The nursing profession has long been crucial to the delivery of health care to the American public, as well as a bedrock middle-class profession, particularly for women and women of color. The COVID-19 pandemic worsened a national shortage of registered nurses, which threatens to further destabilize the American health care system and undermine population health. Policymakers must understand the causes and effects of the shortage and how investments in higher education and coordination strategies can alleviate the pressures on the nursing workforce and health care systems.
A new Center for American Progress report examines the factors behind the current nursing shortage, particularly the problems that inhibit a more cohesive response to nursing shortages and limit higher education’s ability to educate more nurses. It also discusses why nursing is a crucial occupation for improving health, economic security, and racial equity in this country.
The nursing shortage
COVID-19 has strained the health care system. Employment levels for registered nurses declined by 3 percent between 2020 and 2021, the largest decline in at least 20 years.1 Chief nursing officers have consistently reported staffing as their greatest challenge throughout the pandemic, with vacancy rates as high as 30 percent.2 The rise of travel nursing, low morale and traumatic experiences, and the disproportionate amount of adversity that nurses of color face are unacceptable features of today’s nursing shortage and require direct intervention from policymakers.3
Other challenges predated COVID-19, including an aging general population that needs more care, an aging nursing workforce whose retirements will further fuel the shortage, and limited capacity in higher education institutions to train new nurses. The United States also lacks a coordinated strategy across policy, education, employer, and other partners to address spikes in nursing demand.
At the same time, nursing pays solid wages and is relatively diverse, making it an attractive profession for workers. By investing in a fuller and more diverse nursing workforce, the United States can offer high-quality jobs to millions of workers while also delivering better health care, particularly to medically and economically underserved communities.
Constraints on higher education
Evidence points to three main constraints that prevent colleges from educating more nurses:
- A shortage of nurse educators, including college faculty, clinical instructors, and preceptors
- A shortage of clinical placements for student nurses, where students get hands-on experience that is required for graduation and licensure
- Inadequate campus facilities and equipment, such as nursing labs and simulation technology
Without additional funding, nursing programs cannot enroll and graduate the number of future nurses who are needed. For example, colleges need more nursing faculty, but nurses with advanced degrees are dissuaded from careers in education by factors such as comparatively low pay.4 Raising faculty pay is one element of a broader proposal to boost the capacity of nursing programs at higher education institutions.
Federal policymakers must devise long-term solutions to today’s nursing shortage and ensure that the education and health care systems are better prepared to mitigate future shortages. The recommendations in CAP’s report are designed to reach the goals of increasing the number and diversity of nurses entering the profession and creating a standing structure to address changes to supply and demand in the nursing workforce.
Congress should expand the capacity of educational institutions to enroll and graduate more nursing students and improve access and outcomes for student nurses of color by:
- Passing the Future Advancement of Academic Nursing Act
- Passing the Black Maternal Health Momnibus Act of 2021
- Increasing funding for programs related to nursing education authorized under Title VIII of the Public Health Service Act
- Helping institutions of higher education pay for capital projects, such as buildings, laboratories, and equipment
Federal and state actors should introduce new proposals to expand clinical placement capacity and help nurses with associate degrees earn bachelor’s degrees by:
- Funding clinical placements for nursing students from historically disadvantaged backgrounds and for those at underfunded higher education institutions, with the Graduate Nurse Education pilot as a model5
- Investing in pathways for nurses with associate degrees to earn bachelor’s degrees, such as increasing the availability of bachelor of science in nursing degrees at community colleges
Congress should create standing bodies to document and advise on issues of recruitment, training, and retention by:
- Funding the National Health Care Workforce Commission, initially authorized by the Affordable Care Act in 2010
- Funding and deputizing state-level nursing workforce organizations to address state-specific nursing shortages
Major investments of federal funding and sustained coordination are needed to mitigate the impact of nursing shortages and improve the nation’s ability to respond. If policymakers at all levels think more ambitiously about solving the nursing shortage and improving racial equity, more workers will have equitable access to a high-quality and well-paid profession, more patients will have equitable access to high-quality nursing services, and a healthier population will have better educational and life outcomes and build stronger communities.