presented to show that the mortality rates were the same for hospitals in which nurses cared for 8 patients each, on average, and 60 percent had a BSN and for hospitals in which nurses cared for only 4 patients each but only 20 percent had a BSN (Aiken, 2008; Aiken et al., 2003). More research is needed to assess the comparative value of investing in different nursing strategies that evaluate the relative cost and outcomes of increasing nurse staffing, educational levels, and improving the organizational context and culture of the nurse work environment. At this point the evidence is encouraging that a more educated hospital nurse workforce might allow for a smaller nurse workforce without adversely affecting patient outcomes. If confirmed in future research, this finding could have important implications for both cost of hospital care and for the number of nurses actually needed in the future to staff hospitals.
In the ambulatory sector, there is a strong research base documenting that nurses with advanced clinical training, usually master’s degrees in advanced clinical practice, provide primary care with outcomes comparable to, and in some domains like symptom control and satisfaction better than, those of physicians and with lower costs (Griffiths et al., 2010; Horrocks et al., 2002). Rand researchers estimated, for example, that the state of Massachusetts could save up to $8 billion over a decade by attracting more advanced practice nurses and removing barriers that prevent them from practicing at the full level of their education and expertise (Eibner et al., 2009). Increased use of advanced practice nurses is one of the very few practice innovations currently underconsidered in national health reform, including medical homes and chronic care coordination, that would yield net cost savings nationally according to Rand researchers (Hussey et al., 2009).
As argued above, the shortage of BSN nurses has implications for health care quality and safety, access, and costs of care. A less well recognized consequence of the shortage of BSN nurses is a shortage of faculty which could have a long-term impact on national production capacity of nurses for the future.
The Department of Labor estimates that 600,000 new jobs will be created for nurses over the next 10 years, the highest rate of new job production for any profession (Bureau of Labor Statistics, 2009). In addition, over a half million nurses in the current workforce, which has an average age of around 48, will reach retirement age over the same period, resulting in the need for over a million nurses to be added to the national workforce. The good news is that there is tremendous interest in nursing as a career in the United States after a century of difficulty attracting the best and brightest to nursing. The reasons for this unprecedented interest are multifaceted, having to do with attractive incomes, averaging nationally $65,000 a year and higher in some locations, better job prospects than in other employment sectors, and perceptions of personally satisfying work helping others. If we can take advantage of this unprecedented interest and expand nursing school production, future nursing shortages could be greatly attenuated.