The New Health Dialogue

I've been reading lately about the persistent nursing shortage in the U.S. that threatens the quality of patient care. I know something about this: I was born in the Philippines—the world's leading donor of nurse labor—and many of my own relatives, including my mother, migrated to the U.S. to help fill this nursing gap. My mother studied at the University of Philippines and was trained at the Philippine General Hospital. She, like thousands of others, was exported to the U.S. and then later to Australia in the '80s where she was guaranteed a higher salary and greater opportunities. This hasn't changed much. The mass exodus of nurses from the Philippines continues today.

But with the current economic crisis, is there still a growing demand for nurses in the U.S.? Some hospitals have laid off nurses. And some senior nurses are remaining in, or rejoining, the workforce as they choose to postpone retirement or come out of retirement because of financial insecurity.

But the American Association of Colleges of Nursing (AACN) assures us that the "U.S. is in the midst of a shortage of registered nurses (RNs) that is expected to intensify as baby boomers age and the need for health care grows." An analysis by the U.S. Department of Health and Human Services projects that the current nursing shortage will continue to grow in severity during the next 20 years if current trends prevail and that some states face a more severe shortage than do others." This is a sobering thought.

The shortage is not because people do not want to be nurses. Demand for nursing careers is high. Last year, AACN reported that almost 50,000 qualified applicants to nursing programs were declined. The underlying problem is the lack of nursing school faculty. The Obama Administration is paying close attention.

President Obama said during his White House Forum on Health Reform that:

Nurses provide extraordinary care. I mean, they are—they are the front lines of the health care system. And they don't get paid very well. Their working conditions aren't as good as they should be. And when it comes to nurse faculty, they get paid even worse than active nurses. So what happens is, is that it is very difficult for a nurse practitioner to go into teaching, because they're losing money.

HealthLeaders Media reports that:

President Barack Obama has requested $125 million for the federal Nursing Education Loan Repayment Program (NELRP). In addition, the president has asked lawmakers to increase federal Nurse Faculty Loan Program (NFLP) resources by 40 percent over 2008 funding levels as part of the $1 billion allocated for health care workforce development in the fiscal year 2010 budget.

Some states are also taking action. In Texas last year, nursing schools turned away some 8,000 qualified applicants, primarily because there weren't enough faculty to teach them. The Texas Legislature recently committed $30 million in new upfront funding for nursing schools to expand starting this fall. The Robert Wood Johnson Foundation and the New Jersey Chamber of Commerce Foundation have announced a $22 million five-year initiative designed to ensure that New Jersey will have the nursing workforce it needs to meet its future health care demands.

Addressing the nursing shortage (as well as larger issues about our primary care work force) is important in the grand scheme of health reform. As we try to get all Americans high quality affordable health care coverage, we will need more nurses to provide high quality health care and take on many of the challenges of care coordination, patient education, disease management and preventive care.