Two years into the COVID-19 pandemic, the supply of registered nurses in the U.S. appears to be reaching a dangerous level of shortage, a team of healthcare policy researchers has found. Writing in the online “Forefront” section (formerly the Health Affairs Blog) of Health Affairs, David I. Auerbach, Peter I. Buerhaus, Ph.D., Karen Donelan, Sc.D., and Douglas Staiger, Ph.D. state clearly in their article published on April 13, “A Worrisome Drop In the Number of Young Nurses,” that the U.S. healthcare system is rapidly moving into a crisis situation with regard to the recruitment and retention of registered nurses.
“The US has enjoyed steady growth in the registered nurse (RN) workforce since the 1970s, providing the backbone of the nation’s growing and evolving health care delivery systems,” they write. “When this growth was threatened in the late 1990s as new entry into the profession stagnated, Millennials embraced registered nursing and reversed the trend in the early 2000s.” In that regard, the healthcare system experienced “steady growth in the RN workforce growing from a little more than 1.0 million RNs in 1982 to 3.2 million in 2020. On a per capita basis, that growth represents roughly a doubling, from 52 full-time RNs per 10,000 US residents in 1982 to 100 RNs per 10,000 residents in 2020. Put another way, RNs represented 1 percent of the US population in 2020. Today, the number of per capita RNs in the US is either on par with or higher than most other Organization for Economic Cooperation and Development countries, in contrast with the number of physicians, which is among the lowest of these nations.”
Instead, “Now, two years into the COVID-19 pandemic, the supply of RNs is under threat again. Using monthly data from the Current Population Survey, our recently published analyses in Health Affairs showed that growth in the RN workforce plateaued during the first 15 months of the pandemic. Although it is difficult to disentangle the contributing factors, these likely include early retirements, pandemic burnout and frustration, interrupted work patterns from family needs such as childcare and elder care, COVID-19 infection and related staffing shortages, and other disruptions throughout health care delivery organizations. Extending that analysis through the end of 2021 furthers our concern. New data here, covering the entirety of 2021, show the total supply of RNs decreased by more than 100,000 in one year—a far greater drop than ever observed over the past four decades.”
The article’s authors note the perhaps-surprising finding that the largest reduction in nurse numbers by percentage in 2021 was actually among RNs under 35, at 4.0 percent, compared to a 0.5-percent reduction among those 35-49, and a 1.0-percent reduction among those over 50. What’s more, they write, “[T]hese reductions are even more striking compared to what we had expected in 2021 for total nursing supply absent the pandemic. For example, our model projected total workforce supply growth of 4.4 percent from 2019 to 2021 rather than the observed reduction of 1.8 percent, a difference of nearly 200,000 (-6.2 percent) RNs from expectations. This differential was even larger, in percentage terms, among RNs younger than age 35 (-8.8 percent, or 80,000 fewer RNs than expected).
All this portends an ominous trend, they write: “A sustained reduction in the number of younger age RNs would raise ominous implications for the future workforce. Because RNs typically remain working in nursing over their career, a reduction of younger RNs in the workforce would exert an impact that is felt over a generation, in contrast to a relatively modest reduction in long-run RN supply due to early retirement of the baby boomer RNs working into their 60s and 70s.” Indeed, they note, applications to four-year bachelor of nursing programs, which had been growing in recent years, grew up 1.3 percent in 2020. “A further slowdown or outright reduction in applicants in 2021 would be further cause for significant concern,” they add.
David I. Auerbach is an external adjunct faculty member at the Center for Interdisciplinary Health Workforce Studies at Montana State University College of Nursing; Peter I. Buerhaus, Ph.D., is director of the Center for Interdisciplinary Health Workforce Studies and professor of nursing at Montana State University; Karen Donelan, Sc.D., is the Stuart H. Altman Professor and chair in US health policy at Brandeis University; and Douglas Staiger, Ph.D., is the John French Professor in Economics in the Department of Economics at Dartmouth College, and a research associate at the National Bureau of Economic Research, in Cambridge, Massachusetts.