The Aging Nursing Workforce

There’s a perfect storm brewing in health care. As the baby boomer generation continues to age, they will have more extensive health care needs — but how many nurses are baby boomers who will be in that same predicament? As the population ages, health care access improves, and more nurses head for retirement, a critical shortage of nurses is predicted in coming years. Here, we’ll explore the demographics of aging and nursing populations and what nursing schools and employers can do to mitigate the shortage.

Baby boomers are Americans who were born in the years after World War II, when the country experienced a dramatically increased birth rate. Boomers make up the largest generation in history and account for 24.3 percent of the U.S. population. In 2011, the first wave of boomers reached 65 years old, and by 2029, the rest of the generation will have joined them. As these boomers age, they often accumulate health issues along the way. In fact, the lifetime probability of becoming disabled in at least two activities of daily living — such as bathing, dressing, or eating — or being cognitively impaired for those 65 or older is as high as 68 percent.

As individuals live into and beyond their 80s, they have an increased likelihood of living with multiple chronic conditions and experiencing limitations in functionality. This combination makes it more likely that they will need more care in both acute and long-term settings. For the health care system, these increased needs are expected to place a significant strain on available resources. That’s one reason that the Institute for Healthcare Improvement (IHI) created the Triple Aim Initiative — an approach to optimizing health system performance by simultaneously pursuing three goals:

A key component of achieving the Triple Aim Initiative is having a fully staffed and prepared workforce. The nursing population is aging, and it also makes up the largest segment of health care professions. Improving educational and work experiences for RN students and nurses that encourage them to pursue and stay in their careers longer will be essential to caring for the country’s aging population.

According to an American Association of the Colleges of Nursing (AACN) summary of reports, there will be a growing shortage of registered nurses across the country between 2009 and 2030. Although the economic slowdown has delayed the retirement plans for some nurses, analysts predict that such trends are temporary. By 2025 it’s expected we will experience a shortage “twice as large as any nursing shortage experienced in this country since the mid-1960s.” Experts say the rapidly aging nursing workforce is a primary contributor.

As workforce analyst Dr. Peter Buerhaus noted in a 2008 article in the Journal of the American Medical Association, “Over the next 20 years, the average age of the RN will increase and the size of the workforce will plateau as large numbers of RNs retire. Because demand for RNs is expected to increase during this time, a large and prolonged shortage of nurses is expected to hit the U.S. in the latter half of the next decade.” In fact, 55 percent of the RN workforce is age 50 or older, and more than 1 million registered nurses are predicted to reach retirement age within the next 10 to 15 years.

Although a RAND Corp. study released in 2014 downplayed the retirement trends, revealing that many nurses seemed to be working past expected retirement ages, a recent survey found that nearly two-thirds of nurses older than 54 are considering retirement — and 62 percent of them plan to do it in the next three years.

If there were enough new nurses to replace the boomer retirees, concerns about the shortage wouldn’t be as grave. However, nursing school enrollment is not keeping pace with the projected demand for RN and APRN services in the years ahead — often due to the limited availability of nursing faculty to educate them. According to AACN’s report on 2012-2013 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing, “U.S. nursing schools turned away 79,659 qualified applicants from baccalaureate and graduate nursing programs in 2012 due to insufficient number of faculty, clinical sites, classroom space, clinical preceptors, and budget constraints.” Many schools are actively working to increase enrollment in nursing programs by employing various strategies, including partnerships with hospitals for internships and shadowing, improving distance and online learning opportunities for students, and targeting prospective students, some as young as elementary school, and diverse, nontraditional nursing students.

The good news is that there are a number of strategies that employers can adopt to help retain seasoned nurses. Many organizations, such as the Robert Wood Johnson University Hospital, have been successful in using them:

The anticipated nursing shortage will likely create a significant strain on the health care system, impacting everyone involved. However, by adopting specific strategies to retain seasoned nurses and ensuring that critical nursing education is available for the generations who follow, we can work together to address the challenges ahead.