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The United States is facing a critical shortage of registered nurses (RN). By the year 2020 the average RN vacancy rate in the U.S. will be 20%.1 The shortage of registered nurses has contributed to emergency department overcrowding, increased hospital diversions, bed and patient care unit closures and surgery cancellations. It poses a clear threat to trauma center viability.
The problem can be framed as the classic supply and demand dilemma. Supply-side contributing factors include declining nursing school enrollment, shortage of nursing school faculty, decline in RN earnings relative to other career options, and increasing numbers of RNs leaving the profession. This has led to the slowest growth rate of RNs in over 20 years. The age of the average RN is climbing. The current ratio of RNs in their 40s to 20s is now 4 tol.1
Contributing factors on the demand side of the equation include an aging patient population, increasing patient acuity and healthcare cost containment measures that have altered the work environment for the average RN. To cut costs hospitals have reduced clinical educator positions, shortened orientation, significantly decreased the amount of continuing education offered, increased mandatory overtime and increased nurse to patient ratios. This has resulted in a destabilization of nursing care models such as primary nursing or patient centered care.
The shortage is particularly acute for specialty areas like the emergency department, operating room and critical care. Historically specialty care units have attracted younger nurses; the rapid decline in the number of RNs under age 30 in the work force play a large part in shortages in critical care areas.2
Registered nurse turnover rates range from 10% to...