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Current evidence suggests emerging shortages of nurses available or willing to fill some vacant positions in hospitals, nursing homes, and home care. Total employment of registered nurses (RNs) per capita and the national unemployment rate for RNs have declined, and providers from around the country report growing difficulty recruiting and retaining the number of nurses needed in a range of settings. Current problems with the recruitment and retention of nurses are related to multiple factors. The nurse work force is aging, and fewer new nurses are entering the profession to replace those who are retiring or leaving. Nurses report unhappiness with these aspects of the work environment: staffing levels, heavy workloads, increased use of overtime, lack of sufficient support staff, and adequate wages. In many cases, this growing dissatisfaction affects decisions to remain in nursing. A serious shortage of nurses is expected in the future as pressures are exerted on demand and supply. Demand is expected to increase dramatically when the baby boomers reach their 60s, 70s, and beyond. During the same period, the number of women aged 25-54, who have traditionally formed the core of the nurse work force, is expected to remain relatively unchanged. Efforts to improve the workplace environment may both reduce the likelihood of nurses leaving the field and encourage more young people to enter the nursing profession. (YLB)

Current evidence suggests emerging shortages of nurses available or willing to fill some vacant positions in hospitals, nursing homes, and home care. The nationwide unemployment rate for registered nurses (RNs), which has been low for many years, has declined to 1.0 percent, the lowest level in more than a decade. Nurses report job dissatisfaction relating to a variety of issues, including staffing, respect and recognition, and wages, and this dissatisfaction is affecting their decision to work in nursing. Furthermore, the nurse workforce is aging, and fewer new nurses are entering the profession to replace those who are retiring or leaving. A serious shortage of nurses is expected in the future as pressures are exerted on demand and supply. Demand is expected to increase dramatically when the baby boomers reach their 60s, 70s, and beyond. During the same period, the number of women aged 25-54, who have traditionally formed the core of the nurse workforce, is expected to remain relatively unchanged. Job dissatisfaction due to management decisions to restructure health care delivery and staffing may play a crucial role in determining the extent of future nursing shortages. More data is needed to assist in planning and targeting remedies. (YLB)

A national survey of registered nurses and analysis of official statistics provided an overview of the dimensions and dynamics of the labor market for nurses in the United Kingdom. Findings indicated the following: enrollment in preregistration nurse training courses decreased by 27 percent over the 1990s; initial entries to the UK Central Council for Nursing, Midwifery, and Health Visiting Register from preregistration nursing education courses continued to decline; and family-friendly and flexible working arrangements were the solutions proposed to improve recruitment and retention. The majority of respondents employed in nursing had responsibilities for dependent children, dependent adults, or both. Better resources to do the job, better pay, and greater availability of flexible working hours were cited as the three main factors that would have reduced the likelihood of respondents leaving nursing. More than one-third of National Health Service (NHS) nurses would leave nursing if they could; one-fourth were seeking a job change. NHS nurses cited better pay, better resources to do the job, and reduced workloads as the three main factors that would reduce the likelihood of their leaving nursing. An increasing proportion of NHS nurses agreed they could be paid more for less effort if they left nursing. Two-thirds of NHS nurses working internal rotation said it was not their preferred work pattern. Excess hours continued to be the norm. (14 references) (YLB)

The labor market participation, pay, job satisfaction, employment patterns, and turnover of registered nurses in the United Kingdom were examined through an analysis of data from the 1997 Royal College of Nursing (RCN) Survey. Of the random sample of 5,984 nurses from the RCN membership records surveyed, 4,288 (72%) returned usable questionnaires. Of the 90% of respondents who were employed in nursing, 75% worked in the National Health Service (NHS). A comparison of the 1997 and previous survey findings established the following: the number of practitioners not renewing their registration increased from 7,266 in 1990-1991 to 17,572 in 1995-96; the net growth in nursing employment in recent years has resulted from increased employment in non-NHS sectors; the proportions of nurses employed in higher-grade nursing positions and below the top of their pay scales have declined since 1991; 65% the number of nurses working full time declined from 65% in 1992 to 59% in 1997; most job turnover was accounted for by moves between non-NHS jobs. (Fifty-three figures/tables and 22 references are included. Appended is information about the following: 1997 RCN Membership Survey; participation in nursing and estimated pool size; and shift patterns by employment sector and specialty.) (MN)

Selected issues of concern to second-level enrolled (registered) nurses in the United Kingdom were examined through national surveys of two groups: (1) a random sample of 21,762 of the 115,459 nurses holding second-level registration in the United Kingdom, and (2) 700 employers who, included nurse executive directors in all National Health Service (NHS) trusts plus a sample of non-NHS employers. The number of individuals with second-level registration was discovered to have declined by almost one-fourth between March 1993 and March 1996. That decline was attributed to the following: cessation of training for entry to second-level registration; conversions to first-level registration; and retirement and nonrenewal of registration. It was concluded that a significant and continuing supply of second-level registrants would likely exist for the foreseeable future. Although most employers anticipated continued growth in employment of first-level registered nurses and health care assistants, they foresaw a continuing decline in their employment of enrolled nurses. Many enrolled nurses were pessimistic about their future prospects in nursing. (The report contains 55 references and 73 tables/figures. Appended are the following: list of organizations contacted; information about the registered practitioner and employer surveys; and the registrants' and employers' questionnaires.) (MN)

A survey of 6,000 registered nurses in membership in the Royal College of Nursing across the United Kingdom examined some key factors that determined the supply of nurses. A study of the UK nursing labor market indicated that the number of registered nurses has remained more or less static since the late 1980s. Rising demand appeared to be met by increased working hours and workloads, with an accompanying increase in the proportion of unfilled nursing posts. Analysis of New Earnings Survey data revealed that nurses' earnings remained stable, but consistently below the national average for non-manual workers. Findings showed a rise in turnover for a third successive year. Twenty-two percent of nurses changed jobs or stopped working in the last 12 years. Job satisfaction, ill health, injury, and redundancy accounted for nearly one-third of the job changes. Asked what they expected to be doing in two years, nearly one in five nurses said they expected to leave nursing. The spread of short-term contracts was associated with a rise in perceived job insecurity, even among those on permanent contracts. Although the majority of nurses had caring responsibilities for dependent children or adults, only 20 percent reported employers had "family friendly" policies. Reported shift lengths ranged from 3 to 28.5 hours and the average shift length was 8.9 hours. Over half felt under too much pressure at work. Includes 26 figures and 32 tables. (Appendixes contain 21 references, methodology, and workload scale.) (YLB)

A 2-year study of the health care industry in the San Francisco Bay Area identified avenues for reducing health care labor shortages. Focus was on classifications where demand was expected to grow and where current demand exceeds supply: nursing, medical imaging, medical therapy, and medical records management. A modified job analysis technique collected data through intensive interviews with subject matter experts, focus group meetings for data collection on occupational clusters, and surveys of major health care providers. Information obtained for each occupational cluster included the following: changes in settings in which these jobs are practiced, occupational skills that have changed in importance, skills important for entry-level jobs, and skills significant for career advancement. The study identified issues related to the role of educational programs in meeting labor supply and skill requirements in these occupational clusters, changing skills requirements that cross occupational clusters, and skill deficiencies identified by health care employers. Two sets of educational policy recommendations were made: one addressing integration of vocational and academic programs to increase the supply of personnel and another centering on articulated educational programs and their value in increasing labor supply through improved employee retention. (Appendixes, amounting to approximately one-half of the report, include a 91-item bibliography; medical imaging, medical therapy, and medical records occupations tables; and instruments. The occupations tables list skills, knowledge, and abilities that are important for advancement or have recently increased in importance.) (YLB)

A partnership was formed to address the crisis that rural health care facilities in rural Nebraska face in attracting and hiring trained health care workers. The Rural Allied Medical Business Occupations (RAMBO) project trained economically disadvantaged individuals in high technology medical fields. Five objectives were outlined in the project: (1) to solve allied medical shortages; (2) to provide economically disadvantaged individuals with training; (3) to refer disadvantaged individuals for occupational training; (4) to provide training over a 12- to 18-month period; and (5) to provide on-the-job training/classroom opportunities. To arrive at an acceptable level of service, six steps were conducted: (1) develop a program purpose; (2) identify target occupations (respiratory therapists, surgical technicians, laboratory assistants, practical nurses, histology technicians, and drug and alcohol counselors); (3) determine educational requirements; (4) establish curricula; (5) implement the program; and (6) conduct evaluation. Thirty-nine economically disadvantaged individuals were placed in RAMBO; 28 successfully completed the program and 11 dropped out. By providing these individuals with training, RAMBO has given them an opportunity to improve their economic circumstances and help solve the rural health care crisis. (Success stories of participants, participant training information, and periodical clippings are included.) (NLA)

This document provides selected information on characteristics of health personnel disciplines, students preparing for these disciplines, their schools, projections of the personnel supply in each discipline to the year 2020, and discussions of whether the U.S. requirements for health personnel are likely to be met. Following an introduction, chapter 2 provides an overview of major personnel developments, including trends in education and training, the current supply of health care personnel, issues affecting health personnel, and health personnel in the coming years. Current and emerging health issues and personnel issues are covered in chapters 3 and 4. Among the health issues covered are an aging population, infant mortality, human immune deficiency virus, acquired immunodeficiency syndrome, substance abuse, access to health care, a changing health delivery system, and quality assurance and effectiveness in medical practice. The personnel issues addressed include declining applicants and enrollments, the shortage of nurses, primary health care concerns, concerns regarding allied health and public health labor supply, personnel for health care in geriatrics, and underrepresented minorities in the health professions. Chapter 5 discusses the data and methodology used to produce this report. The next 11 chapters provide information on physicians, dental personnel, nursing personnel, public health personnel, allied health personnel, optometrists, pharmacists, podiatrists, veterinarians, chiropractors, and physician assistants. The document contains reference lists that follow each chapter, 95 tables, and 75 figures. (CML)

This report consists of chapter 8 (the chapter on nursing) and relevant other sections of the "Seventh Report to the President and Congress on the Status of Health Personnel in the United States, March 1990." It presents and analyzes recent developments in the education, supply, and distribution of nursing personnel; and provides an assessment of the future supply of and requirements for nursing personnel through the year 2020. An executive summary of the full health personnel report is included. In the reprint of chapter 8 from the full report, s section on current developments in nursing education addresses issues in basic nursing education to prepare for registered nurse (RN) licensure, post-RN academic nursing education, costs of educating nursing students, and programs preparing practical nurses. A discussion of current developments in the registered nurse population examines the registered nurse supply, nurse immigrants, geographic distribution of registered nurses, and distribution of nursing personnel within the health care system. Two final sections discuss, respectively, rates of compensation and the outlook for the future. Other relevant sections of the full report that are reprinted here include the introduction, an overview of major personnel developments for all health personnel, and current and emerging health personnel issues. Includes a total of 34 references. (JDD)

This paper examines health workforce and migration policies in New Zealand, with a special focus on the international recruitment of doctors and nurses. The health workforce in New Zealand, as in all OECD countries, plays a central role in the health system. Nonetheless, maybe more than for any other OECD country, the health workforce in New Zealand cannot be considered without taking into account its international dimension. New Zealand has the highest proportion of migrant doctors among OECD countries, and one of the highest for nurses. There is no specific immigration policy for health professionals, although the permanent and temporary routes make it relatively easy for doctors and nurses who can get their qualification recognised to immigrate in New Zealand. At the same time, New Zealand also has high emigration rates of health workers, mainly to other OECD countries. International migration is thus at the same time an opportunity and a challenge for the management of the human resources for health (HRH) in New Zealand. Increasing international competition for highly skilled workers raises important issues such as sustainability and ability to compete in a global market. In this context, new approaches to improve the international recruitment of health workers, as well as developing alternative policies, may need to be considered. As for international recruitment, better coordination and stronger collaboration between main stakeholders could contribute to more effective and pertinent international recruitment. (A bibliography is included. Contains 23 footnotes, 18 charts, 1 map, 7 boxes, and 2 tables.) [Financial support for the project was provided by Australia, Canada, and the Directorate General for Health and Consumer Protection of the European Commission.]

This report focuses on the supply, distribution of, and requirements for nursing. The first chapter describes the supply of registered and licensed practical nurses. Characteristics of the overall nursing supply are discussed in terms of marital status, age, and employment patterns. Data are also provided on nurses newly licensed to practice, males, and minorities. Projections are made of the supply of registered and licensed practical nurses. Chapter 2 reexamines two approaches for determining requirements for registered nurses: the historical trend-based model that identifies the impact of health system changes on requirements and the criteria-based model that is designed from the development of health care goals. The two sets of requirement projections are compared with four sets of supply projections based on alternative assumptions about the number and types of graduates that might be available. Recommendations are made in chapter 3 for the role of the federal government in support of nurses training and for advanced preparation in nursing. Appendixes, amounting to approximately one-third of the report, include 41 data tables and a list of references. (YLB)

Five final reports on the Nursing Curriculum Project of the Southern Regional Education Board are presented. The reports include (1) RN (Registered Nursing) Education: The Basic Issues; (2) Types of RN Programs; (3) Planning and Operating an RN Program; (4) Acclimating the Novice Nurse: Whose Responsibility? and (5) Statewide Planning for Nursing. A synopsis of SREB's Nursing Curriculum Project for 1972-1981 is provided, along with an outline on the characteristics and levels of nursing practice for primary and secondary care. Specific topics include the issues surrounding career mobility and educational opportunities for RNs and the current and future need for baccalaureate nurses. Six options for RN education are discussed: advanced standing in generic programs for baccalaureate students, "RN only" programs, outreach or satellite programs, competency-based education, independent study, and directly articulated programs. Effective planning and the operation of an RN program are covered, with attention to funding, the curriculum, challenge examinations, teaching strategies, and faculty. Additional topics include: the use of a modular, individualized learning system to help new graduates on the job, and results of demonstration projects in statewide planning for nursing education. (SW)

This paper describes physician and physician extender (i.e., a person who renders services under the supervision and responsibility of a physician) supply and distribution and provides projections of the supply. It addresses inequities of access to health care by examining the relationship to disparities in physician distribution by specialty and geography. The first of eight sections gives the 1976 active physician supply (as determined by American Medical Association and American Osteopathic Association data) as 362,970. Primary, secondary, and tertiary-care physician supply is investigated, and data on osteopathic doctors, women, minorities, foreign medical graduates, and specialty manpower is presented. Section 2 reviews the intern/resident supply for the groups mentioned above. In section 3 characteristics of physician extenders, such as physician assistants and nurse practitioners, are examined. Section 4 looks at the geographic distribution of physician and physician extenders. The fifth section projects the medical specialist supply. A first-year residency illustration shows that primary medical doctor care to population ratio might be expected to increase from sixty-five to eighty-five per 100,000 from 1974 to 1990. Section 6 discusses projected increases in the physician extender supply. Areas for further research are identified in section 7. The final section highlights policies, strategies, and priorities which impact on physician and physician extender supply and distribution. (This publication is an updated version of ED 144 512.) (CSS)

Key issues pertinent to federal support of nursing education and training are considered. Policy options for nurse training include: support for programs to increase aggregate supply, support for programs to improve geographic distribution of nurses, support for programs to increase the availability of nurses with advanced training, and support for programs to expand minority enrollment. In addition to analyzing trends in the supply and demand for registered nurses, the impact of major health system changes, such as health insurance, on supply and demand is examined. The current status of programs authorized by the Nurse Training Act of 1975 and other federal programs that support nursing education and training are described. A summary assessment of the models developed to estimate the future demand for and/or supply of RNs is included. (SW)

In compliance with section 951 of Public Law 94-63, this first annual report presents and analyzes information on the supply and distribution of nursing personnel. The report is organized into three parts. Part I presents data on the projections of supply, distribution, and requirements of nursing personnel. Also included in this section is a discussion of nurse practitioners. Part II represents a description of the data appearing in the latest studies which are of particular importance in the determination of nursing resources and requirements. The findings are presented in the following broad categories: the total nursing group, including those active and inactive and if active, those on a full- or part-time basis; the employment distribution of nursing personnel including data currently available on nurses in specialized areas; the number of nurses with advanced training or graduate degrees; average compensation of nursing personnel; foreign-trained nurses; and registered nurses with minority backgrounds. Part III summarizes the findings about the nursing personnel in the United States. Appended information includes methodological approaches to the area of requirement determination and tables of data related to part II of the report. (JH)

The need and demand for new doctoral nursing programs in the South was assessed, using data collected by the Southern Council on Collegiate Education for Nursing (SCCEN). To learn how many doctoral nurses are now employed and how many are anticipated to be needed by 1990, SCCEN surveyed all collegiate nursing education programs in the Southern Regional Education Board (SREB) region, as well as the larger (over 250 beds) hospitals, and state health agencies. Doctoral-level nurses were needed as faculty for college nursing programs and as leaders in the health care system. Without any additional doctoral programs, the SREB region will be short by 91 doctoral nurses by 1990, and the region will fall short by between 21 and 84 entering positions for doctoral students per year during 1985-1990. However, five of the six existing doctoral nursing programs in the region have no waiting lists of qualified applicants, and about 20% of the enrollments in these programs are from out-of-region. While there is a need for more doctoral students each year, it is doubtful that student demand will justify educational expansion. Background information on nursing education in the SREB states is provided for each level (associate, baccalaureate, master's, and doctoral). Current plans for doctoral programs and resource requirements are also reviewed in detail. (SW)

Results are presented of a study of nursing and nursing education that focused on the need for continued federal support of nursing education, ways to attract nurses to medically underserved areas, and approaches to encourage nurses to stay in the profession. Findings are presented on whether the aggregate supply of generalist nurses will be sufficient to meet future demand, and how changes that could occur in the health care system might affect demand. Attention is also directed to: how the current and future supply of nurses may be influenced by the costs of nursing education and the sources of education financing; and education for generalist positions in nursing. In addition, the supply and demand situation for nurses educationally prepared for advanced professional positions in nursing is examined. The influence of employer policies and practices in utilization of nursing resources on demand and supply is also addressed. Finally, areas in which further data and studies are needed to better monitor nursing supply and demand are identified. In addition to 21 recommendations, appendices include information on Nursing Training Act appropriations, state reports on nursing issues, certificates for specialist registered nurses, projections of registered nurse supply and requirements, and doctoral programs in nursing. (SW)

Information is presented on the number and characteristics of health professionals in the United States, students preparing to enter these fields, and the schools in which they are enrolled. Developments and issues currently affecting these health personnel and the possible impact of these trends on health care delivery are considered. Included is information on accreditation, curricula, enrollments, applicant and student characteristics, student costs and financial aid, graduates, women and minority physicians, medical costs and cost containment, geographic distribution of physicians, allopathic medical education, and osteopathic medical education. Information is included on data collection and analytical activities that are currently ongoing and the areas in which further information or analyses are needed. Recommendations about program activities for nursing and public health are included. The following personnel are covered: physicians, physician assistants, dentists, pharmacists, optometrists, podiatrists, veterinarians, nursing personnel, public health personnel, and allied health personnel (including clinical laboratory technicians, dieticians, medical records technicians, occupational therapists, physical therapists, radiologic technicians, respiratory therapists, and speech, language, and hearing therapists). Summaries, data tables, and reference lists follow each of the 10 chapters dealing with a separate occupational category. (SW)

Presents an overview of the types of approaches currently used by state legislatures to ensure that rural residents receive access to adequate nursing care. (JOW)

This study examined the impact of federal assistance on the number of students entering, continuing in, and graduating from basic nurses training programs. The effects of the Nurse Training Act (NTA) of 1964 were examined through measuring the differences (in admissions, attritions, and graduations) between school years in which NTA funding was received and school years in which funding was not received. Statistical techniques were used to control for differences across schools and years in the size of the available pool of high school graduates and other external factors that might affect admissions, attritions, and graduations. NTA funding was found to have had a significant impact. At least 47,000 additional students entered basic nurses training programs between 1969 and 1979 as a result of federal assistance, and 70 percent or more of these additional students were expected to join the professional nursing work force. (KC)