Research Article| Volume 8, ISSUE 2, P40-46, July 2017

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Four Challenges Facing the Nursing Workforce in the United States

      Four challenges face the nursing workforce of today and tomorrow: the aging of the baby boom generation, the shortage and uneven distribution of physicians, the accelerating rate of registered nurse retirements, and the uncertainty of health care reform. This article describes these major trends and examines their implications for nursing. The article also describes how nurses can meet these complex and interrelated challenges and continue to thrive in an ever-changing environment.


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        • Administration on Aging
        Issue brief #11: Reaching diverse older adult populations and engaging them in prevention services and early interventions.
        (Retrieved from)
        • Alzheimer’s Association
        Alzheimer’s disease facts and figures.
        Alzheimer’s and Dementia. 2016; 12 (Retrieved from)
        • Antos J.
        • Capretta J.
        Republicans should take the time necessary to improve the American Health Care Act.
        (Retrieved from)
        • Association of American Medical Colleges
        2017 update. The Complexities of physician supply and demand: Projections from 2015 to 2030. Final report. 2017 (Retrieved from)
        • Auerbach D.
        • Buerhaus P.
        • Staiger D.
        How fast will the RN workforce grow through 2030? Projections in nine regions of the country.
        Nursing Outlook. 2017; 65: 116-122
        • Auerbach D.
        • Buerhaus P.
        • Staiger D.
        Will the RN workforce weather the retirement of the baby boomers?.
        Medical Care. 2015; 53: 850-856
        • Auerbach D.
        • Buerhaus P.
        • Staiger D.
        Registered nurses are delaying retirement, a shift that has contributed to recent growth in the nurse workforce.
        Health Aff (Millwood) Web Exclusive. 2014; 33: 1474-1480
        • Baernholdt M.
        • Yan G.
        • Hinton I.
        • Rose K.
        • Mattos M.
        Quality of life in rural and urban adults 65 years and older: Findings from the National Health and Nutrition examination survey.
        The Journal of Rural Health: Official Journal of the American Rural Health Association and the National Rural Health Care Association. 2012; 28: 339-347
        • Bohmer R.M.J.
        Leading clinicians and clinicians leading.
        New England Journal of Medicine. 2013; 368: 1468-1470
        • Buerhaus P.I.
        • Auerbach D.I.
        • Staiger D.O.
        How should we prepare for the wave of retiring baby boomer nurses?.
        (Retrieved from)
        • Buerhaus P.
        • DesRoches C.
        • Dittus R.
        • Donelan K.
        Practice characteristics of primary care nurse practitioners and physicians.
        Nursing Outlook. 2015; 63: 144-153
      1. Buerhaus, P. I., Skinner, L., Staiger, D., & Auerbach, D. (In press). State of the RN workforce as a new era of health reform emerges. Nursing Economic$.

        • Buerhaus P.
        • Staiger D.
        • Auerbach D.
        Implications of a rapidly aging registered nurse workforce.
        JAMA. 2000; 283: 2948-2954
        • Centers for Medicare and Medicaid Services
        Medicare program – general information.
        (Retrieved from)
        • Centers for Medicare and Medicaid Services
        NHE projections 2016–2025.
        (Retrieved from)
        • Centers for Disease Control and Prevention
        The state of aging and health in America. 2013; (Retrieved from): 2013
        • Champlin L.
        Maldistribution of primary care workforce challenges efforts [Press release].
        (Retrieved from)
        • Colby S.L.
        • Ortman J.M.
        The baby boom cohort in the United States: Population estimates and projections.
        (Retrieved from)
      2. DesRoches, C., Clarke, S., Perloff, J., O’Reilly-Jacob, M., & Buerhaus, P. (In press). The quality of primary care provided by nurse practitioners to vulnerable Medicare beneficiaries. Nursing Outlook.

        • DesRoches C.
        • Gaudet J.
        • Perloff J.
        • Donelan K.
        • Iezonni L.
        • Buerhaus P.
        Using Medicare data to assess nurse practitioner provided care.
        Nursing Outlook. 2013; 61: 400-407
        • Donelan K.
        • DesRoches C.
        • Dittus R.
        • Buerhaus P.
        Perspectives of physicians and nurse practitioners on primary care practice.
        The New England Journal of Medicine. 2013; 368: 1898-1906
        • Goldman D.
        • Gaudette É.
        Strengthening medical care for 2030: Health and health care of Medicare beneficiaries in 2030. 2015 (Retrieved from)
        • Graves J.
        • Mishra P.
        • Dittus R.
        • Parikh R.
        • Perloff J.
        • Buerhaus P.
        Role of geography and nurse practitioner scope-of-practice in efforts to expand primary care system capacity: Health reform and the primary care workforce.
        Medical Care. 2016; 54: 81-89
        • Gudbranson E.
        • Glickman A.
        • Emanuel E.J.
        Reassessing the data on whether a physician shortage exists.
        JAMA. 2017;
        • Health Resources and Services Administration
        National and regional projections of supply and demand for primary care practitioners: 2013–2025.
        (Retrieved from)
        • Institute of Medicine
        The future of nursing: Leading change, advancing health.
        (Retrieved from)
        • King D.E.
        • Matheson E.
        • Chirina S.
        • Shankar A.
        • Broman-Fulks J.
        The status of baby boomers’ health in the United States.
        JAMA Internal Medicine. 2013; 173: 385
        • Kirch D.G.
        • Petelle K.
        Addressing the physician shortage.
        JAMA. 2017; 317: 1945-1946
        • Macy Jr., Josiah
        • Foundation
        Registered nurses: Partners in transforming primay care.
        in: Proceedings of a conference on preparing regiseterd nurses for enhanced roles in primary care2017 (Retrieved from)
        • Ortman J.M.
        • Velkoff V.A.
        • Hogan H.
        An aging nation: The older population in the United States current population reports.
        (Retrieved from)
        • Perloff J.
        • DesRoches C.
        • Buerhaus P.
        Comparing the cost of care provided to medicare beneficiaries assigned to primary care nurse practitioners and physicians.
        Health Services Research. 2016;
        • Pittman P.
        • Forrest E.
        The changing roles of registered nurses in pioneer accountable care organizations.
        Nursing Outlook. 2015; 63: 554-565
        • Stepler R.
        Smaller share of women ages 65 and older living alone: More are living with spouse or children. Vol. 18419. Pew Research Center, Washington, DC2016 (Retrieved from)
        • Staiger D.
        • Auerbach D.
        • Buerhaus P.
        Registered nurse labor supply and the recession—are we in a bubble?.
        The New England Journal of Medicine. 2012; 366: 1463-1465
        • U.S. Census Bureau
        2014 national population projections.
        (Retrieved from)
        • West L.
        • Cole S.
        • Goodkind D.
        • He W.
        U.S. Census Bureau, P23-212, 65+ in the United States: 2010. U.S. Government Printing Office, Washington, DC2014 (Retrieved from)