As part of our special January issue on the nursing shortage, Nurses' Lounge-DFW scoured volumes of research on the shortage to bring you the most up-to-date information that we could find. We divided the research into national, state, and DFW levels, then applied the newest data to the Dallas-Fort Worth area so you can see exactly what the numbers mean for metroplex hospitals and nurses. To Read the entire Magazine online click here.
The Current National Shortage
According to a report released by the American Hospital Association in 2006, U.S. hospitals needed approximately 118,000 RNs to fill vacant positions nationwide. A 2007 report estimated that the current national vacancy rate is 8.8 percent, and the turnover rate is 9.3 percent.
In 2004, the number of RNs in the U.S. rose 8 percent to a new high of 2.9 million. Of these, only 58 percent are working full time, less than 25 percent are working part-time, and almost 17 percent are not employed in nursing. RNs over 50 are the fastest growing segment of this workforce, while the number of middle-age and younger RNs is declining. When you also consider that a recent survey by Nursing Management indicates that 55 percent of nurses surveyed intended to retire between 2011 and 2020, the shortage will likely worsen as nurses begin to reach retirement ages, accelerating the full time employment attrition rate.
The Texas Shortage
On the state level, Texas' vacancy and turnover rates are estimated to be at higher levels than national rates. In the Texas Hospital Nurse Staffing Survey of 2006, 235 Texas hospitals reported a vacancy rate of 10.2 percent, with 23 percent of the reporting hospitals indicating vacancy rates greater than 20 percent. The report also put the RN turnover rate for Texas hospitals at 18.2 percent.
The U.S. Department of Health and Human Services estimates that Texas currently has 646 employed nurses per 100,000 population, which ranks Texas as 47th out of 50 states in number of nurses employed per 100,000. The state average is 897, running from 590 in California as the lowest to the highest of 2,093 in the District of Columbia.
The Current Dallas-Fort Worth Shortage
Locally, in the eleven counties that make up the Dallas-Fort Worth (DFW) Metroplex, the nursing shortage isn't quite as bad as it is on a state level.
The Dallas-Fort Worth Hospital Council (DFWHC) recently released their 2007 Vacancy & Turnover Survey Report detailing their annual statistics for vacancy rates for nursing positions in the DFW Metroplex. The report indicates that total hospital staff vacancy is at 6.1 percent, with the total vacancy rate for registered nurses at 8.8 percent. This is lower than Texas's state-wide nursing vacancy rate of 10.2 percent.
According to the Texas Department of State Health Services, the DFW area has a population of just under 5.5 million with 37,554 registered nurses. This gives DFW a ratio of 688 RNs per 100,000 population, which is higher than the state's level of 646 per 100,000.
Projected Needs for the U.S.
On a national level, it doesn't look like we'll see improvements to the nursing shortage any time soon. According to the U.S. Department of Health and Human Services, by 2010, the supply of RNs is expected to run over 405,000 nurses short of demand.
To make matters worse, the RN supply will start decreasing in 2010, due to Baby Boomers retiring, and continue until at least 2020, resulting in an estimated shortage of over 1 million nurses.
Projected Needs for Texas
According to the Texas Center for Nursing Workforce Studies' Projecting Baseline RN Supply and Demand, the FTE RN demand in Texas will increase from approximately 143,000 in 2005, to 266,000 in 2020, an 86 percent increase in demand. The total supply of FTE RNs, however, is only expected to increase 53 percent, leaving approximately 71,000 nursing positions in Texas vacant by 2020.
Projected Needs for DFW
The Texas Center for Nursing Workforce Studies predicts that we will see a growth of 70 percent for actual RNs needed in Texas by 2015. If we apply the 70 percent model to DFW, using the Nurses' Lounge estimate of 34,176 total nursing positions in existence, DFW will need an additional 23,923 nurses between now and 2015. If 55 percent of the current workforce retires between 2011 and 20159, 9,524 nurses will retire between 2011 and 2015 (based on an average per year). That brings the total number of additional nurses needed in DFW by 2015 to an estimated 33,447, just from new positions and retirement. This doesn't include natural attrition factors or supply models.
Solutions on a National Level
Of all the projected solutions to the nursing shortage, including higher pay, more incentives and delayed retirement, only an increase in the number of graduates from nursing programs in each state shows any promise of helping provide enough nurses to meet the coming demand. However, in order to meet the projected demand of RNs by 2020, we would need to increase the number of nurses coming from each nursing program by 90 percent from year-to-year.
However, increasing the number of nursing graduates by 90 percent seems an impossible goal, especially since data recently released from the American Association of Colleges of Nursing (AACN) shows that enrollment in entry-level programs has increased by less than 5 percent from 2006 to 2007, and graduation only increased by 7.4 percent. The shortage of nursing faculty is often cited as the number one hindrance to alleviating the nursing shortage. In fact, the AACN estimates that over 38,000 qualified applicants were turned away from nursing schools in 2006 as a direct result of the faculty shortage.
Other recommended solutions include increases in employment incentives, better working conditions, streamlined hiring processes, etc.
Two of the more interesting suggestions for addressing the nursing shortage include encouraging pre-retirement nurses to delay their retirement and changing recruitment tactics to address the needs of Generation Xers and Yers. The Texas Workforce study recommends that hospitals identify the technologies that boost nurse productivity and then provide more time for nurses to learn those new technologies. They also recommend using bigger computer screens to make reading the text easier and identifying ways to reduce the physical demands on nurses.
To address the needs of Generation Xers and Yers, Jennifer J. Westendorf, in her article "The Nursing Shortage Recruitment and Retention of and Future Nurses" in Plastic Surgical Nursing, suggests that "Generation Xers cannot be recruited the same as the Baby Boomer generation...This new generation has a completely different set of motivators in life." To attract a younger workforce, Westendorf suggests using flexible scheduling, vacation packages, on-campus workout centers, and strategies to bridge the communication gap between Baby Boomers and younger generations.
Solutions for Texas
According to the Texas Center for Nursing Workforce Studies, 84 nursing programs in Texas produced 6,674 graduates in 2006. This number needs to increase to 18,000 by 2015. In 2006, the total number of vacant FTE nursing faculty positions increased to an eight-year high of 113.5, causing the second highest vacancy rate (6.0 percent) in Texas schools of nursing since 1997. Had these vacancies been filled, it is estimated that Texas nursing programs could have enrolled an additional 2,724 nursing students.
Had Texas' educational programs been fully staffed, though, the additional 2,724 students still would not provide enough nurses to meet the growing demand. This has moved educational expansion to the forefront of any possible scenario. Faculty takes time to develop, though, so the educational systems are not currently equipped to meet the projected demand over the next few years. In response to this faculty shortage, many local hospitals are partnering with nursing schools to provide additional faculty, specialty training programs, and other educational opportunities.
Solutions for DFW
Most DFW hospitals have been developing programs similar to many of the above recommendations for a few years now. To read more about these programs, please see our "DFW Perspectives on the Nursing Shortage" article elsewhere in this issue.
Where will nurses be in highest demand in Texas between now and 2014?
Home Health Care is expected to have the fastest growing employment rate in Texas at over 69 percent. Compare this to hospitals, whose employment rate is expected to grow by only 20 percent during the same time frame.
Source: Dallas County Workforce Development Area from the Texas Workforce Commission
Over the 2006-16 decade, more than one million job openings are expected for registered nurses seeking first-time employment.
Source: Occupational Outlook Quarterly, Fall 2007, Bureau of Labor Statistics