200k to 450k Nursing shortage in America by 2025 – What we need to do
The nursing shortage that has been building up for decades is rippling across the country. The negative impacts on the healthcare system are immense. Research suggests that the nurse shortage has reached a crisis point and is likely to worsen (Keith, Warshwsky & Talbert, 2021). Nursing is the most significant workforce in the healthcare system, with patients spending more time with their nurses than other healthcare professionals. Yet, at the start of 2023, more than one in every six health organizations in America report a critical nursing shortage, with the majority rationing care and shutting down units.
According to Bailey (2022), the nurse staff shortage is expected to reach 400k to 450k by 2025 if the stakeholders fail to take action. The severity of the shortage hinges on several factors, including increased numbers of patients due to the aging population, increased turnover rate due to the retiring baby boomers, and new nurses departing the field due to higher stress and burnout attributable to increased workload (Keith et al., 2021). Additionally, there are inadequate nursing school positions and a lack of finances to fund schooling. Nurse education is among the most expensive, and as a result, the majority are failing to advance their education.
Similarly, employment rates have declined significantly since the outbreak of the pandemic. A report published by the Bureau of Labour Statistics indicated that the hospital’s recruitment rate is down by 95600 staff. Furthermore, the nursing programs countrywide continue to suffer due to the limited number of applications they accept because of the lack of education staff (Bakker et al., 2019). Nurse burnout and lack of necessary support are causing health providers to quit the profession moving to other healthcare roles. The American Nurses Association (2022) projected that more registered nurse jobs are needed compared to other occupations in the US. However, few nurses are joining the nursing profession, and the turnover rate is at an all-time high, which creates a considerable gap between workforce supply and the number of vacancies that need feeling.
While adapting to the long-term impact of the covid-19 outbreak, the constant and increased workplace stress, pressure, and fatigue experienced by the RNs and the effects on their mental health and wellness cannot be ignored. Registered nurses were already mentally and physically strained even before the pandemic outbreak, which is likely to continue for years. The consequence may cause thousands of nurse professionals to leave their careers, further exacerbating the current situation. Clients will lose access to essential health providers, and the healthcare system will struggle to keep up with the cost of maintaining seasoned and focused providers at the bedside. Scholars concur that without decisive actions, there will be a mass exodus, thus threatening the quality of the care delivery hence putting clients’ lives at risk in addition to further destabilizing the American healthcare system that is collapsing (Keith et al., 2021).
Strategies to resolve the nurse shortage crisis
Promotion of nursing as a professional choice among the high school learners
Nurse recruitment strategy should start from high schools. With other disciplines, particularly in technology, attracting many students, awareness about nursing careers should be created among high schoolers. The Bureau of Labour and Statistics (BLS) projects an increase of 12 percent for registered nurses (RNs) and 11 percent for licensed practical nurses and licensed vocational nurses (LPNs/LVNs) by 2028, which makes nursing careers viable and suitable. Thus, introducing the nursing profession and programs to high school learning augments their awareness about nursing as a career alternative. Though not all high school students aware of nursing careers will become nurses, the strategy is likely to increase the number of new nurses joining the field among other healthcare training fields. Furthermore, introducing programs in high school that will translate to credits in colleges will be critical in incentivizing learners to join nursing as a profession. Institutions adopting such an option may consider assessing the outcome of the high school program to aid in understanding the program’s effectiveness and evaluate the need for changes.
Provide and promote alternative financing solutions
The cost of education and training in nursing differ widely, which depends on factors like the duration of the academic program, location, and the level, among others. The program’s cost for RNs students in community college averages $864 to $1019 for in-state learners and $2,627 to $3,168 for out-of-state students (RNprograms, n.d). On the other hand, university tuition costs are higher than community colleges. There are also license fees and application fees to regulatory agencies, which differ by state, and registration fees for the National Council Licensure Examination (NCLEX), which cost approximately $200. These additional financial needs may hinder those considering a career in nursing. Increasing awareness among learners concerning nonstudent loan financial alternatives like tuition reimbursements, institutional help, and funding available based on Title VIII of the Public Health Service Act is crucial positively impacting the access and affordability of a nursing career.
Additionally, the increased rate of overall unemployment provides an opportunity for persons to reskill into new careers, which underlines the need for nationally funded, higher quality, short-term training courses in the nursing career. LPNs/LVNs offer a career pathway in filling the nursing shortage gap coupled with training courses to help educate those looking for jobs quickly. This provides an opportunity to support the healthcare sector and meet nursing demands. The strategy will help ease the strains on current overworked health providers.
Provide professional support and opportunities
The reasons for dropout differ with nursing programs and learners. Research suggests that “ending up in a downward spiral of physical, psychological and social problems” and “experiencing an increasing mismatch between expectations and reality” as the major reasons for the nursing student attrition among the individuals that dropped out of nursing programs towards the end of their training (Bakker et al., 2019). Though the reasons for early dropout include academic challenges, this is not the case when it comes to dropping out late. Additionally, adverse experience during clinical attachments was further reported as contributing factor in dropping out either early or late (Bakker et al., 2019). Offering state-wide and countrywide networking opportunities for learners to engage with mentors and accessibility to resources could aid nursing trainees’ support while navigating academic and attachment difficulties.
Additionally, integrating evidence-based academic support into all nursing training institutions could allow learners to access resources from their home institutions. Furthermore, performing in-depth and realistic job previews before the commencement of nursing school could aid learners in evaluating whether a profession in nursing suits them, which could help them to prepare mentally and strategies accordingly. The necessity for networking, support, and resources should not cease with graduation and employment. Instead, new nurses should be empowered and supported through their professional practice environment (Heidari, Seifi & Gharebag, 2017). Furthermore, nursing educators should consider teaching approaches that increase the number of learners accommodated.
Strengthen nursing educational materials, faculty, and clinical placement
A report by the American Association of Colleges of Nursing (AACN) published in 2019 indicated that they declined 75029 applications from baccalaureate and graduate nursing programs because of inadequate resources like faculties and clinical sites. Major factors that contribute to the nurse faculty shortage include an increased rate of retirement in addition to the few nurses deciding to join nursing education to replace those retiring. There is an increased demand to fill the faculty positions opening in nursing institutions by attracting more nurses in the nursing education profession (Harris, 2019). This would, in turn, increase the qualified staff accepted into the nursing program. Furthermore, nursing educators should consider teaching approach that aids in increasing the number of learners accommodated.
The nurse school is not the only hindrance to entry into the career. In a survey of nursing institutions conducted by AACN (2018), participants reported a lack of clinical placement as the major hindrance to the expansion of the program’s capacity. The inadequate number of hospital and clinical placements means limited opportunities for new nurses to get practical experience. To resolve this issue, nursing education institutions and local health institutions should create programs that provide healthcare placement to nursing students. This ensures a constant supply of nursing workforce from the nursing schools and the health sector. Policymakers should incentivize industry stakeholders to participate in such programs to offset the potential risks and resources investment they may be required to make from recruiting relatively inexperienced nurses. In addition to developing a workforce supply channel, the training program ought to consider utilizing simulations to supplement nursing learners’ onsite experiences.
Maximization of licensure reciprocity
The licensure requirements across the states differ, hindering licensed individuals from practicing in regions in which they are not permitted. Nurses experience barriers that limit their ability to work in states where they are not licensed. Remarkably, this impact military spouses, with military families likely to relocate after every two to three years and, in most case, to different states. Increased reciprocity policies in which occupational license from one state is recognizable in other states would positively contribute to alleviating barriers while encouraging mobility across states. Participating in compacts enables reciprocity across the member states. The enhanced nursing licensure compact (eNLC) established in 2013 allowed registered nurses and licensed practicing nurses to possess a multistate license. This enables health professionals to practice in person or through telehealth in their home state, among other eNLC participating states. Licensing standards are streamlined in member states, which enables the nurses to apply for a multistate license. Presently, 34 states have passed the eNLC legislation.
Furthermore, the eNLC allows nurses to respond quickly to the demand for nursing services in different states during emergencies and regular times. Moreover, nurse educators possessing multistate licenses are permitted to teach in other states online in eNLC member states. However, this initiative’s success depends on support, including labor unions, which entails passing legislation. Furthermore, the task force and working group play an essential role in establishing the legitimacy of the eNLC. States facing challenges in enacting eNLC policy ought to consider changing their legislation at the licensing boards, thus allowing reciprocity of the licenses from other states.
Leverage high-quality evaluation as an option for some licensing requirement
States should streamline the licensing demands in addition to eNLC. This might contribute to certified individuals providing healthcare services into the workforce fast. Particularly, this is beneficial to nursing practitioners that have trained internationally. When nurse expatriates come to the US, they are required to follow expensive and lengthy procedures. Approximately 263,000 migrants with health-related certifications work in positions requiring lesser degrees than they possess, particularly in the healthcare sector. Since most occupations in healthcare settings necessitate professional licenses, relatively few immigrant healthcare professionals meet the requirement unless they get a US degree and complete the necessary postgraduate first. With the continued shortage of nursing practitioners, it is paramount to reduce the hindrances to joining the nursing workforce while making it easier for qualified personnel to provide nursing services. Skill-based evaluation could be leveraged, which provides an opportunity for professionals to demonstrate the necessary skillset. The assessment could serve as a proxy for education and experience demands that complement the person’s NCLEX performance. For instance, clinical skills could be evaluated via simulations. Furthermore, such evaluations can be coupled with a more lenient demonstration of degree and equivalency requirements.
Improve nursing retention rates while reducing turnover rates
Nurse managers should focus on retaining nurses. Several factors contributed to increased turnover rates, which include burnout, job stress, lack of social support, job dissatisfaction, low staff-to-patient ratios, and low pay (Heidari et al., 2017). Thus, retention can be improved through better working conditions and the creation of a supportive working environment. Furthermore, better salaries and on-time payments reduced workload, allowing providers to choose working times and shifts. Research suggests that intention to stay is positively correlated with increased job satisfaction and relationships with older providers and residents (Heidari et al., 2017).
Improving diversity in nursing students
Diversity is more than just race and gender. It comprises disability, sexual orientation, ethnicity, and religion, in addition to the difference in background, experiences, level of education, and ideologies. Diversity in nursing provides an opportunity for the providers to cultivate an awareness and comprehension of different beliefs and attitudes shared by various populations. Nurses care for patients with different backgrounds (Hughes et al., 2020). However, establishing positive communication and trust necessary for appropriate healthcare service for a diverse client population poses critical challenges. Therefore, nurses may better handle such situations if they share their patient’s background, providing the staff an opportunity to get insight into the client’s treatment preferences and decision-making process.
 Additionally, awareness of the existing beliefs and values helps the nurse respond effectively, thus ensuring quality care delivery. Therefore, improving diversity among students is essential in preparing nurse students for the professional world of nursing. According to the American Association of Colleges, diversity in nursing helps in patient education and adherence to treatment procedures, increases patient satisfaction, enhances effective communication, and improves health outcomes. Furthermore, diversity positively impacts the innovative work environment in addition to improvement in interactions with the patients. This supports the development of the culturally competent care practice and aids providers in sharing information, thus providing an opportunity to adjust critical approaches to care.
In conclusion, the nursing shortage in America is a severe health issue that negatively impacts nurses and patients. The crisis will likely worsen if policymakers and other stakeholders fail to take necessary precautions. With fewer new nurses joining the nursing workforce, more awareness is needed to encourage more people to join the field. This can be achieved by introducing nursing programs in high school, where students can be educated about career in nursing. Furthermore, the program’s credit could be transferred into colleges. This is likely to encourage more students to join nursing professional, thus addressing the issue of nurse workforce supply. Additionally, it is important to reduce the nurse turnover rate, which is current very high. This is achieved by ensuring nurse retention through incentives like opportunities to advance careers. Furthermore, the stakeholders can ensure retention by reducing workplace stress, improved salaries and professional support. Other measures include financial support, a conducive and supportive working environment, improved salaries, improved diversity in both practice and education, financial aid, reciprocity of the licenses, and career support. Particularly, licensure reciprocity is crucial in ensuring that nurses can practice across states. With the advancement of telehealth, nurses from one states can monitor patients from other states, thus reducing workload. Therefore, policies supporting the strategy should be enacted. These strategies are critical in ensuring adequate nursing workforce supply while reducing the nurse turnover rate.

References
Bakker, E. J., Verhaegh, K. J., Kox, J. H., van der Beek, A. J., Boot, C. R., Roelofs, P. D., & Francke, A. L. (2019). Late dropout from nursing education: An interview study of nursing students’ experiences and reasons. Nurse Education in Practice, 39, 17-25
Bailey, V. (2022). 200k to 450K nursing shortage expected by 2025 without action. Available at https://revcycleintelligence.com/news/200k-to-450k-nursing-shortage-expected-by-2025-without-action
Heidari, M., Seifi, B., & Gharebagh, Z. (2017). Nursing staff retention: Effective factors. Annals of Tropical Medicine and Public Health, 10(6).
RNprograms (n.d.). Tuition & Fees. Available at https://www.rnprograms.org/tuition-and-fees.htm
Keith, A. C., Warshawsky, N., & Talbert, S. (2021). Factors influencing millennial generation nurses’ intention to stay: an integrated literature review. JONA: The Journal of Nursing Administration, 51(4), 220-226.
Harris, J. (2019). Challenges of nursing faculty retention. The Midwest Quarterly, 60(3), 251-270.
Hughes, V., Delva, S., Nkimbeng, M., Spaulding, E., Turkson-Ocran, R. A., Cudjoe, J., ... & Han, H. R. (2020). Not missing the opportunity: Strategies to promote cultural humility among future nursing faculty. Journal of Professional Nursing, 36(1), 28-33.
AACN (2019). Fact Sheet: Nursing Faculty Shortage. Available at https://www.aacnnursing.org/Portals/42/News/Factsheets/Faculty-Shortage-Factsheet.pdf

The lack of nurses in the United States is a real crisis that hurts the healthcare industry and the people it serves. The Bureau of Labor Statistics says that the need for registered nurses (RNs) will grow by 12% between 2023 and 2029 and that by 2025, there will be a shortage of nearly 200,000 RNs. Other study suggested that there will be 200k to 450k Nursing shortage in America by 2025.

But here are the 20 reasons why the nursing shortage in America is a true crisis and may affect (already been affecting) the entire Healthcare Industry especially the delivery of Health Care and the outcome for patients.
1.      Aging population
The population of the United States is aging, and the number of people over 65 is expected to double by 2060. This means greater demand for healthcare services, including nursing care.
The aging population may also contribute to the nurse shortage by decreasing the number of younger people entering nursing. This could be because younger people choose to work in other fields or because they think nursing isn't as appealing as it used to be.

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2.                  Retirement of experienced nurses
According to the American Association of Colleges of Nursing, 50% of nurses are over 50 and will retire within the next decade. This means many nurses will retire when health care needs increase because the population is getting older. One study estimates that the nursing shortage in the United States will reach up to 1.2 million by 2030. Part of the reason for this shortage is that older nurses with a lot of knowledge and skills are leaving the field to retire. When these nurses retire, it leaves a gap in the workforce that is difficult to fill, especially since there need to be more new nurses being trained to replace them.
 
3.                  Decrease in nursing school enrollment: According to the American Association of Colleges of Nursing, nursing school enrollment has declined since 2002. In 2002, there were 130,932 applicants to nursing programs, but by 2018, that number had dropped to 63,504. This decrease in nursing school enrollment has contributed significantly to the nurse shortage in America. The nurse shortage in America is a serious problem, with the Bureau of Labor Statistics predicting a shortage of over 1 million nurses by 2024. This shortage can have serious consequences, including increased patient morbidity and mortality, healthcare costs, and decreased patient satisfaction. 

4.                  High workload
According to a report by the American Nurses Association, nurses in the United States work an average of 13-hour shifts and have a workload that is often much higher than their counterparts in other countries. One of the main reasons for this high workload is the increasing demand for healthcare services in the United States. With an aging population and a rise in chronic conditions such as high blood pressure and diabetes, there is a greater need for nursing care. However, the number of nurses available to meet this demand has not kept pace with the growing demand, leading to a shortage of nurses and an increase in workload for those still working.
5.                  Lack of support
One of the main causes of the nurse shortage in America is a need for more government and employer support. According to the American Nurses Association, more than 3 million registered nurses are currently in the United States. Still, more than this is needed to meet the increasing demand for healthcare services. There is a need for support for nurses in terms of career advancement opportunities. Many nurses struggle to find leadership positions or opportunities for further education, leading to feelings of stagnation and a lack of job satisfaction.
6.                  Career and Family
According to a 2020 survey by the American Nurses Association, over 50% of nurses cited work-life balance as a major concern in their careers. This is because many nurses struggle to find the time and energy to balance their demanding work schedules with the demands of their personal lives, including raising children and caring for aging family members. One of the main reasons for this struggle is the need for adequate staffing and resources in the healthcare industry, which often results in nurses needing to be more relaxed and calmer. This leads to high burnout and job dissatisfaction, which can ultimately drive nurses to leave the profession or reduce their hours.
7.                  The negative perception of the nursing profession
The nursing profession is often portrayed negatively in the media, depicting nurses as overworked and underpaid. This negative portrayal can deter potential nurses from entering the profession, leading to a shortage of qualified candidates.
8.                  Lack of nurse faculty
As of 2019, there were approximately 3 million registered nurses in the United States, but there were only about 100,000 nursing faculty members. This means that for every 30 nurses, there is only one faculty member available to educate and train the next generation of nurses. One of the main reasons is the high demand for nurses, which leads to an increase in nursing school enrollment. 
9.                  Lack of clinical experience
According to data from the American Nurses Association, more than 4 million registered nurses are currently in the United States. Still, only a fraction of them has the clinical experience to provide quality care to patients. This lack of experience is due to the high turnover rate among nurses causing a constant influx of new nurses who may need to gain the necessary skills and knowledge to provide the best care to patients.
10.              Location Factor
According to data from the Health Resources and Services Administration (HRSA), there are shortages of nurses in rural areas, particularly in primary care and mental health. In 2021, HRSA designated 3,069 rural counties as Health Professional Shortage Areas (HPSAs) for primary care, with a shortage of primary care providers including nurses. Similarly, 1,941 rural counties were designated as Mental Health Professional Shortage Areas (MHPSAs), indicating a shortage of mental health providers including nurses.
11.              High Education Cost
According to a report published by the American Association of Colleges of Nursing, the average cost of tuition for a Bachelor of Science in Nursing (BSN) program at a public institution was $30,094 in the 2020-2021 academic year. For a private institution, the average cost was even higher at $41,084. These costs can be a significant financial burden for aspiring nurses, especially since many nursing students cannot work full-time while in school due to the program's demands. 
12.              Poor Working Conditions
According to the American Nurses Association, over 50% of nurses cited issues such as heavy workload, insufficient staffing levels, and inadequate breaks as major factors contributing to their decision to leave the profession or limit their hours. Additionally, the survey found that nurses working in understaffed environments reported higher burnout and job dissatisfaction levels.

13.              Limited Benefits
One of the main benefits that nurses often cite as lacking is adequate pay. The average hourly wage for a registered nurse was $43, slightly above the national average for all occupations ($32.10). This pay discrepancy is further exacerbated by the fact that nurses often work long and irregular hours, including nights, weekends, and holidays.
14.              Lack of recognition
A survey by the American Nurses Association in 2020 found that almost half of nurses felt their work was undervalued and not recognized. Additionally, a survey conducted by National Nurses United found that 82% of nurses felt that the public needs to fully understand and appreciate the crucial role that nurses play in the healthcare system.
15.              Shortage of nursing homes
One major contributing factor to the nurse shortage in America is the shortage of nursing homes. According to data from the American Association of Homes and Services for the Aging, more than 1.4 million Americans live in nursing homes. This number is expected to continue growing as the population ages. However, there need to be more nursing homes to accommodate this growing demand.

​18.              Competition from other industries
According to the Bureau of Labor Statistics, the median annual wage for nurses is $77,600, which is lower than the median annual wage for many other occupations, such as software developers ($105,590) and petroleum engineers ($137,170). This can lead to nurses seeking higher-paying jobs in other industries, contributing to the shortage of nurses in healthcare.

19.              Political and economic instability
One aspect of political instability contributing to the nursing shortage is the lack of investment in healthcare infrastructure. In times of economic uncertainty, it is common for governments to cut funding for healthcare programs and facilities. This reduces the number of nursing programs, as well as the number of available nursing positions.
 
20.              Military deployment
According to the Department of Defense data, approximately 11,000 military nurses serve on active duty. These nurses often serve as primary care providers, patient advocates, and educators. In addition to serving in the military, many nurses also work as civilian nurses when not deployed. The deployment of military nurses can significantly impact the civilian nurse workforce, leaving hospitals and other healthcare facilities understaffed.