some causes of nurse
shortages and nurses aides

In summary, recruitment and retention of both nurses and nurse aides are major concerns for health care providers. Experts and providers are reporting a current shortage of nurses, partly as a result of patients increasingly complex care needs. While comprehensive data are lacking on the nature and extent of the shortage, it is expected to become more serious in the future as the aging of the population substantially increases the demand for nurses.

Moreover, several factors are combining to constrain the current and future supply of nurses. Like the general population, the nurse workforce is aging, and the average age of a registered nurse (RN) increased from 37 years in 1983 to 42 in 1998.

Enrollments in nursing programs have declined over the past 5 years, shrinking the pool of new workers to replace those who are retiring. In addition, numerous studies report decreased levels of job satisfaction among nurses, potentially leading to their pursuing other occupations.

Demographic changes over the coming decades may also worsen the shortage of nurse aides in hospitals, nursing homes, and home health care settings. With the aging of the population, demand for nurse aides is expected to grow dramatically, while the supply of workers who have traditionally filled these jobs will remain virtually unchanged. According to the Institute of Medicine (IOM), advocacy groups, and provider associations, a serious shortage of nurse aides already exists.

Retention of nurse aides is a significant problem for many providers, with some studies reporting annual turnover rates for aides working in nursing homes approaching 100 percent. Several factors contribute to providers difficulty in both hiring and retaining nurse aides, including relatively low wages and few benefits. In addition, research has found that the physical demands of the work and other aspects of the workplace environment lead to difficulties in retaining nurse aides.

In 1999, 30 states indicated that they were addressing nurse aide recruitment and retention through task forces, initiatives, and research. The federal government and provider groups also have begun to address this issue. However, few studies have evaluated the effectiveness of these efforts.

Background

RNs and licensed practical nurses (LPN) are responsible for a large portion of the health care provided in this country. RNs make up the largest group of health care providers, and, historically, have worked predominantly in hospitals; a smaller number of RNs work in other settings such as ambulatory care, home health care, and nursing homes.

Their responsibilities may include providing direct patient care in a hospital or a home health care setting, managing and directing complex nursing care in an intensive care unit, or supervising the

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