The Aging Nursing Population

The population is aging at the same time that nurses are reaching retirement age and nursing schools are running out of space and faculty to train their replacements.

The U.S. Bureau of Labor Statistics reports that registered nurses top the list of professions with the largest projected growth – 2.9 million are expected to be employed in the field in 2012, up 21 percent from 2002 levels.

But most professionals in the nursing industry agree that expected employment numbers won’t be enough to meet the growing demand for nursing services.

The reason: Age is taking its toll. In addition to the overall aging of the population, driven by the baby boomer generation, the nursing work force itself also is getting older, and more experienced nurses are reaching retirement age. The same can be said for faculty who teach nursing students, and schools are falling behind in being able to fill a growing number of job openings in nursing.

In 2005, the U.S. Department of Health and Human Services reported 4,577 unfilled nursing jobs in Missouri, representing 8 percent of the total nursing work force. That number is expected to grow to 17,024, comprising 25 percent of the nursing work force, by 2020.

The increased demand means schools are expanding their nursing education programs, and health systems are finding new ways to get nurses to stick around longer and lure young people into the nursing field.

Getting older

The national median age of the U.S. population was 36.4 in 2006, up from 35.3 in 2000. The main culprit is the baby boomer generation, born between 1946 and 1964; more than 61 million people are currently between the ages of 45 and 59.

The average age of registered nurses is increasing too – 46.8 years in 2004, up from 45.2 years in 2000 and 40.3 years in 1980 – according to Health and Human Services. Also, about 41.1 percent of the registered-nurse population is 50 or older, compared to just 16.4 percent younger than 35.

The result is increased competition for nurses.

“I’ll go to a college or university, and there’ll be 15 or 20 different health care institutions and long-term care facilities trying to get a piece of the pie,” said Alan Dixon, senior nursing recruiter for St. John’s Health System. St. John’s employs nearly 1,700 registered nurses and has 110 open positions.

The story is the same at CoxHealth, which employs 1,600 nurses but is looking to fill another 125 openings.

“The competition is always there,” said Joan Cisna, human resources nursing specialist for CoxHealth. “That’s why we have to continually make sure we stay competitive in salary and benefits and encourage nurses to stay.”

The U.S. Bureau of Labor Statistics says that registered nurses in Missouri have average annual salaries of $53,150; that’s higher than the averages in Arkansas, Kansas and Oklahoma. The region including Springfield and Fayetteville, Ark., however, averages $48,340 a year – lower than Kansas City, St. Louis and Tulsa, Okla.

The new breed

Despite their best efforts, though, hospitals will eventually lose older nurses, due either to retirement or to the natural deterioration of their skills.

Although both CoxHealth and St. John’s have nursing schools, and Missouri State University and Ozarks Technical Community College have licensed practical nursing programs that complement the health systems’ registered nursing schools, there still won’t be enough nurses to meet the demand.

Ironically, the problem isn’t that there aren’t enough students interested in nursing.

St. John’s College of Nursing and Health Sciences at Southwest Baptist University has two to three applicants for every available space, according to Virginia Mayeux, director of the school’s associate degree program.

“We have been expanding over the past three years,” Mayeux said. “We went from 50 students per class to 85 per class in the past three years.”

Cox College of Nursing faces the same issues. School President Anne Liners Brett said that the school has about 420 total students, and about twice as many applicants. She said the shortage of nurses has created a favorable environment for graduates.

“There are choices in terms of different organizations, and there are also choices in shifts and specialty areas,” she said. “It’s pretty much write your own ticket.”

OTC will launch a registered nursing program in fall 2008 to help meet the growing demand for nurses. The school already has received approval for the program from the state and the OTC Board of Governors.

OTC’s registered nursing program would be funded by a proposed tax levy increase on the ballot in November and would receive its first 20 nursing students next year.

“Faculty is the most critical shortage,” Cox College President Brett said. “You have to have a master’s degree in nursing (to teach). There aren’t a lot of those people out there. Open faculty positions mean there are clinical groups that can’t be covered, which means we can’t increase our enrollment to combat the nursing shortage.”

OTC President Hal Higdon pointed to the state requirement that registered nursing programs have no more than 10 students per faculty member. A new faculty member, he said, costs about $100,000 including salary, benefits and administrative expenses.

“To start a program for 20 new students is about a $250,000 increase in costs,” Higdon said. “Tuition in no way comes close to meeting that.”

The operating levy, if approved, would increase from 14 cents to 26 cents per $100 of assessed valuation over a three-year period. The expected extra $5 million in revenue would, in part, go to expanding all of OTC’s allied health programs.

Classroom expansion, too, is limited by the number of available instructors, who, like nurses are aging.

According to HHS, the average age of faculty nurses is 51.6 years, and for nursing faculty with doctoral degrees it is 55.4 years.

“The problem is that you have to have a master’s degree in nursing to teach,” Higdon said. “So they cost more because there aren’t as many. Also, they’re aging – those people are cycling out.”

With the nursing shortage reaching critical levels, hospitals are looking for ideas to combat the problem. While Cisna said advances in technology, such as laparoscopic surgeries that shorten hospital stays, help somewhat, there is no magic bullet.

“Anyone that has an idea, whether it’s from on staff or someone who is applying, we’ll take it,” Cisna said. “We have the rule that no idea is a crazy one.”

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