse burnout with increased urinary tract and surgical site infections. In this study of Pennsylvania hospitals, the researchers found that increasing a nurse’s patient load by just one patient was associated with higher rates of infection. The authors conclude that reducing burnout can improve the well-being of nurses and the quality of patient care.
• In a study publishing in the April 2011 issue of Medical Care, Dr. Mary Blegen and her colleagues from the University of California, San Francisco found that higher nurse staffing levels were associated with fewer deaths, lower failure-to-rescue incidents, lower rates of infection, and shorter hospital stays.
• In March 2011, Dr. Jack Needleman published findings in the New England Journal of Medicine, which indicate that insufficient nurse staffing was related to higher patient mortality rates. These researchers analyzed the records of nearly 198,000 admitted patients and 177,000 eight-hour nursing shifts across 43 patient-care units at academic health centers. The data show that the mortality risk for patients was about 6% higher on units that were understaffed as compared with fully staffed units. In the study titled “Nurse Staffing and Inpatient Hospital Mortality,” the researchers also found that when a nurse’s workload increases because of high patient turnover, mortality risk also increases.
• In a study published in the April 2010 issue of Health Services Research, Dr. Linda Aiken and colleagues found that lower patient-nurse ratios on medical and surgical units were associated with significantly lower patient mortality rates. The study is titled “Implications of the California Nurse Staffing Mandate on Other States.”
• In the June 2009 issue of the International Journal of Nursing Studies, a research team lead by Dr. Koen Van den Heede found a significant association between the number of baccalaureate-prepared RNs on cardiac care units and in-hospital mortality. Data analyzed by this international team of researcher that included representatives from Belgium, Canada, the Netherlands, and the United States showed that there were 4.9 fewer deaths per 1,000 patients on intensive care units staffed with a higher percentage of nurses with bachelor’s degrees.
• A growing body of research clearly links baccalaureate-prepared nurses to lower mortality and failure-to-rescue rates. Studies published in the journals Health Services Research in August 2008 and the Journal of Nursing Administration in May 2008 confirm the findings of several previous studies which link education level and patient outcomes. Efforts to address the nursing shortage must focus on preparing more baccalaureate-prepared nurses in order to ensure access to high quality, safe patient care.
• In March 2007, a comprehensive report initiated by the Agency for Healthcare Research and Quality was released on Nursing Staffing and Quality of Patient Care. Through this meta-analysis, the authors found that the shortage of registered nurses, in combination with an increased workload, poses a potential threat to quality. Increases in registered nurse staffing was associated with reductions in hospital-related mortality and failure to rescue as well as reduced length of stays. In settings with inadequate staffing, patient safety was compromised.
• A shortage of nurses prepared at the baccalaureate level is affecting health care quality and patient outcomes. In a study published September 24, 2003 in the Journal of the American Medical Association (JAMA), Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a “substantial survival advantage” if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level. In hospitals, a 10% increase in the proportion of nurses holding BSN degrees decreased the risk of patient death and failure to rescue by 5%.