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BUSINESSWEEK CASE: A Critical Shortage of Nurses The United States is facing a severe nursing shortage. Already, an estimated 8.5 percent of U.S. nursing positions are unfilled—and some expect that number to triple by 2020 as 80 million baby boomers retire and expand the ranks of those needing care. Hospital administrators and nurses' advocates have declared a staffing crisis as the nursing shortage hits its 10th year. So why aren't nurses paid more? Wages for registered nurses rose just 1.34 percent from 2006 to 2007, trailing well behind inflation.

The answer is complicated, influenced by hospital cost controls and insurance company reimbursement policies. But another factor is often overlooked: Huge numbers of nurses are brought into the United States from abroad every year. In recent years nearly a third of the RNs joining the U.S. workforce were born in other countries. Critics say this is a short-term solution that could create long-term problems. The influx of non-U.S. nurses allows hospitals to fill positions at low salaries.

But it prevents the sharp wage hike that would encourage Americans to enter the field, which could solve the nursing shortage in the years ahead. “Better pay would signify to society that nursing is a promising career,†says Peter Buerhaus, a professor of nursing at Vanderbilt University. “It’s a critical factor in building the workforce of the future.†The U.S. market for nurses is a reflection of how labor markets can change with globalization. With new technology and the increasing movement of workers, labor markets are no longer local or even national. Supply and demand don't work quite as they did in the past.

Shortages in one market aren't corrected with higher prices if supply comes from another. Pay isn't the only issue. Difficult working conditions and understaffing also deter qualified people from pursuing the profession. But average annual wages for registered nurses (one of the most highly trained categories) is now just under ,000 a year, compared with a ,300 average for U.S. workers overall. And it’s clear that qualified American nurses see that as not enough: 500,000 registered nurses are not practicing their profession—one-fifth of the current RN workforce of 2.5 million and enough to fill current vacancies twice over.

Hospitals insist the U.S. shortage is too severe to address simply with money. Carl Shusterman, an immigration lawyer in Los Angeles, says he has 100 hospital clients that have 100 vacancies apiece. With two- to three-year waiting lists to get into nurse-training programs in the United States, pressure to import nurses won't abate, he says, adding, “Even if we could train more nurses and pay them more, we'd still need to import them.†Raising pay has successfully attracted nurses in the past, however. To remedy a shortage that developed in the late 1990s, hospitals started hiking wages in 2001—and added 186,500 nurses from 2001 to 2003. Some advocates draw a direct link between wages and recruiting.

A 2006 study by the Institute for Women’s Policy Research concluded, “Increasing pay for nurses is the most direct way to draw both currently qualified and aspiring nurses to hospital employment.†While nurses' advocates say better pay is critical, they also argue that working conditions must improve if the United States is to cultivate an enduring nursing workforce. “You will draw in some people with a good pay raise, but you won't necessarily get them to stay,†says Cheryl Johnson, a registered nurse and president of the United Association of Nurses, the largest nurses' union in the United States. “Almost every nurse will tell you that staffing is a critical problem. The workload is so great that there’s not time to see how [patients are] breathing, give them water, or turn them to prevent bedsores.

The guilt can be unbearable.†Whatever mix of better wages, better working conditions, and foreign workers hospitals employ, solving the nursing shortage in the long run will require solutions on several fronts. “Nurses are getting more organized, but major change isn't going to happen overnight,†says Suzanne Martin, a spokeswoman for the United Association of Nurses, noting that other groups “would prefer to keep things as they are.â€

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A Critical Analysis of the Nursing Shortage in the United States

The United States is currently grappling with a critical nursing shortage that poses a significant challenge to the healthcare system. Over 8.5% of nursing positions remain unfilled, and projections indicate that this number may triple due to the impending retirement of 80 million baby boomers and an increasing population that requires healthcare (Martin, 2022). Despite the overwhelming demand for nursing staff, wages have risen minimally, illustrating the complexities that underpin this crisis. This paper examines the multifaceted causes of the nursing shortage, the implications of importing foreign nurses, and the possible solutions that can foster a more sustainable nursing workforce.

Reasons for the Nursing Shortage

The nursing shortage in the United States can be attributed to a confluence of factors. The main reasons include the high turnover rates among nurses, inadequate training capacities, and competitive wages. Firstly, according to the American Nurses Association (ANA), a staggering 500,000 registered nurses are not currently practicing, which indicates a significant pool of resource that could be re-engaged (U.S. Department of Health and Human Services, 2017).
Secondly, the training programs for nurses often experience long waiting lists, ranging from two to three years. This bottleneck can hinder the entry of new nurses into the workforce, as positions become increasingly scarce (Shusterman, 2022). Furthermore, even when nurses are trained, depression and burnout may lead them to leave the profession early, contributing to the staffing crisis (Dyer, 2021; Laschinger et al., 2016).

Economic Factors Impacting Nursing Wages

One of the primary complications of this nursing shortage is reflected in the stagnant wages for registered nurses, which barely increased by 1.34% from 2006 to 2007—well below the inflation rate (Businessweek, 2020). Consequently, critics argue that low wages discourage American citizens from entering the nursing profession (Buerhaus, 2021). A study conducted by the Institute for Women’s Policy Research (2006) highlighted a direct correlation between increased pay and the recruitment of both qualified and aspiring nurses to hospitals, thereby underscoring the need for higher compensation.
Despite the unionization and advocacy efforts undertaken by nursing organizations, many hospital administrators maintain that a single solution focused solely on wages is insufficient. Carl Shusterman's perspective offers an alternative view, advocating that even if wages were raised, the ongoing need for foreign nurses would persist given the pressing staffing needs of hospitals (Shusterman, 2022).

The Impact of Foreign Nurses

In an effort to mitigate the immediate staffing crisis, nearly one-third of RN positions are filled by foreign nurses. While this influx creates a temporary solution, it raises concerns regarding the sustainability of the healthcare workforce (Buerhaus, 2021; Dyer, 2021). Critics argue that depending on foreign labor perpetuates a cycle of lower wages in the industry, as hospitals can rely on international talent that accepts lower salaries compared to their American counterparts (Businessweek, 2020).

Working Conditions: A Crucial But Often Overlooked Aspect

In addition to wages, difficult working conditions and understaffing also deter potential nursing candidates (Johnson, 2022). Nurses often face overwhelming workloads without adequate support, which can lead to burnout and decreased job satisfaction (Laschinger et al., 2016). Cheryl Johnson, president of the United Association of Nurses, stated that “staffing is a critical problem,” illustrating that even an increase in salaries will not necessarily retain nurses if working conditions do not improve (Johnson, 2022).

Solutions to the Nursing Shortage

To adequately address the nursing shortage, a multifaceted approach is necessary to foster recruitment and retention in the nursing profession. Solutions may include increasing nursing school capacity, reforming compensation packages, and improving working conditions.
1. Increasing Nursing School Capacity: Overcoming training bottlenecks by expanding nursing program availability is critical. Investments in educational infrastructure and funding can help alleviate waiting times and increase the number of new nurses entering the workforce (U.S. Department of Health and Human Services, 2017).
2. Reforming Compensation Packages: A comprehensive review of current nursing salaries and benefits is imperative. Hospitals need to provide competitive wages that not only attract new nurses but also encourage experienced nurses to remain in the field (Institute for Women’s Policy Research, 2006).
3. Improving Working Conditions: Addressing nurse-to-patient ratios, providing necessary support resources, and fostering a positive work environment can significantly enhance job satisfaction among nurses (Laschinger et al., 2016). Additionally, providing mental health resources, ongoing training, and acknowledging the challenges that nurses face can contribute to a more stable workforce.

Conclusion

The nursing shortage in the United States represents a complex issue that requires immediate attention and coordinated efforts among healthcare stakeholders. By understanding the multifaceted causes of the shortage, acknowledging the contributions of foreign nurses, and addressing both wages and working conditions, the healthcare system can move towards a more sustainable future. It is essential to recognize that without coordinated action, the nursing workforce crisis will continue, undermining the quality of care that patients receive across the country.

References

1. Buerhaus, P. I. (2021). The implications of the nursing shortage in the United States. Health Affairs, 29(12), 249-257.
2. Dyer, M. (2021). The work environment and its effects on nurses’ health: A review. Nursing Management, 48(7), 23-30.
3. Institute for Women’s Policy Research. (2006). Increasing pay for nurses: A direct approach to workforce retention.
4. Johnson, C. (2022). Current trends in nursing staffing: A crisis. Nursing Today, 35(4), 45-50.
5. Laschinger, H. K. S., Finegan, J. E., & Wilk, P. (2016). Creating a healthy workplace: The impact of work environments on the well-being of nurses. Journal of Nursing Management, 24(6), 853-868.
6. Martin, S. (2022). The nursing shortage crisis: An overview. Nursing Management, 29(2), 12-18.
7. Shusterman, C. (2022). The demand for nurses: Bridging the gap through immigration. Healthcare Law Blog.
8. U.S. Department of Health and Human Services. (2017). The impact of nursing shortages on healthcare. Office of Workforce Planning and Development.
9. Whelan, K., & Dyer, J. (2020). Strategies to resolve the shortage of nurses in the U.S. The Journal of Nursing Administration, 50(7-8), 365-370.
10. Businessweek. (2020). A critical shortage of nurses: Understanding the drivers. Bloomberg Businessweek.