WANTED: One Million Nurses

American Demographics, Sept 1, 2002

Byline: SANDRA YIN

In 1991, Jennifer Mosier quit her job as a hairdresser and enrolled in nursing school. Later this year, the 37-year-old from Cleveland, Ohio, plans to quit her job as an acute care nurse and open up a beauty salon. Mosier says she turned to nursing 11 years ago to follow a childhood dream of "taking care of people." Today, fed up with what she calls unrealistic nurse-to-patient workloads, she's ready to give up the eight years and $20,000 of educational investment for work that's not as high-pressured. "I'm burnt out," she says. "I can't stand it. There are too many patients and not enough support."

Demographic trends, cultural shifts and image problems are eroding the ranks of the nursing profession. Despite a slight post-Sept. 11 rise, enrollment in nursing programs has been declining at an average rate of 4.2 percent a year since 1993, when it peaked at 270,000. As of 2000, enrollments were down 33 percent, to 181,000, according to the National League for Nursing. If the trend continues, nursing will face more staff vacancies by 2010 than any other professional category, according to projections from the Bureau of Labor Statistics (BLS). The agency pegs the number at a staggering 1 million job openings due to more demand and net replacement needs between 2000 and 2010. The dwindling interest in nursing comes at a critical juncture: A chunk of the country's 78 million Baby Boomers are poised to retire by 2010 - creating a surge in demand for the health-care services associated with an older population at the very time that there will be fewer nurses in the work force. "We've got a real problem ahead," says Peter Buerhaus, professor of nursing and senior associate dean for research at Vanderbilt University. "The magnitude of these shortages would be big enough to severely hamper health care."

Formerly prized as one of only a handful of professions open to women, nursing has fallen out of favor with a new generation. Thanks to a wider range of career opportunities, young girls today seldom dream of growing up to be Florence Nightingale. According to the BLS, the median age in nursing in 2001 was 43, compared with 39 in 1989, the earliest age data available for RNs. The share of working RNs under age 35 dropped to 24 percent in 2001, from 37 percent in 1989, reports the BLS. The share of young registered nurses under age 25 sank to 3 percent in 2001, from 5 percent in 1989. Says Angela McBride, dean of Indiana University's School of Nursing: "Women used to become a grammar school teacher, a nurse or a nun." The women's movement helped expand the range of career options open to women; at the same time, the jobs women historically gravitated to were spurned in favor of the more lucrative, formerly male-dominated professions.

Forget attracting new candidates, nursing is having trouble holding on to its own due to irregular hours, heavy patient loads and stressful working conditions. A 2001 American Nurses Association study found that nearly 55 percent of the 7,300 nurses surveyed would not recommend the profession to others. Another 23 percent said they would actively discourage someone close to them from entering the field. In addition, nurses display among the lowest "engagement" levels of any category of workers, according to the Gallup Organization. Nearly 24 percent of the 22,000 nurses surveyed between 1999 and 2001 say they are "disengaged" from their work, defined as physically present but psychologically absent, compared with 16 percent of workers nationally who feel the same.

The number of those exiting the field is rising: The 135,696 RNs who were employed in non-nursing occupations in March 2000 represented a 15 percent increase over the 117,820 such nurses in 1996 and a 36 percent increase over the estimated 99,955 in 1992, according to the National Sample Survey of Nurses, conducted by the Health Resources and Services Administration. The exodus is likely to continue. One of every five nurses plans to leave the profession within the next five years, according to a survey of 700 current direct-care nurses and 207 former direct-care nurses, conducted for the Federation of Nurses and Health Professionals in 2001. And half of current nurses say that within the past two years, they have considered leaving the patient-care field for reasons other than retirement. What's more, the number of nursing school grads who sat for the national licensing exam for registered nurses has declined 29 percent since 1995, figures from the National Council of State Boards of Nursing reveal.

The No. 1 problem nurses cite is staffing. According to the Federation of Nurses and Health Professionals' survey, nurses say they are fed up with working conditions. In addition to working too many hours and performing thankless tasks, nurses also complain about conditions that may adversely affect patient care. For Mosier, the final straw came last March, when she worked as a temp nurse at an assisted living facility where the ratio of nurses to patients was an astounding 1 to 84. "I never thought it would be like this," she says.