recruitment retention and
the nursing shortage and
nurse aide shortage

HRSAs Division of Nursing is charged with providing national leadership to ensure an adequate supply and distribution of qualified nursing professionals. HRSA has generally focused on licensed nursing professionals, rather than nurse aides, but has recently undertaken a study of the supply of and demand for aides.

Along with HRSA, HCFA and the Office of the Assistant Secretary for Planning and Evaluation (ASPE) are also focusing attention on the nurse aide workforce. HCFA plans to address issues that affect nurse aide recruitment and retention in Phase II of the Report to Congress on Appropriateness of Minimum Nurse Staffing Ratios in Nursing Homes, while ASPEs research is designed to identify successful recruitment and retention programs for nurse aides.

To date, most research on initiatives to address the nurse aide shortage has been largely nonevaluative. Providers cite reduced turnover rates as evidence of effectiveness. Some efforts are now under way to determine the effectiveness of various interventions. Two states, Kansas and Michigan, have gathered longitudinal data on the impact of their wage pass-throughs on turnover. Michigans data indicate that since the implementation of the nursing home wage pass-through in 1990, turnover rates have decreased from 75 percent to 68 percent, while in Kansas turnover has declined slightly, from 120 percent to 116 percent, since implementation in 1998, but these measures may not account for other factors that affect the aide workforce.

Some states and providers have also begun to realize the importance of formal evaluations and have implemented evaluation efforts as a component of their initiatives.

Concluding Observations about the nursing shortage and nurse aide shortage

Recruitment and retention of nursing staffboth nurses and nurse aides pose a problem today that will likely worsen as demand for these workers increases in the future. Demographic forces are widening the gap between the numbers of people needing care and the nursing staff available to provide care.

As a result, the nation will face a shortage of different dimensions than those of the past. The private sector and state governments have taken the lead in trying to address recruitment and retention issues for nurse aides. Additional evaluation is needed to determine which initiatives are most effective. More detailed data are also needed to delineate the extent and nature of nurse and nurse aide shortages to assist in planning and targeting corrective efforts.

As the federal government focuses more on the nursing workforce in hospitals, nursing homes, and home health care, support for the evaluation of efforts to increase the supply of nurses and nurse aides may also help identify more effective steps to ameliorate the shortage.

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