View from Washington: The Nursing Shortage – The Policy Challenge

A recent Washington Post article made mention that by the year 2011, over 74 million Baby Boomers will be hitting the Medicare roles. While discussion is being had about how to pay for care for the residual World War II generation and the Baby Boomers, scant attention by policymakers is being given to exactly who in Generation X is going to be available to provide the required nursing care.

Nursing is the single largest health profession in the United States. Currently, the United States has a relatively slight shortage of nurses. According to a 2007 article in Health Affairs, by the beginning of 2011 the United States will be between 340,000 to 1 million nurses shy of the number of what is projected to be needed. By 2030, essentially all the practicing nurses from the Baby Boom generation, the largest cohort of nursing professionals today, will be retired.

Will the market fix it?
Despite the overwhelming healthcare cost control imperative, some will argue that the nursing shortage will be addressed by the market place – as demand goes up, salaries will rise and more people will enter nursing. However, nurses aren’t unskilled labor that can move easily between jobs with minimal retraining. To become a qualified nurse requires two to four years of significant education and training.

Research at Oxford University has shown that by increasing the ratio of patient-to-nurse by just one, job dissatisfaction rises by as much as 15 percent, and feelings of burnout increases by 23 percent. The dynamic becomes clear: increasing the workload of currently practicing nurses does not help matters much. In the meantime, at the request of some unions and nursing associations, some states are stepping in with laws to enforce strict nurse to patient ratios.

State and federal decisions
What can federal and state policy makers do to help alleviate the nursing shortage? The federal government should institute a national nursing licensure program to make it easier for qualified nurses to move from state to state, and offer incentives for the recruitment, education, and training of up to 500,000 to 1 million new nurses over the next 10 years. The federal government should work with states to expand the capacity of the current U.S.-based nursing programs. The answers do not all rest with new money and financial incentives – although narrowly focused and substantial federal block grants to states will be a key to success. States can play a huge role in exposing middle and high school students to the profession of nursing through outreach and through the development of innovative scholarship programs for future registered nurses. States can also expand the role of community colleges in offering some of the preliminary course work.

The ultimate solution to the nursing shortage is for nurses to gain the respect and recognition essential to job satisfaction. In many respects, the world of nursing has improved over the last three decades, but on the recognition and job satisfaction point alone, much work remains to be done.

About the Author

Robert Betz Ph.D.
Robert Betz, Ph.D., is president of Robert Betz Associates, Inc. (RBA), a well-established federal health policy consulting firm located in the Washington, D.C. area. Additionally, Dr. Betz is an adjunct professor teaching at The George Washington University where he specializes in political science and health policy. For more information about RBA, visit