The registered nurse workforce: infrastructure for health care reform.
As of March 1992, 83 percent of America's more than 2.2 million licensed registered nurses (RNs) were actively employed in nursing. RNs are the largest group of U.S. health care professionals and constitute a major part of the infrastructure necessary to any health care reform agenda. Therefore, it is critical to assess the extent to which the current nurse workforce is adequately prepared for its future role in a reformed health care system. Two central trends in the composition of the nurse workforce are noteworthy. First, while the number of RNs is large and continues to grow, cyclical, demand-driven shortages have occurred nationally since World War II. Further, hospital cost containment strategies periodically depress nurses' relative wages, contributing to the substitution of RNs for other workers. Second, there is concern in nursing, as in medicine, that the RN workforce is not optimally trained to meet future needs. While two-year associate degree programs now produce a majority of nursing graduates, the greatest need is for advanced practice nurses. Demand for such nurses is high and is expected to increase as more of the population gains access to health care services. The incentives put forth in the health care reform debate--expanded health insurance coverage, integrated health care delivery systems, and cost-effective practice--create the potential for expanded roles and increased job opportunities for nurses. Realizing this potential will depend largely on the profession's responsiveness to the changes confronting it under health care reform.
Aiken
L H
LH
Center for Health Services and Policy Research, University of Pennsylvania School of Nursing, USA.
Gwyther
M E
ME
Friese
C R
CR
D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis / Q000639:trends; D004506:Education, Nursing / Q000639:trends; D005260:Female; D005544:Forecasting; D018166:Health Care Reform / Q000191:economics / Q000639:trends*; D006301:Health Services Needs and Demand / Q000191:economics / Q000639:trends; D006801:Humans; D008008:Licensure, Nursing / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D013041:Specialties, Nursing / Q000706:statistics & numerical data*; D014481:United States