It is a dichotomy, said Joanne Spetz, PhD, director of the Center for California Health Workforce Studies at the University of California, San Francisco, referring to an economy-influenced shortage of nursing positions across California and much of the country. In times when the economy is poor, nurses tend to stay put, hunkering down and working extra shifts. Some may have become the main household wage-earner following the lay-off of their spouse; others may have seen their retirement nest egg shrink as the stock market lost ground. Whatever the reason, she said, when the economy starts to right itself, jobs will open up in every region.

Joanne Spetz, PhD

But for now, that's not the case.

Statistical Crystal Ball

Spetz was principal investigator for the 2008 Survey of Registered Nurses for the California Board of Registered Nurses (BRN) and author of the 2009 forecast of the RN workforce in California based on the survey. The new report presents supply and demand forecasts for the RN workforce in California from 2009 through 2030.

The sixth in a series of surveys designed to describe RNs in California and examine change over time, the 2008 Survey of California Registered Nurses gathered information from more than 4,500 RNs with California addresses and 500 who live in other states and are licensed in California. Questions included the most recent nursing position; work hours and description of employment; education, licensure and demographics; reasons for discontinuing nursing work temporarily or permanently; employment with temporary or traveling agencies and registries; employment in California for nurses who reside outside California; and intentions regarding future work in nursing. The survey targeted both RNs with active California licenses living in California and outside California, and RNs whose California licenses had become inactive or lapsed within the 2 years prior to the survey, but who still lived in California.

The forecast additionally used data from the U.S. Bureau of Health Professions 2004 National Sample Survey of RNs and BRN license record data. The 2009 forecasts indicate the shortage of RNs identified in 2005 has narrowed, and will continue to narrow in the foreseeable future, provided that recent expansion of RN education programs is maintained.

Supply & Demand

According to Spetz, the forecast is a matter of balancing supply and demand. On the supply side, factors including the aging of the RN workforce, new graduates from within and outside of California, nurses moving into and out of the state and changes in license status are taken into account. Demand forecasts are based on national numbers of RNs per 100,000 population and have been compared to a forecast published by the California Employment Development Department (EDD), as well as an alternate forecast developed using data from the California Office of Statewide Health Planning and Development (OSHPD) and the California Department of Finance (DOF).

"We developed several alternate forecasts of demand, using national RN-to-population data and estimating future hospital utilization in California as well as looking at forecasts from other agencies," Spetz said. "The demand estimates provide a range of possible future scenarios. The greater the demand, the more nurses are needed. If the staffing pattern currently in place is adequate, then the shortage here has plateaued with California near the bottom of the RNs-per-capita list. If it's not, then we still face a shortage."

Spetz estimates the state is short more than 30,000 RNs based on the 25th percentile of nationwide full-time equivalents (FTEs) per 100,000 RNs. Some of those spots are being filled by the more than 4,000 travelers who come to the state every year while others are taken by new nursing grads. Graduation rates are up 55 percent over the 2003-4 rate and have brought more than 9,500 new nurses into the job market.

"This expansion is due to significant increases in state funding for expanded educational capacity of nursing programs, increased funding for equipment, use of updated instructional technologies, and other needed educational resources," she said. "If the expansion of RN education programs and other program augmentations are maintained, immigration of internationally educated nurses does not change, and inter-state migration rates are constant, this shortage will steadily narrow. California will reach the 25th percentile nationwide of the number of FTE RNs per 100,000 (756.5) by 2016, and will near the national average of FTE RNs per 100,000 population (825) by 2025. If the number of new grads from state nursing programs increases beyond currently estimated rates of growth, we'll reach those levels faster."