Will There Be Enough Nurses? Examining Supply and Demand Predictions

Will There Be Enough Nurses?By Jennifer Larson

Projections on supply and demand for nurses have been anything but clear over the past couple of years.

In April 2013, an article published in the New England Journal of Medicine predicted that the nursing shortage might be over. The authors noted that an unexpected surge in new RN graduates had erased predicted shortages. But they also cautioned that “the future is by no means secure,” and that the supply of nurses may be unevenly distributed and that future demand was uncertain. 

Around the same time, the AMN Healthcare 2013 Clinical Workforce Survey found that 66 percent of the executives surveyed said they were experiencing a shortage of nurses, and 63 percent anticipated that healthcare reform would increase the need for nurses in their facilities in the future.  

Then, in the middle of this year, demand for travel and per diem nurses suddenly began to spike, and increase that has been sustained. AMN Healthcare experienced an 80 percent higher demand for nurses in Q3 of 2014 compared to the same quarter a year earlier. Industry analysis showed that demand for nurses had risen throughout the country and was likely to persist.

Finally, the American Nurses Association made waves recently when it announced that the nation would need to produce at least 1.1 million new nurses by 2022 to meet the demand created by new positions and retirements. 

So what will “enough nurses” really look like as healthcare evolves? Is it possible to produce enough nurses to meet that need, even though we don’t know exactly what that need will be? It may be that while supply is growing, demand is changing and many variables are being introduced by the immense changes occurring throughout the healthcare industry. 

For example, as the population ages and the demand for healthcare services increases in the era of health reform, more nurses will be needed to meet that need—albeit in different types of jobs and roles. A greater emphasis on care coordination and new models of care delivery will also drive the need for RNs in potentially new roles in the future. 

Pam Cipriano, Ph.D., RN, president of the American Nurses Association, noted that healthcare is evolving in ways that meets patients’ needs, while also being cost-effective. That includes shifting the location of where much of healthcare is being delivered now and in the future. 

“We know that jobs are going to continue to move from the hospital to the community,” she said.

Cipriano acknowledged that the recent job market has reflected some “mixed signals,” as some hospitals were laying off nurses while others were advertising heavily for nurses to fill vacancies.

The sudden spike in demand for nurses in the healthcare sector of the staffing industry is probably due to a confluence of factors, according to Ralph Henderson, president of Healthcare Staffing at AMN Healthcare. Leading impacts include an improving economy and healthcare reform. More people have access to health coverage through the health insurance exchanges, while Medicaid expansion has resulted in fewer charity cases. Additionally, patient volumes seem to be increasing as the economy improves. The result is that hospitals have greater revenues to afford to staff at higher levels. 

“Hospitals are doing financially better than they had been doing,” Henderson said. “They have the money now. The mix of business has gotten better.”

Like the rest of the population, the nursing population is aging. Retirements of Baby Boomer nurses also will be a factor in nurses’ demand, he said. With the stock market and housing prices recovering, nurses will have an improved confidence level in the ability to finally retire. The retirement of nurses and the higher percentage of population with insurance are both sustainable trends, Henderson said, and could affect demand for many years.

Coping with high demand

The ANA maintains that the need for nurses will be very clear as the next decade approaches, so it is calling for a 12 percent increase in Title VIII funding in 2015 to ensure that nursing education will grow. This funding source logged a 2 percent decrease each year for the past four years. The ANA is also calling for an increase in transition-to-practice opportunities for new graduates, who many hospitals have not wanted to hire. 

Cipriano said that hospitals are going to need those new grads soon and should consider that in their future strategic plans. 

“We don’t want to disenfranchise groups of individuals who have made the commitment to become nurses,” she said.

Henderson said that hospitals and health systems may have to reconsider their strategies for contingent nurses in order to fill their needs as demand continues to grow. Some hospitals have decided not to hire nurses who weren’t already licensed in their state or hadn’t scored very high on their licensing exams. However, hospitals may have to loosen up on those restrictions, he said. 

“They should look at those criteria to make sure they’re in line with the times,” he added. “Those restrictions they put in place when nursing supply was plentiful could prevent them from getting the best nurses when demand is much higher than supply.”