The U.S. Is Running Out of Nurses, Cont'd

Editor’s Note: This article previously appeared in a different format as part of The Atlantic’s Notes section, retired in 2021.

Rebecca Grant wrote a piece for us on the possible shortage of nurses over the next couple of decades. On the dangers of burnout:

When nurses are stretched too thin, they have less time and energy to devote to each patient. Overworking leads to fatigue and burnout, which threatens the quality of care and increases the incidence of error. Past research has found links between insufficient nursing staffing and higher rates of hospital readmission and patient mortality. Higher patient loads are also linked to higher rates of nurse turnover, which can costly, disruptive, and potentially harmful to patient safety.

Is a shortage of nurses really inevitable? One reader doesn’t think so, pointing to a 2014 report from the U.S. Department of Health and Human Services:

The federal projections have changed: They are now expecting a surplus of 340,000 nurses by 2025. There are far more new grads than available jobs. The shortage is only of experienced nurses in some specialties and in undesirable locations.

According to the report: “Despite projections of an excess of RNs at the national level, 16 states are expected to see their supply of RNs outpaced by increases in demand, resulting in shortages.”

Another reader, meanwhile, “was all set to change careers and attend nursing school a few years ago but backed out at the last minute”:

I kept hearing that new nurses couldn’t find jobs anywhere. Nobody was willing to train them; they only wanted to hire those with experience. I decided I wasn’t willing to spend a year of full time schooling and take out $45k in more student loans only to be unemployed at the end of it. And I didn’t want to deal with the entrenched culture of abusiveness—from doctors, patients, hospitals, and older nurses.

I’m still sad about it because I think I could have made a great nurse. Until hospitals get on board with training new nurses, mandating safe patient/nurse ratios, and fostering a culture of respect, the nursing shortage will continue.

Another personal perspective from a reader:

I was a nurse for over 20 years. What so many of the public do not understand is that it is a brutal job. You are constantly dealing with very sick people who have multiple needs. You are called—in some hospitals, forced—to work long hours. Frequently, supervisors are demanding and punitive. You often have to deal with physicians who want to use nurses as scapegoats. Schools have become more and more brutal about entrance requirements, and financing has become more and more scarce.

I could go on for some time about this, but the shortage is based on much more than salary levels.

Have something to add? Drop us a line. Update from a reader:

I was a nurse for 17 years before going to law school. Nursing is both physically and mentally challenging, though it provides some of the best emotional rewards. The nursing profession combines science, education, and human resources, and the professional nurse has to be good at all of them simultaneously.

Every nurse engages in tradeoffs all the time. Too many medications scheduled for the same time means that some are given early and some late. Communicating with some physicians is challenging, but others really are collaborators in patient care. Unfortunately, the physical nature of the profession causes most nurses to move on to something else, if they are fortunate enough to be able to do so.

From another nurse, who has worked “for 30 years in acute care facilities up and down the East Coast”:

I simply cannot imagine that there will ever be a surplus of nurses. I work for a large healthcare system in Virginia where the problem of retaining experienced nurses is acute. There are ICUs in my system where the most experienced nurse in the unit at any given time may only have 3-4 years experience. With the acuities of the inpatients such as they are, this is really scary.

When I came out of nursing school, it wasn’t unusual to take care of bunioneictomies and other simple maladies in the hospital. Now the inpatients are all really sick and it seems that we are constantly asked to do more with less— staff, that is. Each shift is pared down to the least amount of staff possible, so there is never a day that there is not a maximum patient load—and let me repeat myself, these patients are all sick!  I am seeing new grads all the time who work for 6-12 months at that pace and say, “not for me.”  

So, there may be enough nurses in the pipeline according to some report or another, but I don’t see the retention necessary to reach any kind of surplus. Of course, what I am saying is anecdotal, but I could find you hundreds of nurses who would say the same thing. (Please don’t use my name; my hospital system HATES staff who are not team players.)