The nursing shortage and the Nurse Reinvestment Act

AORN Journal,  May, 2004  by Burke Beu

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AORN was well represented at the recent Nurse in Washington Internship (NIWI), an educational event and federal advocacy opportunity for nurses held each year in the nation's capital. The NIWI is organized by the Nursing Organizations Alliance, of which AORN is a member. Attendees included AORN Executive Director Tom Cooper, CAE, and two AORN members who received AORN's annual scholarship award to NIWI.

The NIWI scholarship award winners will report on their experiences in a future "Health Policy Issues" column. This article highlights the comments of NIWI presenter, Denise H. Geolot, RN, PhD, FAAN, director of the Division of Nursing in the Bureau of Health Professions of the Health Resources and Services Administration (HRSA) at the US Department of Health and Human Services (HHS).

Dr Geolot said that HRSA, as its name unplies, provides general resources and information to the public and for use in policy development by government officials. The Division of Nursing performs analytic activities, measures practice outcomes, and provides public information specific to the nursing profession. One of the division's most strategic mechanisms is the National Sample Survey of Registered Nurses. This survey has been conducted seven times since 1977, and was done most recently in March 2000. The results of the survey were released in 2002.

FACTS AND FIGURES

The survey looks at demographics, employment statistics, educational backgrounds, compensation patterns, job satisfaction, and the employment status of RNs. Dr Geolot noted that between 1992 and 1996, there were more than 400,000 new entrants into the RN population and about 100,000 RNs left the profession. Between 1996 and 2000, there were slightly more than 300,000 new entrants into nursing and more than 150,000 RNs left the profession.

For another perspective on the nursing shortage, Dr Geolot said that in 1980, 25.1% of RNs were less than age 30, but in 2000 only 9.1% were less than age 30. Data from the 2000 survey indicate that 43.3 was the average age of an RN in the United States.

According to Dr Geolot, in 1980, the average annual salary of full-time RNs was $17,398. The 2000 average was $46,782, but that was only $23,369 in real dollars (ie, dollars that reflect inflation and the cost of living). She observed that most RNs begin their careers with what generally are considered good salaries, but their salaries do not seem to grow along with the economy.

Dr Geolot mentioned that the RN population in the United States in 2000 was approximately 2.7 million. That number is expected to remain flat and perhaps even decline by 2020. Meanwhile, the expected need for RNs in the US health care system is nearly three million by 2020. This disparity between supply and demand literally is the definition of the nursing shortage (Figure 1).

[FIGURE 1 OMITTED]

Of the 2.7 million RNs in 2000, 94.1% were female, said Dr Geolot. In addition, the 2000 survey indicated that

* 86.6% of RNs were Caucasian (compared with 69.1% of the total US population),

* 2% were Hispanic (compared with 12.5% of the total population),

* 4.9% were African American (compared with 12.1% of the total population), and

* 3.7% were Asian American (the same as the percentage of the total US population).

NURSE REINVESTMENT ACT

With these data as background, Dr Geolot turned her attention to the Nurse Reinvestment Act. This legislation was passed by Congress in 2002 and became Public Law 107-205 after being signed by the President. It amends Public Law 105-392, which resulted from the Nursing Education and Practice Improvement Act of 1998, under Title VIII of federal regulations administered by HHS. Knowing this history is important so nurses and citizens understand that the programs of the Nurse Reinvestment Act are not entirely new. These programs, which all have separate funding amounts in the federal government's budget for fiscal year 2004, can be divided into six categories, including

* advanced nursing education (eg, projects to support advanced nursing education, including tuition assistance and training)--$58.6 million;

* nursing workforce diversity (eg, projects to increase nursing opportunities, including scholarships, pre-entry preparation, and retention activities, for individuals from minority groups)--$16.4 million;

* nurse education, practice, and retention (eg, grants for a variety of priority areas, such as mentoring, new technologies, noninstitutional settings, underserved populations, quality improvement for managed care, cultural competencies, career ladders, collaborative efforts to promote the involvement of nurses in organizational and clinical decision making)--$31.8 million (this category is a focus of new and enhanced programs from the Nurse Reinvestment Act);

* loan repayment programs (eg, incentives for nurses to work in facilities and areas with critical shortages)--$26.8 million;

* nurse faculty programs (eg, loans for students working as faculty members in a school of nursing)--$4.8 million; and