NBNA BRIEFING STATEMENT ON THE NURSING SHORTAGE

There is a nursing shortage in our Nation. To help stem the tide of this shortage, the National Black Nurses Association along with the nursing community believes that there needs to be a substantial federal investment in nurse education and training and retention programs. Federal and state support is needed to enhance existing programs and create new programs to educate nursing students at all levels; to increase the number of faculty members to educate nursing students; and create educational opportunities to retain nurses in the profession.

REQUEST
The Congressional nursing community’s champions have consistently advocated for funding at $175 million for Title VIII, nurse education and training programs. The Congress approved $151.2 million for Title VIII funding for nursing education and training for FY 2006. The conference agreement between the House and Senate also called for a one percent across the board cut for all discretionary programs.

RATIONALE
The nursing shortage is REAL. It is estimated that there are 2.6 million registered nurses in the United States. According to the National Sample Survey of Registered Nurses 2000, 58.5 percent of RNs are working full time, (this is only one-half percent increase over the 1996 Sample Survey); 23.2 percent work part-time; and 18.3 percent reported not being employed in nursing. 59.1 percent of all RNs are employed in the hospital; 18.3 percent in public/community health; 9.5 percent in ambulatory care including physician-based practices, nurse based practices and HMOs; 6.9 percent in nursing homes and extended care facilities; 2.1 percent in nursing education and 3.6 percent in other settings such as federal administrative agencies, state boards of nursing or health association, health planning agencies, prisons/jails or insurance companies. While African Americans make up 12 percent of the population, only 4.9 percent of RNs are African Americans.

This is an aging nursing work force. The average age of RNs working in nursing is 43 years. In 1980, 26 percent of RNs were under the age of 30; today less than 10 percent of RNs are under the age of 30. RNs, particularly African American RNs, are entering the profession at an older age and will work fewer years in the profession.

Why is there a nursing shortage?

Making the case, employing public policy strategies

The nursing short is REAL.  Our Nation needs to educate and train more nurses.

There is good indication of wide interest in persons attending nursing schools.  However, nursing schools are turning away qualified applicants because they do not have the capacity to meet the demand.   According to the American Association of Colleges of Nursing, enrollment in baccalaureate nursing programs nationwide increased by 13 percent between 2004 and 2005.  AACN reported that nursing colleges and universities turned away 32,617 qualified applicants, largely due to a shortage of nurse educators.

The National League for Nursing reported that 147,465 qualified applicants were rejected for admission, which includes hospital and community college nursing programs.

It is estimated that enrollment in nursing programs would have to increase by at least 40 percent annually to replace those nurse expected to retire.

·    There are not enough faculty members to educate the students.  The number of full time faculty needed to fill the nursing gap may be as high as 40,000.  Currently there are less than 20,000 full time faculty in the system.  The average age of nursing professors is 52; for associate professors the average age is 49.  Nearly 1800 full time faculty members leave their positions each year. 

·    There is not enough classroom space.

·    There are not enough clinical sites with adequate staff to provide training for the nursing students.

·    Student nurses need financial support to attend nursing school.  The Title VIII funding supported only 81 nursing scholarships.

 A business and societal case around the nursing shortage may spur the need for public policy strategies.  A study published January 10, 2006 in the journal Health Affairs provides new evidence that if hospitals invest in appropriate registered nurse (RN) staffing, thousands of lives and millions of dollars could be saved each year. Specifically, the study shows that if hospitals increased RN staffing and hours of nursing care per patient, more than 6,700 patient deaths and four million days of care in hospitals could be avoided each year.  While the business and societal case reported in Health Affairs makes an excellent case to reduce adverse outcomes, we still need more nurses.  Student nurses need funds to attend nursing school. 

Another business case may fuel public policy.  The pharmaceutical industry must conduct clinical trials to bring important drugs into the market place. There is a need for more nurses to be trained to help design and implement clinical trials.  Nurses are an integral part of the research team, recruiting patients, implementing protocols, educating patients, helping to keep them compliant and on their medical regimes, providing follow-up and consultative services.  And, yet, we need more nursing students in the pipeline to become licensed providers who may become interested in conducting clinical trials.

A societal case related to demand for nursing services may spark the public policy debate.  With the demand for more nursing services expected when baby boomers begin to retire in greater numbers in 2020, it is critical that our Nation design strategies to eliminate the nursing shortage.   As the Sample Survey showed, less than 3 percent of nurses are employed in nursing homes or related facilities.  Demand for care will increase as seniors choose to age in their homes, (age in place); move to assisted living facilities; move to senior housing communities. There will be a need for more nurses trained in geriatric nursing to serve the ever growing senior population.

Moreover, the baby boomers who are used to having a certain level of health care services will expect the same level of health care and nursing services as seniors.  With the smaller increase in nurses employed in the hospital setting, there may not be enough nurses to provide nursing services when the seniors need it, this includes surgery.

Hospitals are forced to join the public debate relative to the nursing shortage as much-needed operating rooms close because they lack enough experienced nurses to assist the surgeons.  The closures will exacerbate the hospital’s backlog of surgical cases.  Lack of experienced nurses will force more hospitals to seriously reduce beds in every area of the hospital.

Another societal case for more nurses is that nurses will be called upon to respond to natural, emergency and mass casualty events, (weather related, flu pandemic, homeland security events.)   These are the front-line, first responders in the case of a natural or man-made disaster.  The ability of our Nation to respond to these situations will be impeded by the growing shortage of the nursing workforce.  It is incumbent upon our Nation to make an investment in its public health infrastructure so that we can readily and appropriately respond to mass emergencies. 

The nursing shortage is REAL.

The role of the federal government is to provide additional funding for education and training of registered nurses; funding for training of nurse scientist researchers; provide loans and loan forgiveness programs for secondary education through the Department of Education; and provide funding for workforce programs through the Department of Labor to encourage persons to become nurses.

What is NBNA doing to eliminate the nursing shortage?

The NBNA mission is to provide a forum for collective action by African American nurses to "investigate, define and determine what the health care needs of African Americans are and to implement change to make available to African Americans and other minorities health care commensurate with that of the larger society.”

Visit NBNA at www.nbna.org

                 National Black Nurses Association, Inc.
                 8630 Fenton Street, Suite 330
                 Silver Spring, MD 20910
                 Millicent@nbna.org

2/2/06