Nursing crisis looms over Iowa

Across the spectrum, the age of nursing faculty in Iowa is growing dangerously high. Since there is already a shortage of qualified instructors for existing nursing programs, the reality that a large percentage of advance faculty will retire in the next five years makes creating new faculty members a priority. (Source: Iowa Board of Nursing Annual Program Reports, Dec. 2007)

A shortage of nurses has caused concern among elected officials and health care analysts for decades. At least two Iowa governors have convened task forces to investigate the problem and offer recommendations.

With all the added scrutiny and few practical solutions to show for it, most signs point to a nursing crisis that continues to get worse, and Iowa is likely to bear the brunt of it.

The American Health Care Association estimated in July that 116,000 nursing positions in hospitals and more than 19,000 positions in long-term care facilities were vacant. The problem is projected to skyrocket by 2010 to an estimated shortage of 275,000 nurses. By 2020, the U.S. Department of Health and Human Services anticipates a shortage of 1 million nurses.

A significant cause of the problem is a lack of qualified educators to train new nurses. Nearly 2,000 otherwise qualified applicants to Iowa nursing programs were not able to attend in 2008 due to educator shortages.

“It is the single largest contributor to the shortage,” explained Dr. Rita A. Frantz, professor and dean of the University of Iowa College of Nursing. “We have a national shortage of nurse faculty as well as a shortage of practicing nurses. The two are intricately intertwined. That is, without the appropriate number of nurse faculty, we can’t admit all the qualified applicants to our nursing programs.”

And new nurses are not only needed to fill existing vacancies but to replace a rapidly aging nursing workforce.

In December 2007, the Iowa Board of Nursing stated that 41 percent of the state’s active licensed practical nurses (LPNs) were age 47 and up. In addition, 51 percent of the active registered nurses (RNs) in the state were age 47 and above.

“Here at the University of Iowa, the average age of a faculty member is 56,” Frantz said. “If you look at them by rank, with the most senior rank being a full professor, the average age is 59. Those are your more senior, experienced researchers and teachers. We’re going to have large numbers of them leaving the academic environment to retire in a fairly short period of time.”

Only eight counties in the state of Iowa have more than 1,000 registered nurses. This map, developed by the Iowa Board of Nursing, provides the number of nurses, RNs and LPNs, in each of the 99 counties. Click to view larger graphic.

Demographic shifts, worsening economy exacerbate Iowa’s nursing crisis

The Iowa Nursing Task Force, which presented a written report in March 2008, predicted that by 2020, the state would experience a shortfall of about 9,000 RNs, or one-fourth of the current workforce.

This is dire news for the Hawkeye State, whose aging population places increasing demands on health care services, especially on long-term facilities. An older population, combined with trends of younger families vacating rural counties, could result in a magnified problem in Iowa’s rural areas and smaller hospitals.

“Because rural hospitals have a primary population of older patients, their primary revenue stream is from Medicare,” Frantz said. “Those reimbursement rates for acute care hospitalization are in many cases not sufficient to cover the costs of delivering care to that patient population. … Hospitals in larger areas draw from a larger cross-section of the general population and have more sources for their revenue stream.”

As more of the population is impacted by the economic downturn, more people will likely turn to public health care coverage like Medicare/Medicaid as their primary coverage. This forces even mid-sized, urban hospitals in Iowa to tighten their belts, implementing hiring freezes to control costs. That can have the effect of masking the underlying nursing shortage.

“Hiring freezes are the case in some pockets of the country,” said Frantz. “I worry that might be misinterpreted by the public to mean that the nursing shortage is over. That is not the case. It is a blip on the economic radar screen.”

Frantz believes that once the economy improves and unemployed or underemployed people return to work, many will once again begin full use of health care benefits.

“There is a projection that once the economy turns around again, we will have a huge upswing in the demand for health care services,” she said. “Along with that will come a major upswing for nursing services. At that same time, we have these factors that we know are contributing to the shortage. Those will be more evident and place further stress on health care facilities at the same time.”