OECD Health Working Papers

This series is designed to make available to a wider readership health studies prepared for use within the OECD. Authorship is usually collective, but principal writers are named. The papers are generally available only in their original language - English or French - with a summary in the other.

English, French

Nurse Workforce Challenges in the United States

Implications for Policy

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.


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