A Critical Shortage of Nurses

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Several Factors at Play

In nursing, pay isn't the only issue. Difficult working conditions and understaffing also deter qualified people from pursuing the profession (see BusinessWeek.com, 8/21/07, "Labor Shortages: Myth and Reality"). But average annual wages for registered nurses (one of the most highly trained categories) is now just under $58,000 a year, compared with a $36,300 average for U.S. workers overall. And it's clear that qualified American nurses see that as not enough: There are 500,000 registered nurses who are not practicing their profession—fully one-fifth of the current RN workforce of 2.5 million and enough to fill current vacancies twice over.

Hospitals insist the U.S. shortage is too severe to address simply with money. Carl Shusterman, an immigration lawyer in Los Angeles, says he has 100 hospital clients that have 100 vacancies apiece. With two- to three-year waiting lists to get into nurse-training programs in the U.S., pressure to import nurses won't abate, he says. "Even if we could train more nurses and pay them more, we'd still need to import them," says Shusterman. "It's ridiculous to claim that any foreign nurse is taking a job away from an American."

Undeniable Results

Raising pay has successfully attracted nurses in the past, however. To remedy a shortage that developed in the late 1990s, hospitals started hiking wages in 2001—and added 186,500 nurses from 2001 to 2003. Some advocates draw a direct link between wages and recruiting. A 2006 study by the Institute for Women's Policy Research, "Solving the Nursing Shortage Through Higher Wages," concluded that "increasing pay for nurses is the most direct way to draw both currently qualified and aspiring nurses to hospital employment."

While nurses' advocates say better pay is critical, they also argue that working conditions must improve if the U.S. is to cultivate an enduring nursing workforce. Future projections of staffing troubles are ominous. The current 8.5% shortage is expected to surge to 29%—or more than 810,000 nurses—by 2020, according to the U.S. Health & Human Services Dept. "You will draw in some people with a good pay raise, but you won't necessarily get them to stay," says Cheryl Johnson, a registered nurse and president of the United Association of Nurses, the largest nurses' union in the U.S. "Almost every nurse will tell you that staffing is a critical problem. The workload is so great that there's not time to see how [patients are] breathing, give them water, or turn them to prevent bedsores. The guilt can be unbearable."

Whatever mix of better wages, better working conditions, and foreign workers hospitals employ, solving the nursing shortage in the long run will require solutions on a number of fronts. "Nurses are getting more organized, but major change isn't going to happen overnight," says Suzanne Martin, a spokeswoman for the United American Nurses, which represents 115,000 RNs. "There are other interests and lobbies that would prefer to keep things as they are."

Herbst is a reporter for BusinessWeek.com in New York .