RN Workforce Rebounds After Steep Pandemic Drop

                                                                By Shannon Firth

The registered nurse (RN) workforce rebounded in 2022 and 2023 after a drop during the COVID-19 pandemic, with continued growth forecasted through 2035, according to a retrospective cohort analysis of employment trends.

After a steep drop in 2021, RN employment bounced back, with the total number of full-time equivalent RNs rising to 3.37 million by 2023, reflecting a 6% jump from 2018 and 2019, reported David Auerbach, PhD, of Brandeis University in Waltham, Massachusetts, and colleagues.

Looking ahead to 2035, the number of employed RNs will continue to grow to approximately 4.56 million, which is close to prepandemic forecasts, they noted.

RNs ages 35 to 49 are projected to be the primary drivers of this growth, with expected increases from 38% of the nursing workforce in 2022 to 47% in 2035.

"Whether this forecasted growth will satisfy needs for the types of healthcare services provided by RNs, or match healthcare delivery organizations' demand for RN labor, remains to be seen," Auerbach and team wrote. "These uncertainties suggest a heightened need to continue to monitor changes in the U.S. RN workforce."

Workforce growth from 2018-2019 to 2022-2023 was seen across all age groups, but particularly among RNs younger than 35, with double the rate of growth for those older than 50 (8.2% vs 3.5%, respectively). Growth was also observed among male RNs (14.1%), unmarried RNs (7.4%), advanced practice registered nurses (18.2%), and RNs working in non-hospital settings (12.8%).

In addition, the number of applications to Bachelors of Science in Nursing programs and enrolled students in these programs has also substantially increased over the past two decades, 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.

In the near-term, as Baby Boomer nurses retire, they leave behind "a large number of early-career RNs," said Auerbach, which could create a "mentoring challenge."

Asked about the contrast between his findings and recent headlines, Auerbach acknowledged reports of nurses being stretched thin and nursing strikes.

"That doesn't seem to have dampened enthusiasm to be a nurse overall," he said, although he noted that enthusiasm for hospital work may have waned. RNs are leaving the field, even more so in the wake of a global pandemic, he added. "But ... if you only report on the nurses leaving, and don't account for those who are coming in, you can create some scary sounding headlines."

While there have been reports of nursing shortages in certain states, Auerbach said such reporting is based on forecasts of supply and demand trends for individual states from data released by the Health Resources and Services Administration (HRSA). He said the models are "mostly guessing ... [and] any given HRSA shortage forecast ... is going to have lots of states in surplus and lots in shortage."

Patricia "Polly" Pittman, PhD, of the Milken Institute School of Public Health at George Washington University in Washington D.C., said that the study provides "important empirical evidence that we have a lot of nurses in this country," which is contrary to the narrative of a "so-called nursing shortage," which accounts for the demand for increasing the number of visas for international nurses.

"It's not because we don't have enough U.S. nurses," said Pittman, who was not involved in the study. "It's because we don't have enough U.S. nurses willing to work in hospitals ... It's a problem of hospital employment, rather than a problem of supply."

"Figuring out ways to pay nurses more would certainly be a way to help keep them in hospitals," she added.

For this study, Auerbach and team used data from the U.S. Bureau of the Census Current Population Survey and included 455,085 employed RNs ages 23 to 69 from 1982 through 2023.

Due to the drop in the number of employed RNs in 2021, the authors conducted an analysis of the data through 2023 to understand whether this was a "temporary deviation" or a more "lasting change."

To forecast the growth of the workforce through 2035, Auerbach and team "applied a labor supply cohort model" used in prior forecasts, coupled with data on nursing school enrollment.

The forecasting model relies on the assumption that interest in nursing and retirement patterns will be "relatively steady over the next decade," the authors noted, adding that outside factors and "disruptions" could alter that forecast.