The Impact of the National Nursing Shortage
on Quality Cancer Care
The united states is experiencing an unprecedented nursing shortage that is expected to continue well into the
future—a trend that is mirrored globally (Auerbach, Buerhaus, & staiger, 2007). The Health resources and services
Administration ([HrsA], 2007) projected that the nation’s nursing shortage will grow to more than one million
nurses by the year 2020, and all 50 states will experience a shortage of nurses to varying degrees by the year 2015.
The nursing shortage entered its 10th year in 2007, making it the longest shortage in the past 50 years (Auerbach et
al.). in a report describing employment trends of rns since the mid-1990s, Buerhaus, staiger, and Auerbach (2004)
noted that despite the increased employment of nearly 185,000 hospital rns since 2001, no evidence indicates that
the nursing shortage has ended. in their national survey, a clear majority of rns (82%) and doctors (81%) perceived
nursing shortages where they worked.
According to the 2004 national sample survey of registered nurses by the Federal Division of nursing, the average
age of the rn population in 2004 was about 47 years (American Association of colleges of nursing [AAcn], 2007b).
Based on the Aging Workforce survey released in 2006 by
Nursing Management,
55% of surveyed nurses reported the
intention to retire between 2011 and 2020 (AAcn, 2007b). in the coming years, as the number of nurses entering the
workforce decreases and the number of patients increases (HrsA, 2007), a commensurate decline of oncology nurses will
occur. in the united states, cancer causes one of every four deaths (American cancer society, 2007). cancer primarily is
a disease of older adults; therefore, as the baby-boomer generation ages during the next 15 years, the number of medicare
beneficiaries with cancer is estimated to double. The increased demand for nurses coupled with the aging of the nursing
workforce is projected to result in significant rn vacancy rates, with rural areas, specialty practice areas, and long-term
care settings most adversely affected (HrsA). national surveys of rns, physicians, and hospital executives document
the perceived negative impacts on care processes, hospital capacities, nursing practice, and the institute of medicine’s six
aims for improving healthcare systems (Buerhaus et al., 2007).
Enrollment in schools of nursing is not growing fast enough to meet the projected demand for nurses over the next
10 years. Although the AAcn (2007c) reported a 5% enrollment increase in entry-level baccalaureate programs in
nursing in 2006 over the previous year, the increase is not sufficient to meet the projected demand for nurses. in
2006, HrsA officials determined that to meet the projected growth in demand for rn services, the united states
must graduate approximately 90% more nurses from u.s. nursing programs (Accn, 2007b). According to an
AAcn (2007a) report, u.s. nursing schools turned away more than 32,000 qualified applicants from baccalaureate
and graduate nursing programs in 2006 because of insufficient number of faculty, clinical sites, classroom space,
clinical preceptors, and budgetary resources. in addition, unfilled faculty positions, resignations, projected retire-
ments, and the shortage of students being prepared for faculty roles have decreased the nursing education workforce
(AAcn, 2007a).
Americans can expect a dramatic increase in the need for oncology-specialized nurses to care for the growing
population of patients with cancer and their families. Oncology nurses represent a vital component of quality cancer
treatment across the spectrum of care, but the shrinking nurse workforce ultimately will result in fewer nurses who
choose oncology nursing as a career, stay in oncology nursing, and become certified in oncology nursing. The quality
of cancer care may be negatively impacted as a result.
It Is the Position of ONS That
Workplace Environment
• Improvements in the nursing work environment
include strategies designed to recruit and retain
nurses, such as nontraditional and flexible work
schedules, ergonomically acceptable work
environments, on-site child care, and reentry
programs for nurses who have been out of the
(Continued on next page)
OncOlOgy nursing FOrum – vOl 34, nO 6, 2007
 PDF to HTML - Convert PDF files to HTML files
(Continued from previous page)
• Healthcare institutions address and resolve
stressful, negative workplace issues such as
mandatory overtime, inadequate salaries, and
• Employers ensure that oncology nurses are educated in
the latest technologies and emerging cancer therapies.
• Systems are developed to routinely monitor nursing-
sensitive outcomes of care.
• ONS and other nursing organizations work with
schools and teachers to develop and implement innova-
tive programming at the primary and secondary school
levels to encourage nursing as a career choice.
• More oncology content is incorporated into nursing
school curricula, and more options, such as distance
learning, are available to educate nurses.
• Academic and healthcare institutions collaborate on
initiatives such as innovative internship, mentorship,
and advanced practice programs.
• The employment of immigrant nurses be regarded as
one of many solutions to the nursing shortage, provided
that immigrant nurses meet u.s. standards, their coun-
tries of origin are not at a disadvantage as a result of
their employment in the united states, and the united
states creates and funds methods to supply nurses in
the united states to meet growing demand.
• The National Institute for Nursing Research receives
increased annual appropriations to support research
grants to assess model programs that restructure the
current healthcare environment, make the most ef-
ficient use of all healthcare professionals’ skills, and
evaluate nursing contributions to health care in general
and cancer care specifically.
American Association of colleges of nursing. (2007a).
Nursing faculty
shortage fact sheet.
retrieved may 19, 2007, from http://www.aacn
American Association of colleges of nursing. (2007b). nursing short-
age fact sheet. retrieved may 23, 2007, from http://www.aacn.nche
American Association of colleges of nursing. (2007c).
Student en-
rollment rises in U.S. nursing colleges and universities for the 6th
consecutive year.
retrieved may 16, 2007, from http://www.aacn
American cancer society. (2007).
Cancer facts and figures 2007.
Atlanta, gA: Author.
Auerbach, D.i., Buerhaus, P.i., & staiger, D.O. (2007). Better late than
never: Workforce supply implications of later entry into nursing.
Health Affairs, 26,
Buerhaus, P.i., Donelan, K., ulrich, B.T., norman, l., Desroches, c.,
& Dittus, r. (2007). impact of the nurse shortage on hospital patient
care: comparative perspectives.
Health Affairs, 26,
Buerhaus, P.i., staiger, D.O., & Auerbach, D.i. (2004). new signs of
a strengthening u.s. nurse labor market?
Health Affairs,
Health resources and services Administration. (2007).
What is behind
HRSA’s projected supply, demand and shortage of registered nurses?
retrieved may 17, 2007, from http://bhpr.hrsa.gov/nursing
Public Policy
• Existing federal loan repayment and scholarship pro-
grams are funded fully to provide people interested in
nursing with the financial support they need to enter
and stay in the field.
• Additional federal support is provided to ensure that
u.s. nursing schools can recruit and retain adequate
faculty to teach the next generation of nurses, reduce
the current wait times for accepted nursing students to
matriculate into the classroom, and prevent qualified
applicants from being denied admission because of a
lack of faculty or resources.
• Federal and state legislation enacts loan-repayment
programs to fund scholarships for nurses who wish to
advance their levels of education.
• The federal reimbursement model applied to graduate
medical schools is applied to public and private gradu-
ate nursing schools.
Approved by the ONS Board of Directors, 7/07.
To obtain copies of this or any Ons position, contact the customer service center at the Ons national Office at
125 Enterprise Drive, Pittsburgh, PA 15275-1214 (866-257-4Ons; customer.service@ons.org). Positions also may
be downloaded from the Ons Web site (www.ons.org).
OncOlOgy nursing FOrum – vOl 34, nO 6, 2007