The United States has the largest professional nurse workforce in the world numbering close to 3
million but does not produce enough nurses to meet its growing demand. A shortage of close to a million
professional nurses is projected to evolve by 2020. An emerging physician shortage will further exacerbate
the nurse shortage as the boundaries in scope of practice necessarily overlap. Nurse immigration has been
growing since 1990 and the U.S. is now the world’s major importer of nurses. While nurse immigration is
expected to continue to grow, the shortage is too large to be solved by recruitment of nurses educated
abroad without dramatically depleting the world’s nurse resources. Moreover, the domestic applicant pool
for nursing education is very strong with tens of thousands of qualified applicants turned away annually
because of faculty shortages and capacity limitations. The national shortage could be largely addressed by
investments in expanding nursing school capacity to increase graduations by 25 percent annually and the
domestic applicant pool appears sufficient to support such an increase. A shortage of faculty and limited
capacity for expansion of baccalaureate and graduate nurse education require public policy interventions.
Specifically public subsidies to increase production of baccalaureate nurses are required to enlarge the size
of the pool from which nurse faculty, advanced practice nurses in clinical care roles, and managers are all
recruited. Retention of nurses in the workforce is critical and will require substantial improvements in
human resource policies, the development of satisfying professional work environments, and technological
innovations to ease the physical burdens of caregiving. Because of the reliance of the U.S. on nurses
educated abroad as well as the benefits to the U.S. of improving global health, the nation should invest in
nursing education as part of its global agenda.
Nurse Workforce Challenges in the United States
Implications for Policy
Working paper
OECD Health Working Papers
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