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Posted April 1, 2004

Issue: The aging health care workforce
As the general population ages, so does the health care workforce. For example, between 1980 and 2000, the percentage of RNs under age 30 declined from 25 percent to 9 percent. As these older workers retire at a growing rate, the number of nurses leaving the profession is projected to exceed new entrants by 2016.

The demographics of nursing and other health professions are reflective of our society. However, there are additional factors to consider when looking at the health care workforce. For instance, individuals seeking two-year, four-year or advanced nursing degrees, rather than diploma programs, are delayed in entering the workforce.

A similar trend is underway in pharmacy, with more new entrants emerging from training with advanced Pharm. D. degrees in place of the traditional pharmacy bachelor's degrees. These longer training periods reflect the increased expertise required of health care professionals to meet the more-complex needs of older patients, and the growing number patients who, with assistance from advanced medical technology and practice, now survive injuries and illnesses that were once fatal.

Another contributing factor to the aging health care workforce is the increase in workers from other fields entering health care training programs. Training programs actively recruit mid-life candidates looking for a career change in part because the number of new college graduates is relatively flat, and will remain so.

A push to increase enrollment and capacity in associate degree nurse training program appears to be increasing the number of nurses entering from two-year training programs, though it may be too soon to tell how strong the trend will be. However, given the limited pool of qualified younger candidates and the inexorable advance of medical technology, the trends toward recruiting mature training candidates and longer training time are likely to continue. As a result, more workers will have to be trained to achieve the same number of useful work years in professional practice.

Issue: Inadequate training capacity
In order to meet the projected need for qualified health professionals, educational capacity must increase. This problem is compounded by several factors. First, to qualify as instructors in health care professional training programs, nurses and other professionals usually must complete a master's degree or other advanced training beyond what is required to practice in the field. The pool of qualified instructors is limited. Second, the average age of faculty is growing, and it is anticipated that many current instructors will retire in the next few years. Finally, some programs are limited by the number of clinical rotations that are available to their students. Again, this problem is made more complex by the lack of availability of clinical instructors.

Issue: Diversity in the health care workforce
Diversity is a business imperative for health care. The Institute of Medicine (IOM), Washington, D.C., recently released a report, In the Nation's Compelling Interest: Ensuring Diversity in the Health Care Workforce, that strongly recommends increasing racial diversity in the industry, saying a more diverse workforce would help improve access to care among racial and ethnic minority patients.

African Americans, Hispanics and Native Americans are significantly under-represented among the ranks of registered nurses and most other health care professions. In 2000, according to the U.S. Census Bureau and National Sample Survey of Registered Nurses, African Americans accounted for 12 percent of the U.S. population, but only 4.9 percent of registered nurses. Likewise, Hispanics accounted for 11 percent of the U.S. population, but only 2 percent of registered nurses. By 2020, the census bureau projects that African Americans will account for 13 percent of the U.S. population, while Hispanics will account for 17 percent of the U.S. population.

Males are also grossly under-represented in many health professions, with females making up more than 90 percent of nurses, speech therapists, occupational therapists and dieticians.

Increasing the ethnic and gender diversity of the workforce could significantly expand the pool of health care profession candidates.

Opportunity: Improve efficiency of nurses and other health care professionals
The impact of the shortage of health care workers may be lessened by making better use of highly trained professionals, such as registered nurses and physical and occupational therapists. Work design must be an organizational competency and an ongoing priority. We are challenged to build new work models based on employee competencies, education and experience. These models might include supplementing these nurses with aides and assistants to perform routine tasks such as making patients' beds or delivering meals. Nurses would then be free to perform more complex tasks, such as patient assessment and administration of medications. There are many emerging examples of hospitals developing work designs that balance safety, productivity, employee satisfaction, patient outcomes, patient satisfaction and financial viability. Important components of these success stories include involving staff in the work design process and providing the necessary resources and support that employees need to participate in design projects.

Opportunity: Improve employee retention
Creating a culture that values employees is critical to improving employee retention. Health care professions are inherently stressful, resulting in burnout and high turnover rates. Factors leading to high turnover include poor morale and a perceived lack of respect for nurses and other non-physician health care professionals and a perceived lack of opportunity for professional development. Many organizations are addressing these issues by encouraging inter-disciplinary collaboration in developing and executing patient care plans, and by creating career ladders of increasing skill and responsibility for nurses and others. The growing designation and use of clinical nurse specialists and nurse practitioners in high-acuity services, such as heart surgery recovery and transplant services, are examples of this strategy. Not only do such practices keep health care professionals engaged in their careers, they also improve patient outcomes

Opportunity: Increase training capacity
Even if all training programs existing today were filled to capacity, there would not be enough nurses and other professionals to meet future needs. Actions aimed at increasing capacity include:
" Increased support for advanced studies in health professions to produce more instructors. Scholarships and fellowships to support advanced studies for practicing nurses and other professionals are crucial for increasing training capacity. Without highly trained instructors, training programs cannot exist.
" Increased funding for nursing and other professional schools. As more instructors are trained, schools will need extra funds to add instructors and training slots for additional students.

Opportunity: Increase candidate pool
With the number of college-age students remaining flat as demand for health professionals grows, a variety of strategies are needed to increase the number of students who choose careers in health services. Among the strategies:

* Fund scholarships and tuition pay-back programs. These programs are in full swing in many states, and have been effective in attracting candidates to professional training programs identified as shortage areas.
* Target grade-school children. Typically, students must take advanced mathematics and science courses in high school to get into college training programs. As students graduate from high school, health careers are not an option for them if they have not taken these math and sciences classes. Programs that make children aware of health professions in sixth and seventh grade, and that emphasize the need to take math and science in high school to prepare, could help overcome this problem.
* Target boys and minorities. Focusing early recruitment efforts on these groups that are greatly under-represented in nursing and therapy professions could easily double the number of potential health services candidates. Identifying role models within these communities is a very effective strategy.

The health professions workforce shortage is a complex problem requiring multiple, long-term solutions. The more health professionals can work together with local schools, government and the public, the more likely solutions will be found.

> Continue to Health Care Workforce Shortage Fact Sheet