Exploring the Causes

Clues to Attrition

Understanding the Implications

Proposing Solutions


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The Nursing Crisis: The Solution Lies Within

Michele Mise Pollard
3 Southwicke Place
Arden, NC 28704
(828) 687-1515
University of North Carolina Charlotte


The nursing crisis, in our country, has reached such epidemic proportions that congressional testimony indicates a need for immediate action. Exploring the causes, finding to clues to the attrition, and understanding the implications of this worsening shortage can help us to search for solutions. This paper attempts to express how solutions may lie within the nursing profession itself to stop the outflow of nurses from the profession and to increase the inflow of new individuals to the profession.


On September 25th 2001, a congressional hearing took place to address the needs of the current nursing shortage that has reached critical proportions. Members of the House of Representatives met and heard nurses tell stories of poor working conditions that include inadequate staffing, heavy workloads, use of mandatory overtime, lack of sufficient support staff, and inadequate wages. One such nurse from a Washington area hospital said eliminating mandatory overtime, setting better nurse to patient ratios and giving staff nurses a voice in hospital policy were more important than higher pay. "Until you fix the working environment, the salary issue is kind of moot" (Romig, 2001). The current nursing shortage, unlike those of the past, appears to be headed toward a path of rapid decline.

This unstable environment in the healthcare setting has been blamed on many issues that stem from changes in healthcare to societal attitudes about the nursing profession. There are steps to be taken and words to be spoken that are capable of lessening the declivity of nursing professionals. This has become an issue that affects all Americans and immediate steps need to be taken to stop the worsening progression of this threat to health care as we know it.

Exploring the causes

An aging population of patients that are often in need of more intense and specialized care from qualified medical professionals, of which nurses comprise the largest percentage, is adding fuel to the fire of this worsening crisis (Heinrich 2001). The increase in number of higher acuity patients with the added burden of a shrinking nursing population results in a bleak picture for the future of the profession.

According to congressional testimony by the House of Education and Workforce, the nursing workforce is aging and there are not enough new nurses entering the profession to replace those retiring or leaving (Heinrich 2001). According to Senator Jim Jefford, I-Vt, the average age of a nurse is presently between 42-45 and by 2010 nearly 40 % of the nursing workforce will be over the age of 50 and nearing retirement. "Our nation has suffered from nursing shortages in the past. However, this shortage is particularly severe because we are losing nurses form both ends of the pipeline", Jeffords said (Jeffords, 2001).

Clues to attrition

Not only are the majority of nursing professionals aging but many young people are choosing other careers. A recent study reported that women graduating from high school in the 1990s are 35 % less likely to become nurses than women who graduated in the 1970s (Heinrich 2001). Women today have more job options, many of which offer better pay, more job satisfaction, and perceived better working conditions (Occupational Health Management 2001).

Experienced nurses are opting out of nursing after many years, as well, looking for less stressful and more lucrative careers. A survey done by the Federation of Nurses and Health Professionals found that half of the currently employed RNs had considered leaving the patient care field for reasons other than retirement over the past two years (Heinrich 2001). 

Understanding the implications

The shortage of qualified nursing personnel is an issue that affects anyone who is a provider or consumer of healthcare in this country. Consumers are affected directly by quality of care from nurses who feel they are overworked and overstressed due the increasing demands on their time. Physicians are affected, as well, in their everyday practice and dealings with nurses and patients. According to one physician, "we are increasingly feeling the strain of a hospital nursing staff who are stretched too thin" (Stapleton 2001). The situation inevitably leads to a question of quality of care in settings such as hospitals.

As employers of the largest segment of healthcare professionals, administrators of hospitals and other facilities are also directly affected by the nursing shortage. A poll by the American Hospital Association (AHA), reports from a survey of 700 hospitals that there are approximately 126,000 nationwide RN positions currently vacant (Occupational Health Management 2001). Maryland, for example, reported a statewide vacancy rate for hospitals of 14.7 %, up from 3.3 % in 1997. California reported a vacancy rate of 20 % among their hospitals (Heinrich 2001).

Proposing solutions

There is no tried and true solution to a problem that has been seen before by this profession but how do we stop the downward spiral of losing current and future nurses to other, more attractive career choices? Efforts taken to improve the workplace environment may both reduce the likelihood of nurses leaving the field and encourage more young people to enter the nursing profession. Governmental agencies can help bring new nurses into the profession by offering money for tuition assistance that pays for all related expenses. Hospitals and other healthcare agencies can offer more attractive employment packages and listen firsthand to what the issues are surrounding the dissatisfaction of their nursing staff. Nurse managers that work closely with top administrators and have voices that leaders listen to can take a stand for nursing as a whole. The reports show that nurses would have increased job satisfaction with better working relationships with supervisors that have real power and autonomy (Welch 2001). But the majority of the burden for improving the job satisfaction lies within each of us as nurses.

Improving the workplace environment has to start from within the profession itself. An article in Creative Nursing, "we know we are proceeding into a serious global nursing shortage… And we are discovering that some of the solutions lie within each one of us" (Mueller 2001). As nurses we have voices that can be heard through all the administrative and governmental offices but we must find ways to speak collectively and constructively. Oftentimes nurses are not assertive in telling the story of what it is that causes dissatisfaction among nurses and many degrade the profession by complaining and not acting to improve it. Do we not hurt ourselves as well as the profession by discouraging qualified individuals from choosing nursing as a career? To express ourselves completely and honestly, we must first look to develop personally and professionally. We, as nurses, need to implement a plan of action to further enhance our professionalism and solicit new members. My suggestions for such a plan include:

    • First, "Do no harm", do not degrade the profession by words, actions, or deeds
    • Become a teacher, mentor, role model to young professionals
    • Develop a strategy for community awareness and respect for the profession
    • Strive to continue to elevate our own personal standards and the standards of our profession (i.e.: educational requirements should be MSN for managers and teachers)
    • Find ways to enhance the collective voice of nursing in your workplace, state, country
    • Finally have pride and enjoy the wonderful and rewarding career that you have chosen

These ideas can help our profession gain a sense of why it is we are important to society and why we are irreplaceable to the healthcare system. By continuing to discuss only the negative nursing experiences it is discouraging many prospective nurses from entering the profession all together. Nurses need to share stories of how wonderful and rewarding a career in nursing can be. "I have never been bored or disinterested in nursing because I’ve been able to have so many roles in many settings…nursing is intellectually stimulating as I read articles in nursing, attend conferences and meetings and use that knowledge in my practice…I could share that I have had the pleasure of participating in the professional growth and development and that almost everyday new opportunities present themselves to me because I am nurse…and that I haven’t regretted a day or a moment for having chosen nursing as a career" states Christine Mueller, RN, PhD (Mueller 2001).

It is stories like these that will bring those future nurses into a career that can be more rewarding than most. How many other careers allow you to be a part of the milestones of life like birth and death, recovery from illness and trauma and make a difference in the lives of those that cross your path? Nurses are the backbone of the patient care setting offering holistic care unlike any offered by other members of the healthcare team. And as nurses we have an obligation to save our profession from further deterioration and overall worsening of the nursing shortage.

             Whether you are a bedside nurse or a top nursing executive it is the responsibility of us all to make our voices heard throughout the halls of our hospitals, state legislatures, and this country. We must show why it is important to improve conditions and what a wonderful and rewarding career nursing is and can be to many individuals that have much to offer this outstanding and admirable profession. If we, ourselves, have immense pride and respect for what it is we do, we have to influence others to this frame of mind in order to make a difference in the careers we have chosen. Be proud and speak loudly letting everyone know what a noble and caring profession it is that we share.


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Boehner, J. (2001). Nursing shortage. FDCH Congressional testimony September 25, 2001.

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Heinrich, J. (2001). Emerging nurse shortages due to multiple factors. FDCH government account reports July 10, 2001.retrieved from http://ehostvgw20.epnet.com

Jeffords, J. (2001). Jeffords’ legislation to strengthen nursing profession passes health committee. FDCH press releases November 1, 2001. retrieved from http://ehostvgw20.epnet.com

Mueller, C. (2001). The breadth and depth of nursing. Creative Nursing, 7(4), 3-5. retrieved from http://ehostvgw20.epnet.com

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Welch, M. (2001-2002). The nursing shortage may be permanent. Connecticut Nursing News, 74(4), p24. retrieved from http://proquest.umi.com


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