Description
The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity” report makes recommendations for lifelong learning and achieving higher levels of education.
In 1,000-1,250 words, examine the importance of nursing education and discuss your overall educational goals.
Include the following:
Discuss your options in the job market based on your educational level.
Review “The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity” report’s recommendations for achieving higher levels of education. Describe what professional certification or advanced degrees (MSN, DNP, etc.) you may want to pursue and explain your reasons for wanting to attain this education. Discuss the timeline for accomplishing these goals.
Discuss how increasing your level of education would affect how your competitiveness in the current job market and your role in the future of nursing.
Discuss the relationship of continuing nursing education to competency, attitudes, knowledge, and the ANA Scope and Standards for Practice and Code of Ethics.
Discuss whether continuing nursing education should be mandatory. Provide support for your response.
You are required to cite a minimum of three sources to complete this assignment. Sources must be published within the last 5 years, appropriate for the assignment criteria, and relevant to nursing practice.
Unformatted Attachment Preview
10/13/23, 6:33 PM
Reflection Paper – Rubric
Total
125 points
Criterion
1. Unsatisfactory 2. Insufficient
3. Approaching
4. Acceptable
5. Target
Job Options Based on
Educational Level
0 points
9.38 points
9.88 points
11.13 points
12.5 points
A detailed discussion of
options in the job
market based on
educational level is
omitted or inaccurate.
A discussion of options
in the job market based
on educational level
lacks detail or is
incomplete.
A discussion of options
in the job market based
on educational level is
present.
A detailed discussion of
options in the job
market based on
educational level is
present.
A clear and accurate
discussion of options in
the job market based on
educational level is
present.
0 points
9.38 points
9.88 points
11.13 points
12.5 points
A description of goals
and timeline for
professional certification
or advanced degrees are
present, including an
explanation of reasoning
is omitted or inaccurate.
A description of goals
and timeline for
professional certification
or advanced degrees are
present, including an
explanation of reasoning
lacks detail or is
incomplete.
A description of goals
and timeline for
professional certification
or advanced degrees are
present, including an
explanation of
reasoning.
A detailed description of
goals and timeline for
professional certification
or advanced degrees are
present, including an
explanation of
reasoning.
A thorough and
insightful description of
goals and timeline for
professional certification
or advanced degrees are
present, including an
explanation of
reasoning.
0 points
9.38 points
9.88 points
11.13 points
12.5 points
A discussion of how
increasing level of
education would affect
competitiveness in
current job market and
personal role in the
future of nursing is
omitted or inaccurate.
A discussion of how
increasing level of
education would affect
competitiveness in
current job market and
personal role in the
future of nursing lacks
detail or is incomplete.
A discussion of how
increasing level of
education would affect
competitiveness in
current job market and
personal role in the
future of nursing is
presented.
A detailed discussion of
how increasing level of
education would affect
competitiveness in
current job market and
personal role in the
future of nursing is
presented.
A thorough and
insightful discussion of
how increasing level of
education would affect
competitiveness in
current job market and
personal role in the
future of nursing is
presented.
Relationship of
Continuing Nursing
Education
0 points
18.75 points
19.75 points
22.25 points
25 points
A discussion establishing
the relationship of
A discussion establishing continuing education in
the relationship of
nursing to competency,
continuing education in
attitudes, knowledge,
nursing to competency,
and the ANA Scope and
attitudes, knowledge,
Standards for Practice
and the ANA Scope and
and Code of Ethics is
Standards for Practice
omitted or inaccurate.
and Code of Ethics.
A discussion establishing
the relationship of
continuing education in
nursing to competency,
attitudes, knowledge,
and the ANA Scope and
Standards for Practice
and Code of Ethics lacks
detail or is incomplete.
A discussion establishing
the relationship of
continuing education in
nursing to competency,
attitudes, knowledge,
and the ANA Scope and
Standards for Practice
and Code of Ethics is
presented.
A detailed discussion
establishing the
relationship of
continuing education in
nursing to competency,
attitudes, knowledge,
and the ANA Scope and
Standards for Practice
and Code of Ethics is
presented.
A thorough and accurate
discussion establishing
the relationship of
continuing education in
nursing to competency,
attitudes, knowledge,
and the ANA Scope and
Standards for Practice
and Code of Ethics is
presented.
Mandatory Continuing
Education Nursing
0 points
18.75 points
19.75 points
22.25 points
25 points
A discussion of whether
continuing nursing
education should be
mandatory is omitted or
inaccurate.
A discussion of whether
continuing nursing
education should be
mandatory lacks detail
or is incomplete.
A discussion of whether
continuing nursing
education should be
mandatory is presented.
A detailed discussion of
whether continuing
nursing education
should be mandatory is
presented.
A thorough and
insightful discussion of
whether continuing
nursing education
should be mandatory is
presented.
A discussion of options
in the job market based
on educational level.
Goals for Professional
Education
A description of goals
and timeline for
professional certification
or advanced degrees,
including an explanation
of reasoning.
Increase in Level of
Education and Effect
on Competitiveness in
Job Market and in Role
in the Future
A discussion of how
increasing level of
education would affect
competitiveness in
current job market and
personal role in the
future of nursing.
A discussion of whether
continuing nursing
education should be
mandatory.
Thesis, Position, or
about:srcdoc
Page 1 of 2
10/13/23, 6:33 PM
Purpose
0 points
6.56 points
6.91 points
7.79 points
8.75 points
The thesis, position, or
purpose is not
discernible. No
awareness of the
appropriate audience is
evident.
The thesis, position, or
purpose is unfocused or
confused. There is very
little awareness of the
intended audience.
The thesis, position, or
purpose is discernable in
most aspects but is
occasionally weak or
unclear. There is limited
awareness of the
appropriate audience.
The thesis, position, or
purpose is adequately
presented. An
awareness of the
appropriate audience is
demonstrated.
The thesis, position, or
purpose is clearly
communicated
throughout and clearly
directed to a specific
audience.
0 points
6.56 points
6.91 points
7.79 points
8.75 points
Advances position or
purpose throughout
writing; conclusion
aligns to and evolves
from development.
No advancement of the
thesis, position, or
purpose is evident.
Connections between
paragraphs are missing
or inappropriate. No
conclusion is offered.
Writing lacks logical
progression of the
thesis, position, or
purpose. Some
organization is
attempted, but ideas are
disconnected.
Conclusion is unclear
and not supported by
the overall development
of the purpose.
Limited advancement of
thesis, position, or
purpose is discernable.
There are
inconsistencies in
organization or the
relationship of ideas.
Conclusion is simplistic
and not fully aligned to
the development of the
purpose.
The thesis, position, or
purpose is advanced in
most aspects. Ideas
clearly build on each
other. Conclusion aligns
to the development of
the purpose.
The thesis, position, or
purpose is logically
advanced throughout.
The progression of ideas
is coherent and unified.
A clear and logical
conclusion aligns to the
development of the
purpose.
Evidence
0 points
5.63 points
5.93 points
6.68 points
7.5 points
Selects and integrates
evidence to support and
advance
position/purpose;
considers other
perspectives.
Evidence to support the
thesis, position, or
purpose is absent. The
writing relies entirely on
the perspective of the
writer.
Evidence is limited or
irrelevant. The
interpretation of other
perspectives is
superficial or incorrect.
Evidence is used but is
insufficient or of limited
relevance. Simplistic
explanation or
integration of other
perspectives is present.
Relevant evidence that
includes other
perspectives is used.
Specific and appropriate
evidence is included.
Relevant perspectives of
others are clearly
considered.
Mechanics of Writing
0 points
5.63 points
5.93 points
6.68 points
7.5 points
Includes spelling,
capitalization,
punctuation, grammar,
language use, sentence
structure, etc.
Errors in grammar or
syntax are pervasive and
impede meaning.
Incorrect language
choice or sentence
structure errors are
found throughout.
Frequent and repetitive
mechanical errors are
present. Inconsistencies
in language choice or
sentence structure are
recurrent.
Occasional mechanical
errors are present.
Language choice is
generally appropriate.
Varied sentence
structure is attempted.
Few mechanical errors
are present. Suitable
language choice and
sentence structure are
used.
No mechanical errors
are present. Appropriate
language choice and
sentence structure are
used throughout.
Format/Documentation 0 points
3.75 points
3.95 points
4.45 points
5 points
Uses appropriate style,
such as APA, MLA, etc.,
for college, subject, and
level; documents
sources using citations,
footnotes, references,
bibliography, etc.,
appropriate to
assignment and
discipline.
Appropriate format is
attempted, but some
elements are missing.
Frequent errors in
documentation of
sources are evident.
Appropriate format and
documentation are
used, although there are
some obvious errors.
Appropriate format and
documentation are used
with only minor errors.
No errors in formatting
or documentation are
present.
Communicates reason
for writing and
demonstrates
awareness of audience.
Development,
Structure, and
Conclusion
about:srcdoc
Appropriate format is
not used. No
documentation of
sources is provided.
Page 2 of 2
The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity
3
The Nursing Workforce
Health care delivery systems are “held together, glued together,
enabled to function … by the nurses.”
Copyright © 2021. National Academies Press. All rights reserved.
—Adapted from Lewis Thomas, physician, essayist, researcher
The nursing workforce will be tested in a variety of ways over the next
decade, including responding to an aging population that has more
complex and intense medical needs, demand for more primary care capacity, and the need to bridge medical and health care with the social
factors that influence people’s health and well-being. To build a future
workforce that effectively provides the health and health care that society needs will require a substantial increase in the numbers, types, and
distribution of the nursing workforce, as well as an education system
that better prepares nurses for practicing in community-based settings
with diverse populations that face a variety of lived experiences. These
improvements will occur more rapidly, more uniformly, and more successfully if programmatic, policy, and funding opportunities can be
leveraged by health systems, governments, educators, and payers.
Today in the United States, the health of far too many individuals, families,
entire neighborhoods, and communities is compromised by social determinants
of health (SDOH), such as food insecurity and poverty, as well as by limited
access to health care services. The size, distribution, diversity, and educational
preparation of the nursing workforce needed to assist in addressing these health
challenges are therefore critically important. Even as the potential for nurses to
help improve both SDOH and health outcomes has become clear, however, it has
become increasingly apparent that a robust nursing workforce ready to meet these
59
Copyright National Academy of Sciences. All rights reserved.
National, A. O. S. E. A., National, A. O. M., & Committee, O. T. F. O. N. (2021). The future of nursing 2020-2030 : Charting a path
to achieve health equity. National Academies Press.
Created from gcu on 2023-10-13 22:40:05.
The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity
60
THE FUTURE OF NURSING 2020–2030
challenges does not yet exist. In fact, some of the data discussed in this chapter
highlight the potential for current gaps in the capacity of the nursing workforce
to widen over the present decade.
As described in the committee’s framework for this study (see Figure 1-1 in
Chapter 1), strengthening the nursing workforce is one of the key areas that will
enhance nursing’s role in addressing SDOH and improving health and health care
equity. This chapter focuses on building the nursing workforce needed to respond
to SDOH that affect the health care needs of individuals, communities, and society, including the pressing need to reduce health and health care inequities. The
chapter begins by placing the nursing workforce in context and summarizing its
current state and strengths. Next, it describes key challenges nurses will face over
the current decade. Comparison of these challenges against the current state of the
nursing workforce illuminates numerous gaps in the workforce that will need to
be filled to meet the goal of addressing SDOH and improving health equity. After
summarizing research needed to help nurses meet these challenges, the chapter
ends with conclusions.
The nursing workforce is composed of actively employed registered nurses
(RNs), licensed practical or licensed vocational nurses (LPN/LVNs), and advanced practice registered nurses (APRNs). As described in greater detail at the
end of the chapter, the data and methods used to describe the nursing workforce
come primarily from the 2008 and 2018 National Sample Survey of Registered
Nurses (NSSRN), the U.S. Census Bureau’s yearly American Community Survey
(ACS) for 2000–2018, and other sources.
Copyright © 2021. National Academies Press. All rights reserved.
THE NURSING WORKFORCE IN CONTEXT
The number of nurses in the United States has grown steadily over the past
100 years. The nursing workforce is the largest among all the health care professions and is nearly four times the size of the physician workforce. RNs practice
in a wide variety of care delivery settings, and they provide care to people living
in both urban and rural areas and to vulnerable populations, including women,
people of color (POC), American Indians/Alaska Natives (AI/ANs), low-income
individuals, individuals with disabilities, and people who are enrolled in both
Medicare and Medicaid (dual eligible).
The shift in nursing education from hospital-based diploma programs to
degrees from colleges and universities has prepared RNs for more highly skilled
roles that have expanded their reach and impact, benefiting both nurses and their
employers. The emergence and growth of nurse practitioners (NPs) in the mid1960s, together with other advanced practice nursing roles (certified nurse midwives, nurse anesthetists, and clinical nurse specialists), represent a significant
advancement. Nurses also benefit individuals, communities, and society through
their efforts as scientists conducting clinical and health services research; as
executives and entrepreneurs leading health care organizations; as members of
Copyright National Academy of Sciences. All rights reserved.
National, A. O. S. E. A., National, A. O. M., & Committee, O. T. F. O. N. (2021). The future of nursing 2020-2030 : Charting a path
to achieve health equity. National Academies Press.
Created from gcu on 2023-10-13 22:40:05.
The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity
Copyright © 2021. National Academies Press. All rights reserved.
THE NURSING WORKFORCE
61
hospital and health system boards; as public health officers and educators; and as
members of federal, state, and local governments.
For decades, nurse employment has grown concurrently with increased U.S.
spending on acute care, seemingly impervious to either government or market-oriented efforts aimed at constraining the overutilization of costly health care
services. With unemployment rates rarely exceeding 1.5 percent, job availability
has seldom been a problem for nurses (BLS, 2020; Zhang et al., 2018). Even
during economic downturns, RN employment typically has increased, sometimes dramatically. Hospitals added nearly 250,000 nursing full-time equivalents
(FTEs) during the Great Recession, for example, including in economically depressed areas of the country (Buerhaus and Auerbach, 2011). Even so, vacancies
exist in some areas, including Indian Health Service areas, with uneven distribution across several states, ranging from 10 to 31 percent (GAO, 2018).
RNs and APRNs are among the most highly paid health professionals, making the nursing profession an economic engine for families and communities. In
2018, national RN earnings averaged $76,000, and with an estimated 3.35 million
RNs working on an FTE basis in the United States, total RN earnings amounted
to roughly $255 billion (not counting nonwage benefits). As a result, the value
of the clinical care they deliver typically appears on the cost side rather than the
revenue side of earnings statements for provider organizations. When thinking
about how nurses can promote health equity, however, one should not lose sight
of their contributions to the economic as well as the social and environmental
fabric of the places where they live and work.
The COVID-19 pandemic has illuminated the critical importance of nurses,
but it also has disrupted long-standing employment patterns and threatened nurses’
financial, psychological, and physical resilience. Nurses heroically risked exposure
to the coronavirus each day to care for patients and their families, sometimes without adequate personal protective equipment. But the pandemic also exposed nurses’
vulnerability to their clinical employers’ dependence on reimbursable services,
especially elective procedures, to remain in business. With revenue from private
health insurers in steep decline, many hospitals and clinics seeking quick reductions
in costs have cut back on nursing through furloughs and layoffs (Gooch, 2020).
This counterproductive response to the pandemic could cause long-lasting damage
to the nursing profession and the health care system. This and other destabilizing
effects on the nursing workforce associated with COVID-19 merit close attention.
CURRENT STATE AND STRENGTHS OF
THE NURSING WORKFORCE
Although this chapter’s main focus is on identifying the challenges and gaps
in the nursing workforce that will develop over this decade and describing ways to
overcome them, the success of such actions will depend on leveraging the capacity
and the many strengths of the current nursing workforce. These strengths represent
opportunities to achieve and sustain a workforce of sufficient size, distribution,
Copyright National Academy of Sciences. All rights reserved.
National, A. O. S. E. A., National, A. O. M., & Committee, O. T. F. O. N. (2021). The future of nursing 2020-2030 : Charting a path
to achieve health equity. National Academies Press.
Created from gcu on 2023-10-13 22:40:05.
The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity
62
THE FUTURE OF NURSING 2020–2030
diversity, and expertise to help achieve equity in health and health care and reverse
the trajectory of poor health status seen in communities across the nation.
Copyright © 2021. National Academies Press. All rights reserved.
Registered Nurses
Over the past 20 years, the number of people becoming RNs has increased
rapidly, reaching 3.35 million FTEs in 2018 (see Table 3-1). Although the RN workforce continues to be composed largely of White women, the proportion of White
RNs decreased from 79.1 percent in 2000 to 69 percent in 2018. The workforce
has steadily become more diverse as the proportion of RNs who are Black/African
American now approximates that of the nation’s population (12 percent), while the
proportion of RNs who are Asian (9.1 percent) exceeds that of the population (6
percent). On the other hand, despite doubling since 2001, the proportion of Hispanic
RNs in the nursing workforce (7.4 percent) is well below that of the population (18.3
percent). The proportion of men who are RNs had grown to 12.7 percent by 2018.
RNs are increasingly educated at both the undergraduate and graduate levels.
It is important to note that the 2011 The Future of Nursing report recommends
increasing the percentage of nurses with a baccalaureate degree to 80 percent by
2020 (IOM, 2011). The number of employed RNs prepared with at least a bachelor’s
degree has surpassed the number prepared with an associate’s degree. This growth
has been driven, in part, by RNs completing RN-to-bachelor of science in nursing
(BSN) education programs, which provide additional education needed by RNs
with an associate’s degree to earn a BSN. The increase in educational attainment
has been particularly strong among POC RNs. Table 3-2 shows that nationally, a
higher percentage of Black/African American, Hispanic, and particularly Asian RNs
relative to White RNs have a BSN.1 Proportionately, more Black/African American
and Asian RNs than White and Hispanic RNs have a master’s degree, or a doctor of
nursing practice (DNP) or a PhD in nursing. Box 3-1 provides information on the
nursing workforce educated in countries outside of the United States.
Analysis of data from the American Association of Colleges of Nursing
(AACN) shows that between 2010 and 2017, the number of RNs who obtained a
doctoral degree increased rapidly, with those obtaining a DNP far outnumbering
those obtaining a PhD (see Figure 3-1). Among White RNs, the number of DNP
graduates increased from 982 in 2010 to 4,138 in 2017 (an increase exceeding
3,000 percent), while the number of PhD graduates increased from 363 to 462
1 It is possible that nurses educated in other countries are more likely to have earned a bachelor’s
degree, which could partially account for the higher percentage of bachelor’s-level education reported
by Black/African American and Asian RNs relative to White RNs. When the committee investigated
this possibility, it found no supporting evidence with regard to Black/African American nurses but
a significant impact for Asian RNs. Additionally, when we examined RNs under age 40, the pattern
of results persisted, as a higher proportion of Black/African American (67.3 percent), Asian (76.7
percent), and other (68 percent) RNs compared with White (65 percent) RNs had earned a bachelor’s
degree in nursing, Hispanics (58 percent) being the exception.
Copyright National Academy of Sciences. All rights reserved.
National, A. O. S. E. A., National, A. O. M., & Committee, O. T. F. O. N. (2021). The future of nursing 2020-2030 : Charting a path
to achieve health equity. National Academies Press.
Created from gcu on 2023-10-13 22:40:05.
The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity
63
THE NURSING WORKFORCE
TABLE 3-1 Demographic Characteristics of Full-Time Equivalent (FTE)
Registered Nurses (RNs), 2000–2018
Year
Characteristics
2000
2004
2008
2018
Total FTE RNs
1,985,944
2,142,353
2,542,703
3,352,461
FTE RNs/
population
7.04
7.32
8.36
10.26
Men
157,285
(7.9%)
211,891
(9.9%)
244,363
(9.6%)
424,342
(12.7%)
Women
1,828,709
(92.1%)
1,930,462
(90.1%)
2,298,340
(90.4%)
2,928,119
(87.3%)
White
1,571,136
(79.1%)
1,673,073
(78.1%)
1,906,756
(75.0%)
2,313,002
(69.0%)
Black/African
American
175,669
(8.8%)
191,102
(8.9%)
269,271
(10.6%)
401,755
(12.0%)
Asian
128,064
(6.4%)
161,598
(7.5%)
211,751
(8.3%)
305,740
(9.1%)
Other
37,266
(1.9%)
28,027
(1.3%)
37,370
(1.5%)
84,454
(2.5%)
Hispanic
73,859
(3.7%)
88,553
(4.1%)
117,556
(4.6%)
247,511
(7.4%)
Associate’s
Degree
703,959
(37.7%)
839,506
(37.4%)
997,671
(38.1%)
910,629
(29.3%)
Bachelor’s
Degree
610,735
(32.7%)
778,513
(34.7%)
957,422
(36.6%)
1,411,525
(45.4%)
Master’s
Degree/PhD
202,018
(10.8%)
296,245
(13.2%)
361,559
(13.8%)
644,764
(20.7%)
Hospital
1,307,476
(63%)
1,352,356
(63.1%)
1,606,924
(63.2%)
2,071,034
(61.8%)
Nonhospital
778,461
(37%)
789,997
(36.9%)
935,779
(36.8%)
1,281,424
(38.2%)
50 percent). As RNs in these settings retire, they will be
replaced by more recently educated nurses who, as discussed below, may not
be as prepared for taking care of medically complex patients and addressing
SDOH.
Fewer RNs are working in rural areas today than in the past (17 percent in
2005 versus 14.4 percent in 2018). The percentage working in rural hospitals
also decreased over these same years (from 16.4 percent to 13.4 percent), as did
the percentage of rural RNs working in nonhospital settings (18 percent to 16
percent). Furthermore, the decline in rural practicing RNs occurred more rapidly
among younger RNs (under age 40) (from 18.1 percent to 13.7 percent) than
among RNs over age 40 (from 16.4 percent to 14.9 percent). If this decrease
continues, it will threaten access to care among the nation’s rural population.
Given the large number of RNs working in critical access hospitals (more than
300,000) and the concern that more rural hospitals will close in the years ahead
(Frakt, 2019), the number of RNs and physicians practicing in rural areas could
decline further during this decade, complicating policies aimed at increasing
access to care for the populations in these areas.
Looking to the future, the size of the FTE RN workforce is projected to grow
substantially, from 3.35 million in 2018 to 4.54 million in 2030, enough to replace
all the baby boom RNs who will retire over the decade. However, this projected
growth will not occur uniformly across the nation because the replacement of
the large numbers of retiring RNs by younger nurses will vary by state and by
region. Thus, health care delivery organizations in some regions of the country
will confront more rapid retirements and slower replacements among their RN
workforce relative to other regions, which could in turn result in staffing disruptions. Still, the estimated growth in the RN supply is encouraging and means
that large, long-lasting national shortages of RNs are unlikely to be seen during
the decade. At the same time, as with all projections, these estimates are based
on assumptions that may not hold over the projection period and are subject to
unforeseen developments, such as the economic and noneconomic effects of the
COVID-19 pandemic.
Copyright National Academy of Sciences. All rights reserved.
National, A. O. S. E. A., National, A. O. M., & Committee, O. T. F. O. N. (2021). The future of nursing 2020-2030 : Charting a path
to achieve health equity. National Academies Press.
Created from gcu on 2023-10-13 22:40:05.
The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity
THE NURSING WORKFORCE
69
Licensed Practical/Vocational Nurses
Copyright © 2021. National Academies Press. All rights reserved.
LPN/LVNs (for brevity, referred to here as LPNs) support RNs and APRNs in
providing patient care. In 2018, an estimated 701,650 LPNs provided health care
to mostly racially and ethnically diverse populations both in the community and
in health care organizations. These nurses also add meaningfully to the pipeline
for RN and APRN roles and, importantly, allow RNs to concentrate on caring for
medically complex patients (NCSBN, 2020). As the U.S. population ages, LPNs
are likely to become an important resource for home care, long-term care, and care
for individuals with disabilities and otherwise vulnerable groups. As in the case of
RNs, the majority of LPNs are White (71.4 percent), but there are proportionately
more Black/African American LPNs (18.5 percent) than is the case among RNs
(12 percent). Also, as with RNs, the proportion of Hispanic (7.4 percent) and male
(7.7 percent) LPNs in 2017 was far below their proportion in the population. Smiley and colleagues (2018) report that newer cohorts of LPNs are younger and more
likely to be racially and ethnically diverse (Smiley et al., 2018, p. S46).
As of 2018, more than one-third (38 percent) of LPNs worked in nursing and
residential care facilities, considerably more than in hospitals (15 percent), physician offices (13 percent), and home health care facilities (12 percent). Almost one
in four LPNs lived in rural areas (166,000). Because nearly one-third of LPNs are
over age 55, their impending retirement over the next decade raises concern about
a potential shortage of these nurses (Smiley et al., 2018, p. S59). A 2017 Health
Resources and Services Administration (HRSA) analysis suggests that, because
the demand for LPNs is growing at a slightly faster rate than the supply, a shortfall
of roughly 150,000 FTE LPNs is possible by 2030 (HRSA, 2017, p. 13). Such a
shortage could mean that home care, long-term care, and care for individuals with
disabilities and otherwise vulnerable groups will increasingly have to be provided
by the RN workforce.
Box 3-2 provides information on the impacts of COVID-19 on the nursing
workforce in nursing homes.
Advanced Practice Registered Nurses
APRNs are nurses who hold a master’s degree, post-master’s certificate, or
practice-focused DNP degree in one of four roles: NP, certified registered nurse
anesthetist (CRNA), clinical nurse specialist (CNS), or certified nurse midwife
(CNM). As shown in Table 3-4, counting the number of APRNs is complicated
because many APRNs are prepared in more than one role (e.g., they could be an
NP and also a CNM or a CNS), and because a considerable number are employed
in a position that is not what they were prepared for (e.g., an NP might be working
as an RN rather than as an NP, or a CNM working as an NP). For consistency, this
section focuses on APRNs who are employed in nursing and are working in the
role for which they were prepared. Also, because of the larger numbers of APRNs
practicing in the NP role relative to other advanced practice roles, this section
focuses largely on NPs.
Copyright National Academy of Sciences. All rights reserved.
National, A. O. S. E. A., National, A. O. M., & Committee, O. T. F. O. N. (2021). The future of nursing 2020-2030 : Charting a path
to achieve health equity. National Academies Press.
Created from gcu on 2023-10-13 22:40:05.
The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity
70
THE FUTURE OF NURSING 2020–2030
BOX 3-2
COVID-19 and Nurse Staffing in Nursing Homes
As of 2020, there were 15,417 long-term care facilities in the United States
(CMS, 2020), and in 2017, these facilities housed just over 1.3 million people
(Chidambaram, 2020). As of the end of May 2020, there were 95,515 cumulative
confirmed cases of COVID-19 among nursing home residents in the United States
and 30.2 deaths per 1,000 residents. Almost one-third (31,782) of the 103,700
people who died from COVID-19 in the United States through the end of May were
residents of nursing homes (CMS, 2020). As of the end of July 2020, more than
60,000 deaths had occurred in nursing homes and long-term care facilities in the
United Sates, and close to 800 staff had died (McGarry et al., 2020).
A 2019 study (Geng et al., 2019) assessed nursing home staffing prior to the
spread of COVID-19 using various data available from the Centers for Medicare
& Medicaid Services (CMS). Among the study’s findings were the following:
• Seventy-five percent of nursing homes were almost never in compliance
with what CMS expected their registered nurse (RN) staffing levels to be,
based on residents’ acuity.
• Across staffing categories (RN, licensed practical nurse [LPN], and nurse
aide), staffing levels, especially for RNs, were stable during weekdays
but dropped on weekends. On average, weekend RN staffing in terms of
time spent per resident was 17 minutes (42 percent) less than weekday
staffing, LPN staffing 9 minutes (17 percent) less, and nurse aide staffing
12 minutes (9 percent) less.
Copyright © 2021. National Academies Press. All rights reserved.
Larger facilities, on average, had a larger decrease in staffing time per resident
during weekends. Decreases were smaller among facilities with higher five-star
overall ratings and with lower shares of Medicaid residents.
A 2020 study (McGarry et al., 2020) examined access to personal protective
equipment (PPE), staffing, and facility characteristics associated with shortages
of PPE and staffing from May through the end of July 2020. Findings included the
following:
• One in five nursing homes reported facing a severe shortage of PPE or staff
shortage in early July 2020. Rates of both PPE shortages and staff did not
meaningfully improve from May to July 2020.
• PPE shortages were magnified in nursing homes with COVID-19 cases
among staff or residents and those with low quality scores.
•
Staff shortages were greater in facilities with COVID-19 cases, particularly
among those serving a high proportion of disadvantaged patients on Medicaid
and those with lower quality scores, including pre-pandemic staffing score.
• Most prominent staff shortages were for nurses and nursing aides as opposed to other providers or staff.
As shown in the table below, by a wide margin, the numbers of LPNs, home
and personal care aides, nursing assistants, and other support staff working in
skilled nursing facilities (SNFs) far exceeded the numbers of professionals over
Copyright National Academy of Sciences. All rights reserved.
National, A. O. S. E. A., National, A. O. M., & Committee, O. T. F. O. N. (2021). The future of nursing 2020-2030 : Charting a path
to achieve health equity. National Academies Press.
Created from gcu on 2023-10-13 22:40:05.
The Future o
