According to the American Nurses Association (2012), nursing is the promotion, protection and optimization of health and abilities, prevention of diseases and injuries, alleviation of pain and suffering through diagnosis and treatment of these diseases and illness, and advocacy in the overall care of individuals, families, communities and populations.
By 2015, the population of nursing professionals in the workforce in the United States was approximately 3.5 million. This accounted to nearly three per every five healthcare professionals and technical jobs in US, or 57% of the 6.1 million jobs in jobs in the healthcare and technical operations. The nursing profession plays a key role in the evolution of the U.S. healthcare system, particularly as the reforms under the Affordable Care Act (Obamacare) continue being implemented (Carnevale et al. 2015).
A well-developed career pathway and a high expectation of significant job growth makes nursing appear an attractive route towards a firm economic mobility among many people. Apart from the teaching profession, no any other job in the United States employs more women than nursing. Women constitute about 89% of the nursing workforce. The registered nurses earn relatively high salaries (approximately $ 68,000) as compared to other occupations that are dominated by women; for instance elementary teachers who earn around $50,000. In addition, many women tend to pursue nursing as a lifelong profession, ready to move into and out of the labor market any time as both personal and economic conditions demand. Among all female dominated professions in the US, it is only teachers who stay in their positions longer than nurses. For example, 84% of teachers are still teaching after 10 years from when they started their career, while nearly 75% of nurses practice the nursing in the same position ten years since they started their career. As at present, the U.S has the largest nursing workforce globally; it has more than average concentration of nurses, approximately 11.1 nurses per 1000 people compared to the world’s average of approximately 8.7 nurses per 1,000 people (Buerhaus, 2008).
Carnevale, Smith & Gulish (2015) projected that, based on the age and the makeup of the current nursing workforce, the size of the annual graduating nurses, and the future career decisions regarding to working in the nursing profession, the supply of nurses will steadily rise steadily from the current 3.5 million nurses to about 3.95 million by 2020. Yet, despite this substantial growth in the supply of nurse, they will not be enough to meet the growing demand for the nurses, which will be approximately 4.14 million by 2020. Thus, the nursing workforce is expected to fall short of roughly 193,000 nurses by 2020.
A variety of economic and social factors has contributed to the scarcity of nurses in the United States. These include the increasing aging population, rising disposable incomes, increased health coverage and consistently changing healthcare delivery models. Similarly, a demanding job environment, an aging workforce, and an inconsistent wage increase have led to many qualified nurses to quit their profession. Furthermore, recruitment, training and retention of nurses have continued to pose a serious challenge. As a result, many rural areas especially in the western and Southwestern states have continued to experience shortage of nurses (Buerhaus, 2008).
Healthcare accounts for approximately 18% of the U.S economy. This share is projected to continue growing. The expansion of this sector is expected to reach 20% of the gross domestic product by 2020. The main reason for this high growing demand is change in demographics. It has been projected that by 2030, more than seventy million baby boomers will be attaining the over 65 age group. This segment constitutes about 34% of all surgical procedures, 26% of all physical office visits, and 90% of all nursing home residents; in all these services, nursing plays a critical role (Ricketts, 2011).
Another major reason for the growing demand of the nursing professionals of the expansion of coverage by both the federal and the state health insurance exchanges, as well as the expansion of Medicaid, which has been introduced in most states under the Obamacare health initiative. While it is still difficult to assess the extent to which by which the increase in coverage will translate towards the greater utilization of services, it can be assumed that individuals who gain health insurance coverage will consume more healthcare services than they consumed when they were not insured, hence contributing towards the growing demand for healthcare (Carnevale et al. 2015).
It has been established that as the economy grows, the demand for nurses will increase while their supply will reduce. With the expanding economy, many qualified nurses are opting not to work in their profession. It has been estimated that as the economy expands, approximately three-quarters of nurses holding Bachelor’s degree will remain in their nursing career; this is lower compared to 85% for teachers The AMN Healthcare survey (2013) found that 23% of the nurses aging 55 years and above will change their career or switch to practice their nursing profession to part-time as the economy continues to grow (Buerhaus, 2008).
Stressful working environments characterized by long working hours and tight inflexible schedules contributes to many nursing practitioners to move in and out of the nursing field based on personal circumstances and economic circumstances. Nearly 44% of qualified nurses who do not practice nursing indicate their reason as due to work-related issues like the physical demands of the job, burnout, inadequate staffing, scheduling and low payment compared to other opportunities available in other health related services such as pharmaceuticals, medical equipment fields, retail sales and services and biotechnology (Ricketts, 2011)..
The nursing profession will also be faced by the aging nursing workforce. While the U.S. aging population (those with 65 and above) stands at 14% of the total population currently, this proportion is expected to increase to about 20% by 2030. This population will raise the demand for the nursing care and services and reduce the supply of nurses simultaneously; this reduction in supply will result as a result of the retiring of baby boomer nurses. Currently, baby boomer nursing population constitutes approximately 1.1 million of the total nursing population. Presently, nurses aged over 40 years comprise the majority, accounting for 62% of the total population of nurses (Ortman, Victoria, &Howard, 2014).
The nursing profession is also facing a relatively demanding environment. Nurses continue to face an increasing number of challenges such as an increasing aging population leading to tighter budgets, sicker patients, physical and psychological pressures due to shift working, fear of punishments in case they make errors in the course of duty, and the challenge of adapting to the ever-changing technologies. All these factors coupled with unpredictable and infrequent increase in salaries and wage increments have accelerated the level of stress. The modern trend towards shorter hospital stays and an increasing number of patients with several severe health conditions have led to increased intensity of nursing care that is provided in hospitals; hence accelerating the already strenuous nursing work environment (Ricketts, 2011).
Furthermore, pressure in the nursing profession has resulted has resulted from the government initiative to reduce costs, leading to reduction of incentives for hospitals to invest in additional staffing over and above the bare minimum. This has increased stress on the existing nurses as they have to work extra harder to attend the increasing patient population which has also been found to be detrimental to the patient population. At some instances, nurses are faced with the challenge of dealing with excess documentation work which detracts them from focusing on patient monitoring (Carnevale et al. 2015).
Some government programs that have been initiated with a goal of easing the problem of nursing shortage have resulted to other unintentional consequences. For instance; scholarships, grants, loan reimbursements and tuition vouchers; though meant for decreasing the cost of nursing education, they also tend to depress the starting wages for the nurses once they are employed. This is because all nursing graduates who have in one way or the other benefited from these programs are forced to work for lower real wages than they would work for if they did not enjoy these benefits, due to deductions to refund the costs of the benefits extended. In addition, while the number of graduates graduating from the nursing colleges is growing, filling the vacancies being left by retiring nurses has not been simple in the recent past. This is because many healthcare providers shy away from employing newer nurses citing lack of experience. This is expected to be a hindrance for these young nurses obtaining jobs if the government and other relevant authorities do not step in to rescue the situation, since unless these students are provided with these opportunities, they will continue to find hardship in obtaining gainful employments (Carnevale, Smith & Gulish, 2015).
References
Buerhaus, P. I. (2008). Current and future state of the US nursing workforce. JAMA, 300(20), 2422-2424.
Carnevale, A. P., Smith, N., & Gulish, A. (2015). Nursing: Supply and Demand through 2020. Georgetown University Center on Education and the Workforce.
Carnevale, A. P., Smith, N., Gulish, A., & Hanson, A. R. (2015). Iowa: Education and Workforce Trends through 2025. Georgetown University Center on Education and the Workforce.
Jourdain, G., & Chênevert, D. (2010). Job demands–resources, burnout and intention to leave the nursing profession: A questionnaire survey. International journal of nursing studies, 47(6), 709-722.
Ortman, J., Victoria V., &Howard H. (2014): “An Aging Nation: The Older Population in the United States.” Washington, D.C.: U.S. Census Bureau. Current Population Reports 25- 1140.
Ricketts, T.C. (2011): “The Healthcare Workforce: Will It Be Ready as the Boomers Age? A Review of How We Can Know (or Not Know) the Answer.” Annual Review of Public Health. 417-430
