Increasing numbers of NPs leads to a shortage of RNs

The number of full-time equivalent (FTE) nurse practitioners in the U.S. has more than doubled in recent years, according to researchers, with an increase of 109%. Will this surge of NPs lead to a shortage of RNs?

While the nurse practitioner population increased by 109% from 2010-2017—going from 91,000 to 190,00—the number of RNs and physicians has declined, according to a February 2020 Health Affairs study. RN numbers increased by only 22% in that same time period and physicians a mere 9%. The explosive growth of licensed NPs is great news for policy leaders who recommended they could fill the care gaps during the current shortage of primary care providers. However, the unintended consequence of this trend is its contribution to a shortage of approximately 80,000 practicing RNs nationwide, especially in acute care.

Researchers David I. Auerbach and his colleagues Peter I. Buerhaus and Douglas O. Staiger found the number of NPs increased in every region of the U.S., and was fueled by the swift growth of NP programs which attracted large numbers of millennial RNs.

“The number of NP programs increased from 356 in 2010 to 467 in 2017,” said Auerbach, MS, PhD health economist and external adjunct professor for the Center for Interdisciplinary Health Workforce Studies at Montana State University in Bozeman, Mont.

Other key findings:

  • Employment for NPs grew at similar rates in different settings with the fastest growth seen in outpatient clinics

  • Hospitals, physician offices and outpatient centers employed 83% of NPs in 2017 (a growth from 116% to 142%)

  • Inflation adjusted earnings for NPs grew 5.5% from 2010-17

  • Less than 1% of all NPs were not employed

PCP demand remains high

The demand for primary care providers is high, but the supply of MDs is growing slowly and not keeping up with the demand, Auerbach said.

“It has been easier to increase the capacity of NP programs versus MD programs as the training time is shorter,” he said.

Another reason it’s easier to ramp up NP education programs is they don’t require residencies as MD programs do, said Auerbach.

“There are real limitations regarding the residency process,” he said. “The number of residencies available is dependent on the number of hospitals offering them. This places another set of constraints on the whole process.”

Auerbach and his colleagues found the growth in the numbers of NPs per capita from 2010-17 varied, depending on the region in the U.S. being examined.

“The rates differed – from 49% in the South Atlantic region to more than 150% in the East South Central and West South Central regions,” he said.

Adding fuel to the fire – baby boomer RNs are leaving the nursing profession and retiring at various rates depending on the region of the country, Auerbach said.

“Couple RN retirements, along with RNs leaving to become NPs and this leads to nursing shortages,” he said. “Hospitals and acute care have been impacted the most by this.”

One finding that was consistent with other research – the more restrictive the state’s NP scope-of-practice laws, the lower the rate of growth of additional NPs, Auerbach said. “States in which NPs have full practice authority saw a rate of growth of 133% versus 100% growth in states with more restrictive practice regulations,” he said.

Recruitment and retention efforts can help stem the loss of RNs

With the huge number of baby boomer generation nurses in the midst of retiring across the U.S., it could behoove healthcare organizations to find ways to retain these nurses a bit longer Auerbach said.

“Two options that could be considered are identifying less physically demanding roles for baby boomer nurses, along with looking at positions that are part-time,” he said.  “These strategies could possibly lead to more of these nurses being willing to stay on longer with an organization, rather than retire.”

Other job-related factors Auerbach said he has qualitatively observed as important to many nurses are salary, benefits and working conditions.

“Employers looking to actively recruit nurses and those who hope to retain nurses in their employ longer, will want to look at factors that are important to nurses,” he said.

Working conditions Auerbach highlighted include:

  • Competitive salaries
  • Comprehensive benefits packages
  • Staffing to patient ratios – many nurses feel they are stretched too thin
  • Autonomy
  • Overall work environment – work culture

In Massachusetts, where Auerbach is based, he said there are many new RNs coming right out of nursing school to work in hospitals, and experienced RNs leaving the profession.

“New grad programs require a lot of investment from hospitals,” he said. “Hospitals will want to consider finding ways to make the training process for new grads an easier transition to go from nursing student to working nurse, to help with retention efforts.”

If the current trend and rate of growth of the NP profession continues, Auerbach said there is a danger of possibly having too many NPs in the future. What can we expect if an influx of NPs leads to shortage of RNs?

“If this should happen,” Auerbach said, “we may see NP earnings drop and their unemployment levels rise.”