Nursing and Nursing Education Public Policies and Private Actions (1983) / Chapter Skim
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CHAPTER II MEETING CURRENT AND FUTURE NEEDS FOR NURSES
CHAPTER II MEETING CURRENT AND FUTURE NEEDS FOR NURSES
Pages 51-88
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From page 51... ...
However, it is important that policymakers see the potential magnitude and characteristics of the supply that would be required if one were, instead, to adopt professional criteria of nursing "need." This report, thus, also sets out estimates that have been made and published on the basis of judgments by nursing leaders as to what the demand should be to meet staffing standards they believe to be either minimally necessary or desirable to provide nursing services to patients in different settings of care. In this framework, the chapter presents the committee's observations and conclusions as to the immediate and long-tenm prospects for a sufficient overall national supply of registered nurses (RNs)
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From page 52... ...
Thus, nurse shortages did not develop from a drop or leveling off of the supply, but rather from dramatic growth in the demand for nursing services in hospitals and nursing homes during the decade of the 1970s -- a growth that, until the economic recession in 1982, consistently outstripped the marked growth in supply. Therefore, to address the problem of present and potential future shortages, at both national and state levels, requires that as much attention be paid to the demand side of the equation as to the supply.
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From page 53... ...
The rate of labor force participation of RNs has been increasing substantially over several decades. To the employer or potential employer of RNs, labor force participation must be looked at in terms of the proportion of currently licensed RNs who are employed.
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From page 54... ...
. _ ~ ~ 1' a' 40 AGE FIGURE 5 Registered nurse labor force participation, by age, 1949, 1960, and 1980; all graduates of programs preparing for registered nurse kc ensure.
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From page 55... ...
, the total number probably is close to 700,000. The estimate of the 1980 active supply cited above was made by the DHHS on the basis of data contained in the 1974 Inventory of Licensed Practical Nurses, which showed 406,000 employed LPNs in 1974.
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From page 56... ...
The Demand for Nurses Registered Nurses The 1970s witnessed fundamental changes in the way health care was provided to the United States population. Most important in creating increased demand for nursing services was the population's increasing access to health care during that decade, made possible by liberalization of many aspects of health care financing.
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From page 57... ...
. Implementation and rapid expansion of Medicaid in the 1960s resulted in an explosive growth of nursing homes .
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From page 58... ...
As the table shows, hospitals employed almost 40 percent more RNs at the end of 1980 than TABLE 9 Employed Registered Nurses, by Work Setting, 1977 and 1980 Number Employed b 1977-1980 Change Work Setting 1977 1980 Number Percent Hospital 601,011835,647 234,636 39.0 Nursing home 79,647101,209 21,562 27.1 Public/community health 77,13983,440 6,301 8.2 Physicians/dentists office 69,26371,974 2,711 3.9 Student health service 41,36544,906 3,541 8.6 Nursing education 37,82646,504 8,678 22.9 Occupational health 24,31729,164 4,847 19.9 Private duty 28,56320,240 -8,323 -29.1 Other and unknown 19,10239,768 20,666 108.2 TOTAL 978,2341,272,851 294,617 30.1 aSOURCE: Roth, A., et al. 1977 national sample survey of registered nurses: A report on the nurse population and factors affecting their supply, Table 51, p.
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From page 59... ...
States hit hardest by the 1982 economic recession appeared to have the most reduction in demand for nurses, partly because of a drop in hospital utilization as health insurance benefits ran out for the unemployed. Licensed Practical Nurses The greit majority of practicing LENS also work in hospitals.
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From page 60... ...
General hospitals reported average vacancy rates of 9 percent for RN staff nurses and 6 percent for LPNs, but the corresponding rates in chronic disease hospitals were 30 and 26 percent, respectively.27 There is no comparable survey to provide current vacancy rates for nursing homes. However, in testimony before the Select Committee on Aging of the House of Representatives in 1980, the executive vice president of the National Council of Health Centers cited a recent national survey that reports a national shortage of 53 percent.28 In 1981, the AHA conducted a nursing personnel survey of a 20-percent sample of United States hospitals.
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From page 61... ...
In 1977 there were six states and the District of Columbia in which the supply of RNs and LENS, taken together, provided more than 700 FTE 7004 a 0 500 To o o 400 o ~ 300 z cc ~ 200 LLJ J ~ 100 LL 0 ° 600 ~ south ! _-_ ~ ~ ~1 OTT TV= ~ 1 962 1' ~ ~ 1972 1977 1980 YEAR FIGURE 6 Employed registered nurses per 100,000 population by regions of the United States, 1962, 1972, 1977, and estimated 1980.
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From page 62... ...
62 0 200 400 600 800 1 000 Washington DC New Hampshire Massachusetts Vermont Rhode Island Connecticut Arizona M innesota Pennsylvania Delaware Colorado New York Maine North Dakota Nebraska Washington Illinois Oregon Iowa Florida South Dakota O trio Kansas Hawaii U.S average New Jersey Wisconsin Maryland Missouri North Carolina Michigan Nevada Wyoming Alaska Virginia I nd ia no West Virginia California Ida ho Georgia Montana New Mexico Tennessee South Carolina Kentucky Utah Texas Ok lahoma Alabama Louisiana M ississippi Arkansas 0 200 400 600 RNs r I LPNs l 800 1 000 FIGURE 7 Employed registered nurses and licensed practical nurses (FTE) per 100, 000 population, by state, 1977.
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From page 63... ...
The Third Report to Congress submitted by the Secretary of Health and Human Services on February 17, 1982, presented the latest departmental supply and demand projections.31 They were made to the year 2000, based principally on data from the 1977 National Sample Survey of Registered Nurses. Congress asked the Institute of Medicine to consider the future supply of nurses and the future need for nurses under the present health care delivery system, as well as under some alternative possibilities.
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From page 64... ...
assumes that the labor force participation of RNs will continue the rise of recent years, although at a somewhat slower rate. It assumes also that financial resources for nursing education will not diminish appreciably and that new entrants to nursing schools will continue to come from a wide age distribution.
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From page 65... ...
· The low projection assumes that the rate of labor force participation will not rise above the 1980 level and that the number of graduates will drop to 10 percent below that of the intermediate level, so that the number of graduates will slide to 63,000 in 1990. Such effects might result from continued economic recession reflected in reduced ability to pay for nurse education.
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From page 66... ...
A recent DENS report on the phenomenon of recurrent shortages of KNs describes the lag between changes in compensation rates and the rates of entrants to nursing and postulates that changes in nurse graduations cause cycles of boom and bust.33 The relatively short length of nurse education programs, however, allows a more rapid response to increased or decreased demands in local labor markets than is possible in most of the other health professions.
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From page 67... ...
No distinction is made in this model as to the type of RN educational preparation. Its projections extend to the year 2000.
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From page 68... ...
The projections of the two models for numbers of nurses employed in hospitals are comparatively close, as are those for physicians' offices; the judgment-of-need reduced projections for nursing education appear primarily to be caused by technical peculiarities of the two projection processes. The judgment-of-need model, unlike the historical trend-based demand model, also projected the number of RNs needed according to levels of educational preparation.
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From page 69... ...
Third report to the Congress, February 17, 1982: Nurse Training Act of 1975, 1982, pp. 174 and 176 (see Reference 10 for complete citation)
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From page 70... ...
We assume that restructuring of many types of positions in a variety of settings will occur, but we believe that in view of the evolutionary nature of this process and the lack of national consensus on staffing mix (by educational preparation) , the potential restructuring phenomenon does not lend itself to national projection at this time.
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From page 71... ...
depicts the possible effect on demand for RNs if stringent cost containment policies at federal and state levels were to become progressively effective over the balance of the decade. The assumptions are that governmental budget imbalances and continuing increases in hospital costs, as well as the continuation of an appreciable rate of inflation in overall health care costs, will cause Medicare and Medicaid (federal and state)
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From page 72... ...
The slope of the resulting trend lines is portrayed in Figure 9. It is assumed that in 1990, as in 1980, nurses working part FIGURE 9 Demand for registered nurses (FTE)
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From page 73... ...
(17,200) 104,400 77,900 ll3,000 113,000 Nursing home100,000100,000 100,000 Community health123,000123,000 123,000 Home care30,00030,000 62,000 Physicians' office64,00064,000 22, coca HMO-type organizations10,00010,000 32,000 Nursing education57,00052,000 50,000 Private duty and other63,00063,000 63,000 TOTAL1,472,0001,348,000 1,298,000 NOTE: Detail may not add to totals because of rounding.
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From page 74... ...
At the same time, the supply also can be expected to increase, assuming continued financial support for nurse education to assure the reasonably steady rates of graduation described earlier and depending on a continuing high rate of labor force participation. The three supply projections for RNs made by the committee for the end of 1990 all fall within the wider range of estimates for 1990 demand (Table 15 and Figure 10~.
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From page 75... ...
Some of the forces that could operate to influence the extent, nature, and distribution of the future RN and LPN supply, either positively or negatively, are discussed in detail in succeeding chapters of this report. ~ Given the likelihood of change, nurse education planning, like any other education planning, should rely on a continuing monitoring of the needs of the population as well as conditions in the profession and in health services so as to guide appropriate allocation of nurse education resources.
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From page 76... ...
RE COMMENDATION 1 No specific federal support is needed to increase the overall supply of registered nurses, because estimates indicate that the aggregate supply and demand for generalist nurses will be in reasonable balance during this decade. However, federal, state, and private actions are recommended throughout this report to alleviate particular kinds of shortages and maldistributions of nurse supply.
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From page 77... ...
TABLE 16 The Supply of Employed Registered Nurses, 1980 and Projected to 1990, by Highest Educational Preparation (Study's Intermediate Projection) Highest Educational 1980 1990 Intermediate Projectionb ~.
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From page 78... ...
. 1920 1925 1930 1935 1940 1945 1950 YEAR BORN 70 65 60 55 50 45 40 AGE IN 1990 195519601965 1970 353025 FIGURE 11 Supply of active registered nurses, 1990, by age and educational preparation (study's intermediate projection)
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From page 79... ...
Conversely, our study foresees that by 1990 the educational system will have produced a much lower supply of RNs with baccalaureate and advanced degrees than the WICHE process projected through its panel's judgment of need (Table 17~. TABLE 17 Percent Distribution of Active Registered Nurses in 1990, by Highest Educational Preparation, Study's Intermediate Projection, Compared With DHHS WICHE Lower Bound Projection of Need Highest Educational Preparation Study's Judgment-of-Need Intermediate a Projectiont Supply Projection (Lower Bound)
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From page 80... ...
Hospitals and other potential employers like to have nurse education programs available in their localities to assure new recruits to their nursing staffs because, as will be described further in Chapter VI, the majority of newly licensed RNs, especially those with associate degrees and diplomas, as well as LPNs, begin their careers in the communities in which they were educated.43 Legislators may be attuned to special problems of nurse shortages in their particular districts. Nurse educators and nursing service directors may hold strong but not necessarily similar views on the types of nurse education preparation that should receive priority.
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From page 81... ...
parallels that of the national panel, described earlier. State panels, including nurses in leadership positions in nursing education and nursing service and other health profesionals, adopted assumptions about potential and desirable changes in health care conditions and practices, and about appropriate mixes of staff and levels of educational preparation required to handle anticipated responsibilities in different settings of care.
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From page 83... ...
Those who allocate resources to initiate or maintain support for different types of nursing education programs at the state level frequently do not have sufficient reliable information at hand on the probable future market demand for their graduates and on the relative ability of those graduates to satisfy the needs of various types of employers. Information on hospital and nursing home vacancies provides little guidance, because when the qualifications for desired applicants for generalist nurse positions are specified, they usually are expressed in terms of required clinical nursing experience rather
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From page 84... ...
Future planning efforts for health services in general, and nursing resources in particular, should be closely coordinated. Conclusion Although fully cognizant that substantial changes in political, economic, and professional activities at the state level rarely are the direct result of the development of master plans, the committee nevertheless believes continued efforts are needed in the states to coordinate the planning and resource allocation decisions for nursing education and the development of nursing personnel.
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From page 85... ...
Projections of needed future supply appear to be hampered by the absence of continuing processes to consider systematically the potential future estimated market demand for registered nurses and licensed practical nurses by hospitals and other employers. The committee concluded that a relatively small outlay of federal technical assistance dollars employed to develop demand forecasting techniques better suited to state uses would yield benefits in strengthened state planning efforts.
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From page 86... ...
The registered nurse population, an overview. From national sample survey of registered nurses, November, 1980 (Report 82-5, revised June 1982~.
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From page 87... ...
NLN nursing data book 1982. In press, 1982.
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From page 88... ...
The registered nurse supply and nurse shortage. Background paper of the Institute of Medicine Study of Nursing and Nursing Education.
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