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One of the largest present and future problems in healthcare in the United States is the shortage and unequal distribution of nurses. There are many reasons for the shortage, including a deficiency of nursing program educators, a trend toward upward mobility in nursing, increasing pressures that make nursing today less than attractive, and the aging of the baby boomer population. The unequal distribution of nurses is a geographical phenomenon, caused by urbanization, a change in societal expectations, fewer opportunities in some areas of the country, and pay disparities.
There is a serious concern in nursing programs regarding the hiring and retention of teaching staff, such that some nursing programs have actually lost their accreditation. If a nursing program does not have sufficient teaching staff, it cannot turn out more nurses, and this has an exponential effect, since it is among nurses with advanced degrees that the teaching staff is found. There seems to be a demand right now for nursing education, but the system cannot meet the demand.
Simultaneously, nurses who are able to move upward in a healthcare system are doing so, becoming administrators, for more money and less backbreaking work. Every nurse who becomes an administrator is a nurse who is no longer taking care of patients.
There are also tremendous pressures upon healthcare systems to contain costs, both in for-profit and non-profit entities. One of the easiest ways to contain costs is in the area of human resources, and nurses in particular are suffering because of this. They are increasingly burdened with additional responsibilities, including more patients, more record-keeping, and more mastery of new technologies. As just one example, it is common today to require nurses to work back to back shifts because of call-offs or shortages. All of these conditions frequently cause burnout, and nurses either try to move upward or leave the nursing profession altogether.
As all of these are occurring, the largest group in the population of the United States is aging and living longer than any previous generation. The baby boomers are becoming senior citizens, and modern medicine is keeping people alive now, but alive in ways that require more healthcare services than ever before. People with diabetes can live into their 90s, and bypass surgeries have become routine. All of these people need and will need skilled nursing care, at just the time that we experience this shortage.
In major metropolitan cities, there seems to be little difficulty hiring nurses, although retention is a problem. But most such cities do have accredited nursing programs, so the supply seems endless. It is in rural areas that the shortages are most keenly felt.
First, there is a "back to the city" movement going on right now, with people wanting to conserve energy, avoid long commutes, and be able to walk around in their neighborhoods. Cities are building housing in downtown areas and attracting many young people. This means that rural areas are losing young people, nurses included.
Second, there was a time that someone raised in a rural area was likely to remain in that area because of community and family expectations. That is no longer the case, with young people seizing their freedom to move wherever they please, no longer staying where they were raised, no longer feeling an obligation, for example, to stay around to take care of their parents as they age or to allow their own offspring to be raised in the same town with grandparents. It is a different world today, and young people are on the move.
One factor that creates this tendency to leave rural areas is a lack of employment opportunity. There might be one small hospital in the area. How many nursing positions are there really going to be? If one wants to be a nurse, as in any other profession, one must go where the jobs are.
Pay scales in rural areas are usually lower, too, and this is a disincentive to remain. The salaries in growing areas are often an enticement, and few people stop to consider the cost of living differential they are going to experience, simply attracted by the big numbers.
All of these are problems that could be solved, but we seem unwilling to commit the resources necessary to do so. The healthcare industry has a powerful lobby, taxpayers are unwilling to spend more to solve the problem, and so we go into this new reality in which people will die for lack of proper nursing care.
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