How many nurses are working in the us according to the bureau of labor statistics

WASHINGTON – The unprecedented demands that the pandemic placed on the nation’s nurses – combined with retirements and an aging workforce – have greatly increased the need for nursing workers in the U.S.

The U.S. Bureau of Labor Statistics projects that more than 275,000 additional nurses are needed from 2020 to 2030, and that employment opportunities for nurses will grow at 9 percent, faster than all other occupations from 2016 through 2026.

To help address challenges to developing a skilled healthcare workforce, the U.S. Department of Labor today announced an $80 million funding opportunity through its Nursing Expansion Grant Program to support nursing training programs designed to expand the pipeline of nursing professionals while advancing equity and creating pathways for workers to fill these jobs and improve the nation’s healthcare system.

“Many healthcare workers, nurses among them, have worked around the clock throughout the pandemic to care for those in need and save countless lives, often while risking their own health and well-being,” said Secretary of Labor Marty Walsh. “Today, they face diminished ranks of colleagues to help shoulder these burdens as patients continue to depend on them. The funding opportunity announced today will support training and other programs to help advance workforce equity while bringing more nurses into the industry.”

Administered by the department’s Employment and Training Administration, these H-1B Skills Training Grants emphasize training people from historically marginalized and underrepresented populations to bring greater employment equity in underserved communities and improve healthcare workforce diversity. These grants also emphasize using research and evidenced-based practices, supportive services, sector strategies, and training that address barriers to becoming nurses.

Driven by partnerships between public and private sector entities, these grants will support organizations that use worker-centered industry strategies to train nursing instructors or create nursing professional career pathway programs. Applicants must propose training program models that attract workers, unions, worker organizations and employers while building partnerships with community-based organizations and training institutions.

These grants align with the department’s Good Jobs Initiative and the Biden-Harris administration’s commitment to support an equitable expansion and diversification of the U.S. healthcare workforce by improving job quality, skills training and employment support services. 

Learn more about or apply for this funding opportunity.

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AUTHORS:
Bensson Samuel, MD, PhD, DBA, CHCQM, CPE1 • Nicole Oliver, RN, BSN, MBA2

AFFILIATIONS:
1Medical Director of Inpatient Services/Hospitalist Program, War Memorial Hospital, Sault Sainte Marie, Michigan
2Senior Director of Nursing Services, War Memorial Hospital, War Memorial Hospital, Sault Sainte Marie, Michigan

CITATION:
Samuel B, Oliver N. The US nursing shortage: opportunity to close the gap. Consultant. Published online July 15, 2021. doi:10.25270/con.2021.07.00004

Received February 27, 2021. Accepted March 2, 2021.

DISCLOSURES:
The authors report no relevant financial relationships.

CORRESPONDENCE:
Bensson Samuel, MD, PhD, DBA, CHCQM, 500 Osborn Boulevard, Sault Ste. Marie, MI 49783 ()

As frontline health care professionals, registered nurses (RNs) play a critical role in the provision of patient care and support, as well as administrative duties such as recordkeeping and directing nursing care systems. Moreover, they ensure that hospitals and other health care facilities are in the best position to achieve their goals and missions. Although nursing is the largest health care profession in the United States, with approximately 3.8 million RNs practicing in 2020, the United States currently faces a shortage of RNs.1 It is projected that by 2022, there will be 100,000 new RN job openings per year—more than any other profession.2

With the ongoing COVID-19 pandemic, the growing aging population, and the increasing prevalence of chronic diseases, there is a strong need for more RNs now and in the future.

Current Trends in Nursing

Overall, the current and future shortage of RNs varies by state (Figure 1). The shortage of nursing in relation to the demand will only increase with time.3 A contributing factor to this shortage might be the age of RNs in the United States (Figure 2). The US Bureau of Labor Statistics projects that more than 500,000 RNs will retire by 2022, leaving a shortage of 1.1 million RNs across the country.2 Although the number of RNs is anticipated to increase 15% by 2026, the increase is not enough to close the gap.1

Figure 1. Supply and Demand of RNs by 2030
 

Figure 2. Age Distribution of RNs in the United States
 

In an effort to encourage medical students to join nursing programs, federal and state agencies, as well as universities, are offering incentives.4,5 NursingCAS, an American Association of Colleges of Nursing (AACN) strategy, provides a centralized nationwide registration for nursing students. In addition, financial incentives are being offered in some states to increase RN program registration.6

Another factor contributing to the trend in nursing might be the salary ranges, which vary by state, years of service, roles and duties, qualifications, and other factors (Table). Health care professionals are among the highest-paid occupations in the United States, but nurses do not rank as high as specialists.7 The annual mean wage for RNs is highest in California, Hawaii, Massachusetts, Alaska, New Jersey, Maryland, Rhode Island, and Washington8 (Figure 3).RNs in Central states, such as South Dakota and Missouri, receive the lowest annual mean wage.8

Figure 3. Annual Mean Wage of RNs by State, May 2020
 

The COVID-19 pandemic has also impacted the nursing profession over the past year. The US health care system is one of the hardest-hit industries by the COVID-19 pandemic. Since the onset of the pandemic in 2020, health care professionals have treated millions of patients with COVID-19.9 As frontline workers, RNs have had complex and increased responsibilities. Longer shifts, experiencing patients’ suffering, and scarcity of resources had a major impact on health care professionals overall and the RN retention rate specifically.10 Because of this, work-related stress, burnout, depression, low job satisfaction, and exposure to the virus have increased, leading to a higher turnover rate.10

Reasons RNs Leave and Proposed Solutions

Low salaries coupled with factors such as burnout, lack of work-life balance, and dual roles as parents are the major reasons why RNs leave their jobs. Currently, the average RN turnover is estimated to be 19.1%, which varies by region as well as the nursing specialty.11 The high turnover rate reduces the quality of health care services and limits hospitals’ operating abilities. Therefore, some solutions have been proposed.

Salary

RNs are choosing other, better-paying positions or roles over those that offer lower salary, which may mean relocating out of their home state. (Figure 3). The supply of nurses was not evenly distributed, with the smaller hospitals experiencing greater shortages explained partially by the lower salaries.12 Another factor is better employment contracts that offer higher hourly rates, including contracts with travel nurse companies. Many RNs are also returning to school to obtain a nurse practitioner certification, which offers better salary and often better benefits such as vacation time, retirement match, and continued education assistance. From 2019 to 2020, only 39,000 new nurse practitioners had graduated.13

As a solution to this issue, institutions can consider providing a retention bonus. Research suggests that retention bonuses help RNs feel that they are valued by their employer, as well as boost morale and foster loyalty.14 Although the COVID-19 pandemic has caused financial challenges for the health care sector, organizations that have a culture of providing merit bonuses such as end-of-year, years-of-service, or employee-of-the-month bonuses should consider still doing so. Additionally, offering current staff a recruitment bonus can help hire more RNs, as well as improve current staff engagement and satisfaction.

Burnout

Burnout contributes to more than 50% of workforce turnover in all industries.15 In nursing, many factors contribute to burnout, including managing complex patients, administrative duties and responsibilities, treating and managing the aging Baby Boomer generation as well as the growing prevalence of chronic diseases, and working long shifts16 with little sleep. Many health care facilities across the country are understaffed, which has led to an increase in workload for other health care providers.17 As such, the nurse-to-patient ratio is unbalanced.18

One solution to this issue is to consider increasing the number of ancillary staff, who can provide support to RNs.19 Utilizing certified nurse aids or care technicians is key to supporting RNs and allowing them the time to devote to quality patient care, while maintaining the basic needs of the institution.

Work-Life Balance

About 1 in every 10 US adults spends more than 40% of their time at work.15 RNs also struggle to balance work and life, especially those who are parents. For RNs with children, balancing homeschooling during the COVID-19 pandemic with their nursing duties and responsibilities has been a challenge because of the long shifts mandated during the pandemic. Lack of work-life balance results in stress, which is an occupational hazard that can escalate to mental and physical issues.20

To alleviate this stress, institutions should consider implementing work-life balance practices such as flexible working hours, additional paid time off, or leisure perks to promote social time with friends and family. It offers an environment away from the workplace to mentally decompress.21 Institution leaders can consider facilitating a self-activated approach as well. Cultivating a training program that focuses on avoiding burnout can be a starting point for addressing RNs’ needs and creating an effective work-life balance.

Connecting with family is important and can be a tool to mentally destress. However, the COVID-19 pandemic had caused closures of childcare and daycare facilities, which was another challenge faced by RNs who are parents. When parents do not have childcare available, their stress level increases and job productivity decreases. For parents who are RNs, this also leads to a higher occurrence of medical errors.22 To better integrate work-life balance, institutions should consider offering daycare services so that working parents know their children are safe.15

Conclusion

The shortage of RNs is detrimental to the US health care industry as a whole. Not only does the shortage affect productivity in the institution and patient care and satisfaction, but it also increases the burden on other health care providers and contributes to burnout throughout the industry. As a long-term solution for the shortage crisis, stakeholders in the nursing industry and individual institutions should consider implementing RN retention strategies.

References

1. Nursing Fact Sheet. American Association of Colleges of Nursing. Updated April 1, 2019. Accessed June 30, 2021. https://www.aacnnursing.org/news-Information/fact-sheets/nursing-fact-sheet

2. Workforce. American Nurses Association. Accessed June 30, 2021. https://www.nursingworld.org/practice-policy/workforce

3. US Bureau of Labor Statistics. Registered Nurses. Occupational Outlook Handbook. Updated June 2, 2021. Accessed July 13, 2021. http://www.bls.gov/ooh/healthcare/registered-nurses.htm

4. Marć M, Bartosiewicz A, Burzyńska J, Chmiel Z, Januszewicz P. A nursing shortage - a prospect of global and local policies. Int Nurs Rev. 2019;66(1):9-16. https://doi.org/10.1111/inr.12473

5. Improve Your Admissions Process. American Association of Colleges of Nursing. Accessed June 30, 2021. https://www.aacnnursing.org/NursingCAS

6. Nursing Shortage. American Association of Colleges of Nursing. Updated September 2020. Accessed June 30, 2021. https://www.aacnnursing.org/news-information/fact-sheets/nursing-shortage

7. 25 highest paying occupations in the U.S. Investopedia. Published June 10, 2021. Accessed June 30, 2021. https://www.investopedia.com/personal-finance/top-highest-paying-jobs

8. Occupational Employment and Wages, May 2020: 29-1141 Registered Nurses. U.S. Bureau of Labor Statistics. Updated March 31, 2021. Accessed June 30, 2021. https://www.bls.gov/oes/current/oes291141.htm

9. Schutz V, Shattell M. Impact of COVID-19: what does it mean for nurses and health systems? J Psychosoc Nurs Ment Health Serv. 2020;58(8):2-3. https://doi.org/10.3928/02793695-20200707-01

10. Giménez-Espert MDC, Prado-Gascó V, Soto-Rubio A. Psychosocial risks, work engagement, and job satisfaction of nurses during COVID-19 pandemic. Front Public Health. Published online November 20, 2020. https://doi.org/10.3389/fpubh.2020.566896

11. Lockhart L. Strategies to reduce nursing turnover. Nurs Made Incred Easy. 2020;18(2):56. doi:10.1097/01.NME.0000653196.16629.2e

12. Serow WJ, Cowart ME, Chen Y. Hospital perspectives on nurse employment. In: Cowart ME, Serow WJ, eds. Nurses in the Workplace. Sage Publications; 1992: 117-120.

13. 2020-2021 enrollment and graduations in baccalaureate and graduate programs in nursing. American Association of Colleges of Nursing. Published 2021. Accessed July 13, 2021. https://www.aacnnursing.org/Store/product-info/productcd/IDSR_21ENROLLBACC

14. Leonard K. Importance of compensation in the workplace. Chron. Updated March 1, 2019. Accessed June 30, 2021. https://smallbusiness.chron.com/importance-compensation-workplace-38470.html

15. Montañez R. Burnout is sabotaging employee retention: three things you must know to help. Forbes. Published online June 5, 2019. https://www.forbes.com/sites/rachelmontanez/2019/06/05/burnout-is-sabotaging-employee-retention-three-things-you-must-know-to-help

16. Wake up to the facts about fatigue. KRONOS. Published 2018. Accessed June 30, 2021. https://www.kronos.com/resource/download/24266

17. Nurse burnout: risks, causes and precautions. The University of St. Augustine. Published July 2020. Accessed June 30, 2021. https://www.usa.edu/blog/nurse-burnout

18. Gutsan E, Patton J, Willis WK, Coustasse-Hencke A. Burnout syndrome and nurse-to-patient ratio in the workplace. Paper presented at: 54th Annual MBAA Conference; April 18, 2018; Chicago, IL. https://mds.marshall.edu/mgmt_faculty/196/

19. Balasubramanya B, Nisha C, Ramesh N, Joseph B. Staff working in ancillary departments at a tertiary care hospital in Bengaluru, Karnataka, India: How healthy are they? Indian J Occup Environ Med. 2016;20(1):44-47. https://doi.org/10.4103/0019-5278.183844

20. Jennings BM. Work stress and burnout among nurses: role of the work environment and working conditions. In: Hughes RG, ed. Patient safety and quality: an evidence-based handbook for nurses. Agency for Healthcare Research and Quality; 2008. https://www.ncbi.nlm.nih.gov/books/NBK2668/

21. Mullen K. Barriers to work-life balance for hospital nurses. Workplace Health Saf. 2015;63(3):96-99. https://doi.org/10.1177/2165079914565355

22. Melnyk BM, Tan A, Hsieh AP, et al. Critical care nurses' physical and mental health, worksite wellness support, and medical errors. Am J Crit Care. 2021;30(3):176-184. https://doi.org/10.4037/ajcc2021301

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