The nursing workforce shortage: causes, consequences, proposed solutions.

Introduction R egistered nurses (RNs) are the single largest group of health care professionals in the United States. Current and projected nursing shortages reflect the fact that fewer people are entering the profession. Shortages are difficult to estimate and project. In the past, shortages have tended to be resolved as wages rose in response to increased need for RNs. In addition, there is a cyclical aspect to shortages, as RNs are more likely to work when the economy is doing less well. Projected shortages differ from past circumstances in that, by 2020, a decline in the number of available nurses will coincide with an increased need for nursing services due to aging of the baby boom generation.These changes suggest that it will be more difficult, and more costly, to respond to the future shortage. The nursing profession involves three types of workers: registered nurses, licensed practical nurses, and nurse aides. Registered nurses provide direct patient care and also manage nursing care. They are state-licensed and hold associate degrees (two-year community colleges), diplomas (three-year hospital programs), or baccalaureate degrees (four-year colleges). Licensed Practical Nurses (LPNs) provide patient care under direction of an RN or physician. Also licensed by the state, LPNs must complete 12 to 18 months of training. Nurse aides assist in routine care activities, such as bathing, dressing, and feeding patients. Aides who work in nursing homes or home health agencies that receive Medicare or Medicaid funds are required to complete at least 75 hours of training. Most RNs work in hospitals, while LPNs work primarily in either hospitals or nursing homes. Nurse aides may work in hospitals and home care settings, but most commonly work in nursing homes. The Commonwealth Fund is a private foundation supporting independent research on health and social issues.The views presented here are those of the author and should not be attributed to The Commonwealth Fund or its directors, officers, or staff.