The registered nurse (RN) workforce, which experienced a decline during the COVID-19 pandemic, has rebounded strongly in 2022 and 2023 according to a retrospective cohort analysis of employment trends. The total number of full-time equivalent registered nurses (RNs) rose to 3.37 million by 2023, reflecting a 6% increase from 2018-2019 according to David Auerbach, PhD of Brandeis University in Waltham, Massachusetts, and his colleagues. The growth is expected to continue through 2035, up to approximately 4.56 million, which is close to pre-pandemic levels, they noted in JAMA Health Forum.
The primary drivers of this growth are expected to be RNs between the ages of 35 to 49, whose numbers are forecasted to increase from 38% of the workforce in 2022 to 47% in 2035. This growth is seen across all age groups, particularly among RNs younger than 35, with double the rate of growth for those older than 50. Growth was also observed among male RNs, unmarried RNs, and advanced practice registered nurses, and RNs working in non-hospital settings.
Despite recent reports of nursing shortages and challenges in the field, including nurses leaving hospital work, the study suggests that overall enthusiasm for the nursing profession remains high. The increase in applications to Bachelors of Science in Nursing programs and the number of students enrolled in these programs over the past two decades have substantially increased, with both measures falling slightly in 2022. Moreover, the number of U.S.-trained students taking the National Council Licensure Examination (NCLEX) for the first time grew from 154,000 in 2016 to 185,000 in 2021.
Auerbach acknowledged reports of nurses being stretched thin and nursing strikes, but he believes it doesn't dampen enthusiasm to become a nurse overall, although he noted that enthusiasm for hospital work may have waned. RNs have been leaving the field, even more so in the wake of a global pandemic, but according to Auerbach, if we only report on the nurses leaving, and don't account for those who are coming in, then we create some scary sounding headlines.
Auerbach noted that reports of nursing shortages in specific states are primarily based on forecasts of supply and demand trends for those states, using data from the Health Resources and Services Administration (HRSA). He described these forecasting models as somewhat speculative, suggesting that any HRSA shortage forecast is likely to show some states with a surplus of nurses and others with a shortage.
Patricia "Polly" Pittman, PhD, from George Washington University's Milken Institute School of Public Health, highlighted the study's significance, stating it provides empirical evidence of a substantial nursing workforce in the U.S. This contrasts with the narrative of a supposed nursing shortage, often cited as a reason for increasing the number of visas for international nurses.
Pittman emphasized that the issue lies not in the availability of U.S. nurses but rather in their willingness to work in hospitals. She suggested that increasing nurses' pay could be a strategy to retain them in hospital settings.
In this study, Auerbach and colleagues analyzed data from the U.S. Bureau of the Census Current Population Survey, including information on 455,085 employed registered nurses (RNs) aged 23 to 69, spanning the years 1982 to 2023.
Because of the decrease in the number of employed registered nurses (RNs) in 2021, the authors extended their analysis of the data through 2023 to determine whether this decline was a temporary deviation or a more lasting change.
To predict the workforce's growth up to 2035, Auerbach and his team utilized a labor supply cohort model, which they had previously used for forecasts. They combined this model with data on nursing school enrollment.
The forecasting model is based on the assumption that interest in nursing and retirement patterns will remain relatively steady over the next decade, as noted by the authors. However, they also acknowledged that external factors and unforeseen disruptions could potentially change this forecast.