Nursing, the largest health care profession in the U.S., is also one of the nation’s fastest growing professions according to the Bureau of Labor Statistics. But by 2030, the state of Texas will be short nearly 16,000 registered nurses. A study by the National Center for Health Workforce Analysis says Texas will have the second-largest shortage in the country, behind only California, which is projected to lack nearly 45,000 nurses in 2030.
That nearly 16,000 nurses will amount to only a 5% deficit overall for Texas. More rural states will be likely to see a larger percent of their overall nursing jobs go unfilled, barring intervention. A suspected cause of the shortage is the ever-increasing number of people reaching retirement age. Before the beginning of 2020, people 65 and older will outnumber children under 5 globally, according to a report from the U.S. Census Bureau. It’s the first time this has happened in human history, and by 2030 the elderly population will reach 1 billion. It’s likely that nurses will be primarily tasked with caring for these people.
“The scope of practice for nursing has really increased over the years, which is a good thing because we actually care for the patients in a hospital 24 hours a day,” says Dr. Anne Dabrow Woods, chief nurse of Wolters Kluwer Health Learning, Research, and Practice. “So what we do as nurses is a lot. We do a lot of what physicians used to do.”
Nurses care for patients on more personal level than a physician traditionally would, Woods says. They’re tasked with everything from showing patients how to check their blood pressure to diagnosing and treating illness. Simply put, Woods says, nurses are the best at working with and teaching patients.
But the evolving nature of nurses’ role in health care is yet another stress added to a historically stressful occupation. Staffing and safety issues, the emotional toll of breaking bad news to family members and hectic work schedules all contribute to high turnover rates and nurse burnout, specifically the first three years in the case of the latter. This, Woods says, is largely being addressed by hospitals requiring new nurses to get their bachelor’s degrees and undergo lengthy orientation periods. But it’s outside of hospitals where they will be needed most.
“We used to just teach people how to be nurses in the hospital,” she says. “A lot of care is done out in the community, it’s done in long-term care centers, it’s done in primary practice, it’s done in clinics. You have different resources available to you. There’s different things that would be a priority for the patient. It’s only through having the proper education and training that we can help nurses learn how to care for people in those settings.”
Since the adoption of the Affordable Care Act, health care providers have been offered incentives to adopt a value-based purchasing model. That means, in part, the institutions that treat elderly patients covered under Medicaid are now using an outcome-based system to determine success, further exacerbating the need for more nurses as well as advanced practice nurses as time goes on. An associate's degree just won’t be enough for nurses in the future.
Staffing and safety issues, the emotional toll of breaking bad news to family members and hectic work schedules all contribute to high turnover rates and nurse burnout.
“When you look at what’s changing in health care, it’s kind of been upended,” Woods says. “So instead of just getting paid for what you do, you have to really know how to improve quality care and improve patient outcomes, and at the bachelor’s level for a nurse, they just start to talk about that. It’s at the master and doctoral level that you’re really taught how to improve practice, improve patient outcomes, how to optimize reimbursement and really look at health care systems and how we deliver care.”
Nearly a third, or roughly 1 million, of the nurses in the U.S. are expected to reach retirement age in the next 10-15 years, according to data from the World Health Organization. Another report from Nursing Outlook, a journal from the American Academy of Nursing, says that roughly a third of nursing faculty members will also reach retirement by 2025. This is another cause of concern considering more than 75,000 prospective nursing students were turned away in 2018 due in part to faculty shortages, according to the American Association of Colleges of Nursing.
“The average age of the nurse is high, it’s 51 years old now, where a few years ago it was in the 40s. That’s a huge problem,” Woods says. “In areas of our country where we have a lot of schools of nursing, the shortage doesn’t seem quite as bad. But in areas where it’s more rural, we have a huge problem overall and part of it is because we don’t have enough faculty and we don’t have clinical sites.”
A number of solutions to this problem are already underway nationwide, with Hawaii becoming the fourth state to pass legislation granting tax credits to preceptors. Woods, who has been an adjunct faculty member at Drexel University in Philadelphia for close to five years, also suggests that APRNs and nurse practitioners can help ease the burden by taking on adjunct teaching roles while still practicing. Considering the high degree of specialization required in nursing roles, maintaining that knowledge pool for future nurses is more important than ever.
Luckily for Dallas and the rest of Texas, steps were taken in 2015 with the launch of 60x30TX. The program’s goal is to ensure 60% of adults between 25 and 34 will earn a certificate or degree by 2030. This focus on encouraging higher education will likely play a part in helping Texas avoid any shortage of nurses, though only time will tell if the state can bridge the gap over the next decade. As of now, Woods says health care education has to innovate and grow when it comes to nurses.
“We have to really understand what’s going on in our health care institutions and not just do things the way we always used to do them," Woods says. "We have to make sure we’re looking at the latest evidence and using that to help inform our practice decisions so that we are always making the best decisions with our patients. Not for our patients but with our patients.”