By John Eric Weinstein, Ph.D
The phrase “perfect storm” is often used to describe a phenomenon resulting from an exceptionally rare combination of circumstances. Although the term is overused, I believe it accurately portrays the challenges facing the health care industry over the next 10 years.
At the center of this metaphorical storm is America’s aging population and the demand for registered nurses. The country has experienced nursing shortages before; however, the circumstances surrounding the looming shortage are fundamentally different. Experts agree that this shortage could result in a national crisis, and health care in the Lowcountry stands in the direct path of this approaching storm.
According to Rebecca Grant in an article that appeared earlier this year in The Atlantic, the nursing profession will be influenced by four major factors over the next decade. The first factor, and primary driver of the gathering storm, is America’s aging baby boomers. It has been estimated that the number of senior citizens (aged 65 or older) in the U.S. between 2010 and 2030 will increase 75 percent to 69 million. By 2050, that number is expected to grow to 88.5 million. As the population ages and experiences more health-related problems, the demand for nurses will increase. But that demand will primarily be driven by care for the chronically ill, which is ongoing care that becomes increasingly complex as illnesses and health problems become multi-layered. So, it may not only be diabetes that a patient is dealing with, but heart disease, renal failure, amputations, and a decrease in vision – all of which multiply the complexity of care.
Second, nurses are also aging, and many will soon be retiring and leaving the workforce. In fact, the Bureau of Labor Statistics estimates that 700,000 nurses in the U.S., which represents about one-third of the workforce, will retire over the next 10 years. Many nurses postponed retirement during the Great Recession, choosing to work longer hours and overtime to increase their financial security. Today, the economy’s slow growth is having the opposite effect, and more people are retiring sooner. With each retiring nurse, a considerable amount of knowledge and experience leaves the workforce that simply cannot be replaced by a newly graduated one. In fact, research has demonstrated that patient outcomes and safety are directly influenced by the experience level of the nurse.
Third, nurses are being called upon to serve a greater role in the health care arena as a result of increased retirements among physicians in combination with the increased access to health care provided by the Affordable Care Act. According to Dr. Peter Buerhaus, a healthcare economist and professor of nursing at Montana State University, nurses today need to be savvy about health care reform and value-based care. They will increasingly have responsibility in the prevention of disease, the delivery of care, chronic care of the aging, and end-of-life care. Once viewed as subordinate members of the health care team, today’s nurses are full and essential partners and need to be educated to assume leadership roles.
Fourth, the demand for nurses has outpaced the ability of the nursing education system to supply them. According to the American Association of Colleges of Nursing (AACN), U.S. nursing schools turned away more than 68,000 qualified applicants from baccalaureate and graduate nursing programs in 2014 due to insufficient faculty, clinical sites, classroom space, clinical preceptors, and budget constraints. Contributing to the faculty shortages is an aging faculty, with the average age of nursing professors, associate professors, and assistant professors being 61.6, 57.6, and 51.4 years of age, respectively. Given that the average age of retirement of nursing faculty is 62.5 years old, a wave of retirements is expected in the next 10 years. In fact, that wave of retirements is already evident, as the AACN reported in 2014 that there were 1,236 faculty vacancies in a survey of 714 nursing schools across the country, representing a national nurse faculty vacancy rate of 6.9 percent. The ability to increase the number of qualified faculty is compounded by the lack of faculty to teach at the graduate nursing level.
In South Carolina, the AACN reported that there are more than 55,000 licensed registered nurses. Nursing programs at both the baccalaureate and graduate levels are producing about 1,400 graduates per year. On a statewide basis, the Office for Healthcare Workforces reports that the supply and demand for nurses has been more-or-less balanced in recent years, perhaps as a result of graduates of associate degree programs. However, the Institute of Medicine is recommending that nurses should achieve higher levels of education to meet the demands of a changing healthcare system, and calls for an all-baccalaureate workforce at the entry level, which could exacerbate shortages. Regardless, the AACN predicts that a statewide shortage of nurses may begin to develop in the next six to eight years, and grow to a shortage of 6,400 by the year 2028. Here in the Lowcountry, there has been a chronic shortage of nurses for years. In fact, there are currently more than 260 vacancies for registered nurses in the Charleston area alone. Based on the latest projections for this perfect storm, local shortages in the nursing workforce will grow more urgent through time, exacerbated by the population growth in this area, which is among the highest in the nation, and the popularity of the area to retirees.
John Eric Weinstein, Ph.D, is the interim dean for The Citadel’s School of Science and Mathematics. The Citadel was recently approved to begin a Bachelor of Science in Nursing program for the South Carolina Corps of Cadets during the day and a degree completion program for evening undergraduate students.