The current nursing shortage may seem unprecedented from the perspective of the patients, providers, and healthcare professionals experiencing the shortage firsthand. The pains associated with nursing shortages are certainly felt by healthcare professionals, patients, and facilities alike.

However, some may be surprised to learn that nursing shortages have persisted over most of the past century. Some shortages have had healthcare-specific causes, while others have followed more general trends in the labor market and the economy.

Which leaves us asking the question, what can be done to address these shortages?

Nursing Shortages Throughout History

One of the earliest major nursing shortages occurred in the 1930s when the United States was gripped by the Great Depression. An article for the University of Pennsylvania’s Penn Nursing program explains that, like most 20th-century nursing shortages, this shortage was largely demand-driven; i.e. the shortage was due more to increasing usage of healthcare than to a reduction in the supply of nurses. Nursing shortages were a novel problem in the 1930s, and hospital administrators struggled to cope with these shortages or find constructive solutions to the problem. “Unaccustomed to dealing with nurse shortages, hospital administrators reacted slowly to the situation,” according to the Penn Nursing article. “Some blamed nurses themselves for creating the shortage by failing to live up to the ideals of their profession and refusing to work.”

As America mobilized for war in the early 1940s, its ongoing nursing shortage became even more pressing. To make matters worse, supply-side challenges emerged to compound the existing demand-side struggles. While the U.S. military was able to pull in sufficient resources for the war effort – 77,000 nurses who joined the military services by the end of the war – by and large, these nurses were not newly trained additions to the workforce. They were drawn from the civilian sector, which lost roughly a quarter of its pre-war nurses.

In response to the shortage, the U.S. government took aggressive steps to shore up the nursing labor force. Passage of the 1943 Bolton Act and the creation of the U.S. Cadet Nurse Corps provided $160 million for nurse education funding and financial support for nursing students. “Students enrolled in the program received a free education as well as a monthly stipend and uniforms.”

Post-war efforts to fix the nursing shortage did little to address the problem, and in 1964 the federal government again stepped in to correct it. The 1964 Nurse Training Act, which authorized $283 million into building new nursing schools, sought to expand nurse training and provide loans for nursing students.

Throughout the middle of the 20^th century, supply and demand played a role in what can be considered a decades-long shortage with brief periods of relief.

A couple of key factors can explain many of the shifts in supply and demand. Demographic changes from the early 20^th century meant that more Americans were living longer, thereby experiencing more age-related healthcare needs. Americans also became wealthier on average, increasing their ability to pay for medical services and allowing the demands of their old age to increase relatively unchecked.

Nursing Shortages Today and Contributing Factors

For those who haven’t had direct exposure to the current nursing shortage, a few data points may help illustrate the current problem the industry is facing.

In October 2010, the Institute of Medicine released its landmark report on The Future of Nursing. Initiated by the Robert Wood Johnson Foundation, the report called for increasing the number of baccalaureate-prepared nurses in the workforce to 80% and doubling the population of nurses with doctoral degrees.

According to the American Association of Colleges of Nursing 91,938 qualified applications were turned away from graduate nursing programs in 2021 due to insufficient number of faculty, clinical sites, classroom space, and clinical preceptors, as well as budget constraints further exacerbating the nursing shortage.

This shortage may persist across the country through 2030 according to the United States Registered Nurse Workforce Report Card and Shortage Forecast: A Revisit

The global COVID-19 pandemic is a predictable target for those seeking to assign blame for the problems of U.S. healthcare. But even granting the pandemic’s heavy repercussions, it’s not the sole factor at play in the current nursing shortage, which is more complex than it might seem.

First, demographic changes in the United States are contributing to the problem. An aging population simultaneously reduces supply and increases demand for healthcare services. “The population surge from the baby boomer generation has led not only to a greater number of aging patients but also means that a large portion of the nursing workforce is heading toward retirement,” according to the University of St. Augustine for Health Sciences. “Between 2000 and 2018, the average age of employed registered nurses increased from 42.7 to 47.9 years old. And nearly half (47.5%) of all RNs are now over the age of 50.”

Second, the labor market phenomenon known as the “Great Resignation” continues to pose challenges for employers across many industries, as both scheduled and early retirements strip the labor force of experienced professionals at a faster rate than they can be replaced by new entrants. Part of this trend could have been predicted decades ago by simply considering birth rates. It was always apparent that Baby Boomers would start to retire in their 60s, and that subsequent generations weren’t as large. But many retirements during the great resignation have accelerated that schedule, making shortfalls more intense than birth rates indicated. That is, more people are retiring sooner than expected.

So, what can be done to address these issues? One possible solution may be the Train More Nurses Act, which passed in January 2024.

What is the train more nurses act?

The Train More Nurses Act is a bipartisan bill introduced by Senators Jacky Rosen (D-NV), Mike Braun (R-IN), and Susan Collins (R-ME) and was unanimously passed by the US senate on January 24, 2024. It will move next to the U.S. House of Representatives for consideration.
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The bill directs the Secretary of Health and Human Services and the Secretary of Labor to conduct a review of all nursing grant programs to find ways to increase faculty at nursing schools, particularly in underserved areas. It also increases pathways for Licensed Practical Nurses to become Registered Nurses. This effort may help address the nursing shortages impacting long term care.

The goal of this bill is to further support the nursing workforce. Supporters of the bill want to review nursing grant programs to find ways of increasing faculty at nursing schools, particularly in underserved areas. More educators would allow more opportunities for students to enroll in nursing courses and increase the number of graduates available for employment.

In light of the nursing shortages, increasing educators, classrooms, and clinical space should have a direct impact on the size of the nursing labor pool available. More nurses graduating means better outcomes for nurses, facilities, and patients alike.

The bill will also increase career pathways for many healthcare professionals. The bill lays out opportunities for experienced nurses to become educators themselves. This not only helps nurses to level up their own careers, but also creates a wider pool of educator talent. Not only does the bill provide opportunities for nurses to become educators, but also for LPN to become RNs through non-traditional pathways.

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