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America’s healthcare workforce has been spotlighted during the COVID-19 pandemic. This spotlight has also brought increased focus to the nursing shortage that began in 2012 and is expected to last until 2030.

The shortage is driven by many factors, including an increased need for healthcare around the country. As American’s largest generation — the baby-boom generation — gets older, there will be an unprecedented strain on the healthcare system, with over a million new nurses needed by 2030.

Nurses are a vital part of the healthcare system. Studies have shown that when hospitals and other healthcare facilities have the appropriate amount of nurses, it improves patient safety, mortality rates, and overall patient outcomes.

Unfortunately, having enough nurses to care for patients isn’t always easy. For nearly a decade, the United States has been facing a critical nursing shortage. The shortage is expected to continue for several more years. In fact, over 1 million new registered nurses (RNs) will be needed by 2030 to meet healthcare demands.

In addition to newly created roles, the roles of nurses expected to retire or leave the profession will also need to be filled. The United States Bureau of Labor Statistics (BLS) projects this will create a total of 175,900 openings for RNs every year until 2029.

RNs aren’t the only role that will need new graduates over the next decade. The BLS also projects growth across multiple nursing roles, including:

  • Licensed practical nurses (LPNs). An additional 65,700 new LPN roles will be created by 2029, for a growth of 9 percent.
  • Nurse anesthetists. An additional 6,200 new nurse anesthetist roles will be created by 2029, for a growth of 14 percent.
  • Nurse practitioners. An additional 110,700 nurse practitioner roles will be created by 2029, for a growth of 52 percent.
  • Nurse midwives. An additional 800 nurse midwife roles will be created by 2029, for a growth of 12 percent.

The need for nurses with master’s degrees, such as nurse anesthetists and nurse practitioners, will also drive some need for new RNs. This is because current RNs advance their education and take on these higher-level nursing roles.

More education for nurses is another large piece of the overall puzzle. RNs can choose to earn licensure through a bachelor’s degree, associate degree, or diploma. Recent recommendations have advocated for 80 percent of RNs to hold bachelor’s degrees, but currently, only 64.2 percent of RNs do.

There is a need for nurses across the country, but certain areas face a much greater shortage than others. The southern and western portions of the nation are expected to face some of the largest needs for nurses. California alone is projected to need about 44,500 new RNs by 2030.

The United States Department of Health and Human Services predicts that these states will have the greatest need for nurses by 2030 (in order of greatest need):

  1. California
  2. Texas
  3. New Jersey
  4. South Carolina
  5. Alaska
  6. Georgia
  7. South Dakota

The nursing shortage is a complex problem with several causes. There are many factors at play, from a larger-than-ever population of older adults to nursing burnout.

The combination of these factors is driving the nursing shortage and causing it to grow over time.

The growing population of older adults

The generation born between 1946 and 1964, known as baby boomers, is one of the largest in American history. About 21 percent of current American adults are baby boomers. There will be a projected 71 million Americans age 65 or older by 2029.

Age-related conditions lead to a significant rise in the need for healthcare services. In fact, the Centers for Disease Control and Prevention (CDC) reports that over half of Americans over age 65 have two or more chronic health conditions.

Plus, with advances in healthcare and movements to improve healthcare access, the baby boomer generation will likely have a longer lifespan than previous generations.

Healthcare reforms

Recent changes to the healthcare system have increased the number of Americans who can access care. This has shifted the healthcare focus into many nursing-driven roles.

For example, the Affordable Care Act made it possible for more Americans to get health insurance. In many states, the Affordable Care Act meant that more people qualified for Medicaid. Newly insured people are now able to seek the care they couldn’t in previous years, creating a demand for more nurses.

There have also been initiatives to minimize hospital stays over the last several years. This has led to the increasing importance of primary care, urgent care, and home healthcare.

Nurses have an important role to play and will see increased demand as healthcare continues to change in America.

Retirement and burnout

The millions of Americans who will be reaching their mid-60s over the next decade doesn’t just mean there will be an increased need for healthcare services. Those Americans will also be retiring and leaving job openings in fields like nursing.

In fact, the average age of RNs in this country is 50 years old. Additionally, the COVID-19 pandemic sped up the retirement of many nurses across the country, leading to an even greater nursing shortage.

The retirement of experienced nurses also leaves a lack of nurses qualified to train and educate new nurses. As current nurse educators retire, nursing programs around the country need capable teachers to take their place. Without enough faculty, nursing programs won’t be able to train enough nurses to address the shortage.

However, nurses reaching retirement age aren’t the only ones leaving the profession. As the COVID-19 pandemic demonstrated, nursing is an incredibly stressful and demanding job. Nursing burnout and lack of support are common and lead to skilled RNs leaving the field or transitioning to other healthcare roles.

Unlike many other fields that face employer shortages, there is no way to minimize the demand for healthcare. Hospitals and other healthcare facilities will always need qualified nurses. Unfortunately, that also means a shortage creates several challenges, such as:

  • Nurse burnout. Burnout is both a cause and symptom of the nursing shortage. Understaffed nursing units increase the pressure and stress on nurses. The mental and physical toll of this pressure can quickly lead to burnout.
  • Longer wait times for care. Patients have to wait longer when healthcare facilities don’t have the nursing staff they need. When seeing more patients, nurses are often rushed and stressed. That can lower patient satisfaction and negatively affect patient outcomes.
  • Medication errors and fatalities. Patient care and safety are improved when there’s an appropriate number of nurses on staff. Errors in medication and other care delivery are more likely when facilities are understaffed. These errors can have serious consequences.

The nursing shortage has many causes that all need to be addressed. We will need multiple solutions to address this complicated issue. Some possible steps to take include:

  • More educational opportunities. Nursing programs can increase their enrollment by offering options that make it easier for aspiring nurses to get the education they need. Encouraging and supporting students to earn a bachelor’s degree and to move on to higher education is an important step toward preparing qualified nurses. Additionally, online course options and flexible schedules can make school possible for more people.
  • Increased nurse leadership. Taking on leadership roles in healthcare systems can create opportunities for nurses. Experienced nurses in these roles can provide mentoring and education to younger nurses and demonstrate a possible career path to new graduates. They can create the benefits packages and job tools that help attract and retain new nurses.
  • Advocacy. Healthcare policies that are driven by nurses advocacy organizations can help create changes that will address the nursing shortage and the needs of nurses. For example, legislation that regulates how many nurses are needed in healthcare facilities could boost nurse education and recruitment. Improved staffing practices can also provide a supportive workplace for current nurses and help to recruit new nurses.

The United States nursing shortage is driven by many factors, including an increased need for care, large numbers of the workforce reaching retirement age, and recent healthcare legislation.

The situation is further complicated by nursing burnout. Since burnout is often caused by short staffing and job stress, which in turn leads to nurses leaving the field, the burnout cycle will continue until the nursing shortage and the needs of nurses can be addressed.

Increased access to nursing education, improved staffing practices, and more leadership roles for nurses are a few possible solutions to this complex problem.