Linda Richards qualified as America's first "trained" nurse in 1873, in a time when most nurses' training was on-the-job and nursing was little better than slave labor. Technological advances in medicine called for educated people, as outlined in the 1922 Goldmark Report, published by the Rockefeller Foundation.11 The report advocated financial support of university-based schools of nursing. The Nursing Training Act of 1964 allocated nearly $300 million to nursing education, with $35 million designated for college-level programs. It seemed that nursing might finally be recognized as a respectable profession — albeit one dominated by women (about one in 20 nurses is male) — with all the baggage that comes with a female-dominated profession, such as low pay.
As the graphic demonstrates, in 1970 there were 750,000 registered nurses; by 2000 there were 2.3 million. The number of nursing school graduates at the baccalaureate, associate, and diploma levels rose 28%, from 75,523 in 1970 to a peak of 97,052 in 1995 (a rather steep drop in enrollment in 1990 may be attributable to the "baby bust.") Enrollment in 1996 was down to 94,757. Not shown on the chart is a reported upturn in enrollment that happened as the economy soured in 2001. According to the American Association of Colleges of Nursing, enrollment in entry-level baccalaureate programs rose 3.7% in fall 2001 compared to fall 2000, marking the end of a six-year period of decline. Total enrollment in all nursing programs leading to the baccalaureate degree was 106,557.
The table shows a national average of 366 nurses per 100,000 population in 1970, compared to 832 nurses in 2000, a 127% increase. Yet U.S. Health Resources and Services Administrator Elizabeth James Duke, Ph.D. noted in June 2002 that "a shortage of nurses threatens the quality of health care in communities across America." The nursing shortage is called one of the most pressing problems now facing the health care system. How can this be? For one thing, statistics for licensed registered nurses do not reflect the fact that many of those licensed nurses are no longer employed in nursing.
Projected Supply and Demand of RNs
A demand for nurses that was not projected to become critical until 2007 had already become evident in 2000, as the small chart shows. The projected demand for new nurses for the period 2000-2020 is nearly 1 million more nurses than the projected supply. Factors driving the growth in demand for nurses include a growing population, a larger proportion of elderly persons who will require intensive health care services (the 65+ group is projected to grow 54% between 2000 and 2020) and medical advances that require nurses with special skills and experience. Factors affecting the supply of RNs include declining numbers of nursing school graduates, the aging of the RN workforce (average age in 1999: 45), declines in relative earnings, and the emergence of alternative job opportunities.
Like doctors, nurses complain that managed care and the pressure to cut costs have changed the profession and discourage young people from entering it. It takes a special sort of person to be a nurse. Dr. Denise Geolot, director of the division of nursing at the Bureau of Health Professions, says: "I think one of the things we have to address is the image of nursing and lack of respect that nurses experience."
Supply 2000 2002 2004 2006 2008 2010 2012 2014 2016 2018 2020
Sources: Chart: Health Resources and Services Administration, United States Health Workforce Personnel Factbook, http://bhpr.hrsa.gov/healthworkforce/factbook.htm, and National Center for Health Statistics, Health, United States, 2002, Table 102. DeSales University, Significant Events in the History of Nursing," http://www4.allencol.edu/~sey0/hist1a.html.. Bureau of Health Professions, "Projected Supply, Demand and Shortages of Registered Nurses: 2000-2020," http://bhpr.hrsa.gov/healthworkforce/rnproject/default.htm. "Facts About the Nursing Shortage," http://www.nursesource.org/facts_shortage.html. Health and Human Services Administration News, "HHS Awards $30 Million to Address Emerging Nursing Shortage," June 4, 2002, http://newsroom.hrsa.gov:80/releases/2002releases/nursegrants.htm. Emily Friedman "Troubled past of 'invisible' profession," JAMA, The Journal of the American Medical Association, Dec 12, 1990 v264 n22 p2851(5). Melanie R. Margolis, "Nursing School Enrollment Increases," http://www.law.uh.edu/healthlawperspectives/MedicalProfessionals/020131Nursing.html.Information retrieved September 30, 2002.
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