Position Statement

Shortage of Nursing Professionals

This Position Statement was developed as an educational tool based on the opinion of the authors. It is not a product of a systematic review. Readers are encouraged to consider the information presented and reach their own conclusions.

There is a growing crisis in the delivery of nursing care in this nation. The supply of nurses is decreasing while the demand is increasing. Approximately 80 to 85% of hospitals have reported a shortage of nurses and nationwide there is a 10-12% vacancy rate for nurses in health care facilities.¹ Studies also indicate that hospitals and other health organizations are experiencing difficulty recruiting nurses. The American Hospital Association surveyed over 700 hospitals across the nation and found that out of 168,000 open positions in hospitals, 126,000 of these openings were for registered nurses.²

There are multiple factors contributing to the growing nursing shortage. These factors include:

1. Existing nurses are leaving the profession due to dissatisfaction with their jobs;
2. The nursing workforce is aging and many of these nurses are reaching retirement age;
3. Fewer younger persons are entering into this profession.

Job dissatisfaction has been identified as a contributing factor for nurses leaving the profession earlier than anticipated. Inadequate staffing, heavy workloads, and mandatory overtime are reasons cited for job dissatisfaction among nurses. As evidence of the aging nursing workforce, the percentage of nurses in the year 2000 under the age of 40 was less than 33 percent, while in 1980, over 50% of nurses were under 40.³ Fewer nurses are entering into the profession to replenish the supply of nurses who are retiring. From 1993-1996 enrollment in nursing diploma programs declined by 42 percent.⁴ Over the past several decades, opportunities in various careers have expanded for women and fewer women graduating from high school are choosing to enter into the nursing profession.

This nursing shortage impacts the quality of patient care and safety. Inadequate staffing and heavy workloads for the remaining nurses may delay needed care for patients, increase patient waiting time for surgeries, and increase medical errors by nurses.⁵ A recent study published in the Journal of the American Medical Association concluded that surgical patients face higher risks of death and injury from infection and other preventable complication if the nurses’ workloads exceed four patients per shift. Patients face a 7 percent greater likelihood of death for every patient above four assigned to a particular nurse.⁶

The American Academy of Orthopaedic Surgeons and the American Association of Orthopaedic Surgeons (AAOS) support the efforts of nursing organizations to obtain federal and state initiatives that would ensure quality patient care and safety by encouraging more individuals to join the nursing profession and by maintaining the supply of existing nurses. These initiatives could include loan forgiveness and scholarship programs for individuals in nursing schools, efforts to educate young people about the nursing profession, expansion of nursing schools and the amount of nursing faculty, and finally, legislation regulating the amount of mandatory overtime for nurses and appropriate staffing ratios for healthcare facilities. States should consider appropriating money from the tobacco settlement to fund these initiatives.

Most importantly, the AAOS encourages orthopaedic surgeons and other physicians, as well as hospitals and other healthcare facilities, to assess the work environment for nurses and take appropriate steps to reduce their job dissatisfaction. Mechanisms to reduce nurses’ job dissatisfaction should include higher pay, flexible work schedules, ability to advance within the profession and increased staffing to help manage the nursing workload.

References:

1. Prepared Witness Testimony of Linda O’Leary, Federation of American Health Systems, Before the Subcommittee on Health of the House Committee on Energy and Commerce, August 1, 2001 (citing report Health Care Staffing Shortage, Fitch IBCA, Duff & Phelps).
2. American Hospital Association Special Workforce Survey, June 5, 2001 (www.hospitalconnect.com/aha/key_issues/workforce/resources/FactSheetB0605.html).
3. United States General Accounting Office, “Nursing Workforce: Emerging Nurse Shortages Due to Multiple Factors”, July 2001, p.7.
4. Ibid at pp.6-7.
5. Some Worry Nursing Shortage Could Put Patients At Risk, January 12, 2001 (www.cnn.com/2001/HEALTH/01/12/nursing.shortage/index.html).
6. Aiken LH et al. Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction. JAMA. 2002;288:1987-1993.

© February 2003 American Academy of Orthopaedic Surgeons

This material may not be modified without the express written permission of the American Academy of Orthopaedic Surgeons®.

Position Statement 1158

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