The U.S. is projected to experience a shortage of Registered Nurses (RNs) that is expected to intensify as Baby Boomers age and the need for health care grows. Federal authorities project a shortage of 78,610 full-time RNs in 2025 and a shortage of 63,720 full-time RNs in 2030. Compounding the problem is the fact that nursing schools across the country are struggling to expand capacity to meet the rising demand for care.
While the demand for qualified nurses continues to climb, nursing schools are struggling to produce graduates at the rate needed to fill the gap. According to the American Association of Colleges of Nursing (AACN)’s report on 2023-2024 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing, U.S. nursing schools turned away 65,766 qualified applications from baccalaureate and graduate nursing programs in 2023 due to insufficient number of faculty, clinical sites, classroom space, and clinical preceptors, as well as budget constraints.
Here are three key factors contributing to this complex issue:
1. The Faculty Shortage
Faculty shortages at nursing schools across the country are limiting student capacity at a time when the need for professional registered nurses continues to grow. This shortage creates a bottleneck, limiting the number of students who can be admitted and trained. A total of 1,977 full-time faculty vacancies were identified in a recent AACN survey of 922 nursing schools with baccalaureate and/or graduate programs.
This problem of staffing university professors in nursing schools is attributed to several factors:
- Low salaries: Compared to clinical roles, nursing faculty salaries are often less competitive, making it difficult to attract and retain experienced nurses in academia. According to the Bureau of Labor Statistics, the median salary across advanced practice registered nurse roles is $129,480. By contrast, AACN reports the median salary for a master’s-prepared professor in schools of nursing is $93,958.
- Increased workload: Faculty members juggle teaching, research, clinical practice, and administrative duties, leading to burnout and high turnover.
- Retirement: A significant portion of nursing school faculty is nearing retirement age, further exacerbating the shortage. One third of the current nursing faculty workforce in baccalaureate and graduate programs are expected to retire by 2025, underscoring the urgency for the nursing education community to address the impending exodus of senior faculty and to develop younger faculty for succession.
- Doctorate requirement: Many nursing schools require faculty to hold a doctoral degree, which can be a barrier for nurses who may be excellent educators but lack the time or resources to pursue advanced education.
2. Lack of Clinical Placement Sites
Nursing students require hands-on clinical experience to develop their skills and prepare for real-world practice. However, a shortage of clinical placement sites is hindering nursing programs’ ability to provide adequate training opportunities. In fact, the most frequently reported reason (69%) cited for not admitting qualified students in a university’s nursing program is insufficient availability of clinical sites. Some reasons this is occurring:
- Shortage of Preceptors: Hospitals are facing a shortage of preceptors – experienced nurses who supervise students during clinical rotations. To combat this, some states including Colorado, Georgia, Hawaii, Maryland, South Carolina, and Virginia offer tax incentives for nurses serving in these teaching roles. On the federal level, bipartisan legislation introduced in January 2024 would establish a pilot program to augment wages for nurse educators and support efforts to recruit and retain faculty.
- Heavy Competition for Few Spots: Competition for clinical placements is fierce, with nursing programs vying for limited spots in hospitals and other healthcare facilities.
- Liability and Financial Concerns: Hospitals may be hesitant to take on the liability associated with student nurses. At the same time, providing clinical placements for students can be costly for healthcare facilities, particularly smaller ones.
3. Capacity Constraints in Nursing Schools
Beyond faculty and clinical site shortages, nursing schools themselves face capacity constraints that limit their ability to increase enrollment. A few key reasons include:
- Limited classroom space and resources: Physical space, simulation labs, and equipment are often in short supply, restricting the number of students that can be accommodated.
- Budgetary constraints: Nursing programs require significant financial resources to maintain high-quality education. Funding limitations can hinder expansion efforts. Additionally, it makes it harder to incentivize student enrollment with financial aid or scholarships.
- High attrition rates: Nursing programs can be demanding, and some students may drop out due to academic challenges, personal reasons, or financial difficulties. This further reduces the number of graduates.
Addressing the Nursing Shortage
Solutions include:
- Investing in nursing education: Work with government partners to increasing funding for nursing schools to support faculty recruitment and retention, expand capacity, and enhance resources.
- Creating incentives for clinical placements: Providing financial support and resources to healthcare facilities that offer clinical placements for nursing students.
- Exploring innovative models of education: Utilizing technology, such as simulation labs and online learning, to supplement traditional clinical experiences.
- Supporting nurses in the workforce: Addressing issues like burnout, workplace safety, and career advancement opportunities to retain experienced nurses. Nurses often have intense and demanding workloads, resulting in them feeling emotionally and physically exhausted. Nurses are at greater risk of injury and physical illness than the general public, statistically speaking, and also of mental illness caused by high levels of stress. The job can be all-consuming.
The nursing shortage is a multifaceted problem that demands a comprehensive approach. In the end, producing more nurses is fixing just part of the problem. But by starting at the beginning and tackling the core nursing school challenges mentioned above head-on we can pave the way for a stronger and more sustainable nursing workforce to meet the growing healthcare needs of our nation.
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[1] https://www.aacnnursing.org/Portals/0/PDFs/Fact-Sheets/Nursing-Shortage-Factsheet.pdf
[2] https://www.aacnnursing.org/news-data/research-data-center/annual-data-reports [3]https://www.aacnnursing.org/Portals/0/PDFs/Data/Vacancy23.pdf
[4] https://www.aacnnursing.org/Portals/0/PDFs/Fact-Sheets/Faculty-Shortage-Factsheet.pdf
[5] https://www.aacnnursing.org/news-data/all-news/january-2022-data-spotlight-impact-of-insufficient-clinical-sites-on-baccalaureate-program-admissions
[6]https://www.congress.gov/bill/118th-congress/house-bill/7002/text