An Educator’s View of Florida’s Nursing Shortage

Critical Nursing Shortage. Since the turn of this century, these three words have continuously driven the health care industry into an anxious state, and sparked action on many professional and academic levels. But this current shortage in Florida is particularly daunting, encompassing faculty, students and practitioners. The entire spectrum of the nursing profession is working furiously to avert the public health crises that may occur if the predicted demand is not met.

Crisis Synopsis

According to a 2005 report from the Florida Hospital Association, Florida currently has about 152,000 registered nurses (RNs), but is facing a projected need by 2011 closer to 194,000 RNs. Florida is growing and aging faster than other states in the country. Our total population is expected to increase by 22% between 2000 and 2020, while the population of residents age 65+ is projected to rise by 63% during that same period (Health Resources and Services Administration, 2003). By 2010 when most of Florida’s baby boomers turn 65, the state will have a shortfall of some 17,000 RNs, with the deficit rising to 61,000 RNs by 2020 (National Center for Workforce Analysis, 2002). When you combine the State’s burgeoning elderly population and impending onslaught of baby boomer retirees with the already high and growing demand for intensive health care services, the aging of the nursing workforce, the increasing wave of RN retirements, and the aging and shortage of nursing faculty, this particular nursing shortage is more complex than those of years past.

Adverse Impact of Nursing Shortage on Hospitals.

Because nurses constitute the largest segment of hospital staff delivering most health care services, a shortfall of nurses endangers the quality of care and places patients at risk for increased illness and death (Robert Wood Johnson Foundation, 2002). One of the most startling statistics to qualify the gravity of the situation was a 2002 report by the Joint Commission on Accreditation of Healthcare Organizations that cited inadequate nurse staffing levels as a factor in 24% of unanticipated events that resulted in death, injury or permanent loss of function.

Lack of Capacity in Florida Nursing Programs.

In direct response to the nursing shortage, Florida’s nursing schools have mounted successful recruitment campaigns that helped increase nursing school enrollment 225% from 1990 to 2006. However, the Florida Center for Nursing (2006) reported that 63% of candidates for BSN programs and nearly 50% of ASN program candidates were turned away because of lack of capacity. The major factors hampering the expansion of enrollment cited by nursing program deans or directors were:

• Shortage of qualified faculty (30%)
• Insufficient faculty lines or funded positions (25%)
• Insufficient clinical sites (22%), and
• Non-competitive faculty salaries (16%).

Nursing Faculty Shortage.

As Florida’s nursing education programs deal with increasing faculty vacancy rates and demand for more faculty positions, current faculty end up carrying heavy student loads, which in turn may make it more difficult to attract and retain faculty. The aging of Florida’s current nursing faculty — with many approaching retirement — will further exasperate the problem. The progression of our nursing shortage is inevitably clear: faculty shortage leads to decreasing student enrollment/graduations, which leads to a shrinking nursing workforce.

Conclusions and Solutions.

Our capacity to grow the pipeline of nursing professionals by expanding enrollment is inhibited by insufficient resources. Addressing the problem effectively demands multiple solutions:

• Legislative support for additional funding is necessary to expand nursing programs commensurate with the projected demand. The increased appropriations for Title VIII Nursing Workforce Development programs are much needed, as these constitute the largest source of federal funding for nursing programs, students, and health systems in recruitment, education, and retention of RNs. Additionally, the Nursing Education, Expansion, and Development (NEED) Act would provide capitation or formula grants to increase enrollments in nursing schools and may be used for hiring new faculty, purchasing additional equipment, or recruiting students.
• Faculty salaries need to increase to attract potential educators away from higher-paying positions in clinical and private sector settings, and to maintain the pool of nursing faculty in the face of increased retirements and rising costs of living.
• More scholarships and stipends for graduate nursing education are needed in order to stimulate students to enter graduate-level nursing programs, a critical factor in building the ranks of nursing faculty.