Hospital Speedups and the Fiction of a Nursing Shortage

In recent years, hospital managers and public policy makers alike have focused considerable energy on the prospect of an imminent national shortage of hospital nurses. In response, officials have urged both increased funding for nursing schools and increased importation of foreign nurses from the Philippines and other developing countries. The study below documents that this policy direction is fundamentally misguided. There is no shortage of nurses in the United States. The number of licensed registered nurses in the country who are choosing not to work in the hospital industry due to stagnant wages and deteriorating working conditions is larger than the entire size of the imagined "shortage." Thus, there is no shortage of qualified personnel—there is simply a shortage of nurses willing to work under the current conditions created by hospital managers. Extensive survey data among both currently working nurses and those who have left the profession indicate a very strong consensus regarding the causes and potential solutions to this problem. Nurses will return to hospital work if the wages are improved and, above all, if nurse-to-patient ratios are restored to a level at which RNs believe they can provide professional care. If conditions are improved, enough nurses will be drawn back into the hospital industry to solve the alleged shortage. If, on the other hand, conditions remain stagnant or deteriorate further, new graduates of nursing schools will continue to abandon the profession in large numbers, and no increase in new graduates will suffice to keep hospitals adequately staffed. In a final section of the paper, a survey of magnet hospitals indicates that the industry can afford to implement improved staffing levels while remaining economically competitive.