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Population Health for Nurses

5.4 Health Care Workforce

Population Health for Nurses5.4 Health Care Workforce

Learning Outcomes

By the end of this section, you should be able to:

  • 5.4.1 Evaluate workforce shortage trends that could jeopardize access to health care.
  • 5.4.2 Assess the impact of the COVID-19 pandemic on the health care workforce.
  • 5.4.3 Discuss the lack of diversity among the health care workforce and its impact on client care.
  • 5.4.4 Discuss the aging of the health care workforce and its impact on the nursing workforce shortage.

According to the American Nurses Association (2023), there are approximately 4.3 million registered nurses working in various settings across the United States. Nurses are key to ensuring positive health outcomes for clients and communities. A strong health care workforce is essential to address health disparities in the United States. However, the American Hospital Association (AHA) found that between 2019 and 2020, health care workforce vacancies increased by 30 percent (AHA, 2023a).

Effects of the COVID-19 Pandemic on the Nursing Workforce

The COVID-19 pandemic precipitated the “great resignation,” during which more than 50 million Americans quit their jobs (Richter, 2023). The great resignation was especially impactful in health care, as many health care providers, including registered nurses, exited the health care system in mass numbers (Balasubramanian, 2022). A study by the Kaiser Family Foundation (2021) found that approximately three in 10 health care workers considered leaving the profession during the COVID-19 pandemic. Approximately six in 10 health care workers stated that stress related to the pandemic impacted their mental health. An additional survey by the American Organization for Nursing Leadership, which falls under the umbrella of the American Heart Association, found that nurses stated that “emotional health and well-being of staff” were the top challenges nurses faced during the COVID-19 pandemic.

Effects of the Registered Nurse Shortage

The American Nurses Association refers to registered nurses as the backbone of the health care system. Without adequate highly qualified registered nurses, client health outcomes will suffer.

The U.S. Bureau of Labor Statistics projects that there will be an average of approximately 194,500 annual openings for registered nurses between 2020 and 2030. By 2026, there will be an estimated shortage of approximately 3.2 million health care workers (AHA, 2023b). A shortage of qualified health care professionals such as registered nurses, physicians, and respiratory therapists, for example, limits access to quality health care services for individuals who already experience less-than-optimal health outcomes. Prevention is one of the top means by which chronic diseases such as diabetes, heart disease, and hypertension can be controlled, especially in underrepresented communities. Individuals from these communities, who disproportionately experience chronic diseases, would benefit from preventive health care services that public health nurses are well qualified to provide.

A U.S. Bureau of Labor Statistics study suggested that more than 275,000 additional nurses would be needed from 2020 to 2030 (Balasubramanian, 2022). Employment opportunities for nurses are projected to grow at a faster rate (9 percent) than all other occupations from 2016 through 2026 (Balasubramanian, 2022).

The nursing shortage is the most significant of any profession in the health care system. For this reason, extra attention and emphasis are being placed on the number of nurses needed for the health care system to function properly. The American Hospital Association framed the nursing shortage as a national emergency and predicted a deficit of 1.1 million nurses by the end of 2022 (AHA, 2023b; Chamlou, 2022). Hospitals in major cities, with their larger populations, have experienced the worst level of nursing staff shortages when compared with other areas and settings throughout the country. Rural areas are also impacted, especially in hospitals in less populous areas (Chamlou, 2022), where access to health care is already lacking. According to the Kaiser Family Foundation, rural hospitals have fewer intensive care unit (ICU) beds: approximately 1.7 per 10,000 people when compared with 2.8 per 10,000 in more populated urban areas. For this reason, rural hospitals tend to become overwhelmed faster than urban care centers. Additionally, nursing salaries tend to be lower in rural areas, which makes it more difficult to recruit nurses in these areas (Chamlou, 2022).

The lack of qualified health care workers has driven up wages, especially for nurses. This increase in wages has placed a financial strain on the health care system, which has led to an increase in health care costs across the board. When hospitals and other organizations within the health care system increase costs, access to care for vulnerable populations may be further hampered, which, as has been stressed throughout this chapter, leads to less-than-optimal health outcomes for these individuals.

One of the issues contributing to the shrinking number of health care providers is the aging of the nursing workforce. According to the American Nurses Association (2023), the median age of registered nurses in 2020 was 52. Approximately one-fifth of these nurses expressed their intent to retire within the next 5 years.

Achieving Diversity in the Nursing Workforce

In addition to the overall shortage of personnel in health care, the health care workforce lacks diversity. Nurses care for clients across the gender spectrum; however, in 2020, 90 percent of all nurses worldwide were female (Buchan & Catton, 2020). A study conducted by the National Council of State Boards of Nursing (NCSBN) asked members of the nursing workforce to self-identify by race/ethnicity. The study found a striking lack of diversity in the workforce, in stark contrast to the diversity of the client populations nurses serve (Figure 5.6).

A pie chart shows the nursing workforce by race. 80.6% of nurses are white; 7.2% of nurses are Asian; 0.5% of nurses are American Indian or Alaskan Native; 6.7% of nurses are Black or African American; 0.2% of nurses are Middle Eastern or North African; 0.4% of nurses are Native Hawaiian or Pacific Islander; 2.3% of nurses identify as other; and 2.1% of nurses identify as being two or more races.
Figure 5.6 The nursing workforce in the United States is predominantly White according to the results of the 2020 National Nursing Workforce Survey. (data source: American Association of Colleges of Nursing, 2023; attribution: Copyright Rice University, OpenStax, under CC BY 4.0 license)

Given these statistics, the AACN, along with other national organizations such as the National Black Nurses Association, National Coalition of Ethnic Minority Nurse Associations, and the National Association of Hispanic Nurses, asserts that, to address increasing racial and ethnic diversity in the U.S. population, it is necessary to further diversify the nursing workforce (AACN, 2023). Research has shown that racial and ethnic minority health care providers are more likely to return to their communities to provide care, and these providers are more likely to advocate for those communities. They are able to bridge cultural and linguistic gaps related to client education and the provision of care, which leads to better health outcomes for individuals in those communities (AACN, 2023).

Nursing leaders recognize and understand the link between a nursing workforce that is culturally diverse and that workforce’s ability to provide high-quality and culturally appropriate care (AACN, 2023). To provide quality care for other underrepresented populations, such as members of the LGBTQIA+ community and individuals with disabilities, increased representation of those individuals in the nursing workforce is needed.

The current shortage of nurses and the need for more diversity among nursing faculty both threaten already compromised health outcomes for underrepresented groups (AACN, 2023). Organizations such as the AACN have strategies in place to address this issue. For example, the Building a Culture of Belonging in Academic Nursing program, a program funded by Johnson and Johnson in January 2022, seeks to assist nursing schools in creating a more inclusive environment. A more diverse nursing faculty can help ensure a more diverse nursing workforce. According to the AACN (2023), nursing students tend to have better outcomes and are more successful when faculty can relate to them culturally. In addition to the need for minority professionals to practice in their home communities, there is a great need for policies that can ensure positive health outcomes within underrepresented groups (AACN, 2023).


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