Nurse Shortage? Job Shortage? The Catch-22s We Can’t Seem to Escape

I continue to read in articles and online forums the lamentations by nurses as to whether or not we currently have a shortage of nurses or a shortage of jobs. According to the August 2012 nurse’s workforce report by the Alliance for Health Reform (supported by the Robert Wood Johnson Foundation) we will need over 250,000 new nurses — or nurses, period — by 2025. The following is their general statement about why this is true:

It is projected that 260,000 additional nurses will be needed by 2025 to care for the increased population, the increase in insured population and the explosive care needs for chronic diseases in the population and geriatric care in older age groups.

What jumped out at me when I read this was the part about the “increase in insured population”. Is the report getting ahead of itself by making that declaration? Doesn’t that assume that the Affordable Care Act will still be in place? It’s a bold futuristic statement especially with a current dead heat for the next presidential candidacy. No matter. It got my attention because it seemed like an unlikely reason for having a nurse shortage.

I’m trying to break it down, with difficulty. First off, 2025 is less than 15 years away. Initially I thought, Wow! If the US has to wait until 2025 for health insurance we’re going to have some mighty sick patients! No wonder we’re going to need so many nurses! But our patients are already very sick, it’s 2012 and we aren’t sure if we have enough nurses now.

If more of our patients have health insurance does that make them need us more? Or less? That’s a Catch-22. If we get more people accessing healthcare then we’ll need to be there when they do. If they started getting healthier in 2010 (when the ACA was revving up) they should be healthier by 2025 and they wouldn’t need us as much. The latter is based on our illness-focused medical approach, so if we shifted to being wellness-focused then the entire equation gets turned on its heels.

Another thought to consider is what happens to the supply of nurses when more nurses get access to insurance for themselves? That’s a puzzling equation. How many nurses do we have? How many nurses do we have with insurance? Without insurance? How sick will the nurses be in 2025? It never ends. I’m glad I’m not a statistician!

The Alliance for Health Reform then goes on to say the reason for the shortage actually boils down to this: Do we have enough providers, just in sheer numbers? Or is it that we have plenty of them but they aren’t evenly distributed? Well that’s another Catch-22! In order to fix misdistribution (say that 10x fast) we must have enough nurses in the first place. So we’re back to square one.

In my opinion, after reading on this topic until my neck is having spasms, we have plenty of nurses. And at the current rate we’re spitting out new grads, by 2025 we’re going to be just fine, as long as we have enough nursing instructors to keep the supply going. And that is a topic for another post.

Don’t forget to vote!

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