Despite fears that the COVID-19 pandemic would devastate the American registered nurse (RN) workforce for years to come, a new study found that nurse employment has actually grown in the past 2 years, according to a new study.
In 2023, the number of RNs on the job was actually 6% higher than in 2019, before the pandemic.
Looking ahead, the US nursing force is expected to grow from 3.35 million in 2023 to 4.56 million in 2035, researchers led by David I. Auerbach, PhD, of Brandeis University, Waltham, Massachusetts, reported on February 16 in JAMA Health Forum.
“This forecast suggests that the pandemic’s impact on employed RNs, at least thus far, is unlikely to have a significant impact on the future growth of the overall RN workforce,” the researchers noted.
Scholars, policymakers, and nurse union leaders have long warned of a looming national nursing shortage, citing an aging workforce and burnout over high patient-to-nurse ratios, inadequate pay, and workplace safety concerns. One study examining a 2022 survey of more than 50,000 nurses found that 62% saw their workloads increase, and about half reported daily or near-daily fatigue.
Concerns only mounted as an estimated 100,000 nurses quit in 2021.
For the new report, researchers examined US Census data for 455,085 full-time RNs — including advanced practice registered nurses (APRNs) — aged 23-69 from January 1982 through October 2023.
According to the study’s calculations, the RN workforce grew from 2 million full-time equivalents to 3.19 million in 2019, then fell by 46,000 in 2020 and 2021. But the workforce then grew by 222,000 (95% CI, 47,000-397,000) from 2021 to 2023, reaching 3.37 million (95% CI, 3.25-3.49 million).
“Workforce growth from 2018-2019 to 2022-2023 occurred among all age groups but was led by RNs younger than 35 years (8.2% growth), who grew in number at twice the rate of RNs older than 50 years (3.5%),” the researchers reported. “Growth was also more pronounced for male RNs (14.1%), unmarried RNs (7.4%), APRNs (18.2%), and RNs working outside of hospital settings (12.8%).
The shift in RN employment away from hospitals was entirely due to a drop in hospital employment among RNs older than 40 years, the researchers noted.
The researchers project that the nursing workforce will grow by 1.2 million by 2035, when people aged 35-49 will account for half of RNs, up from 38% last year.
“Whether this forecasted growth will satisfy needs for the types of healthcare services provided by RNs or match healthcare delivery organizations’ demand for RN labor remains to be seen,” the researchers wrote.
The study did not explore why more nurses are on the job now than in 2019.
As for limitations, the researchers noted that the standard error on its forecasts is about 5%, and they added that “our forecast will be too low if nurses increasingly delay retirement in the future or if future cohorts are much larger than recent cohorts.”
They also pointed out that the demand for RNs may change as new models of care are tested.
And they noted that almost all the growth in the workforce from 2018 to 2023 occurred outside hospitals: “This shift may help explain why some hospitals have reported shortages of RNs, despite robust growth of the overall workforce in 2022 and 2023.”
Study authors reported grants from the Johnson & Johnson Foundation, Hartford Foundation, Robert Wood Johnson Foundation, and UnitedHealthcare. One author holds an equity interest in and consults for ArborMetrix Inc., a healthcare analytics company. Another author reported a gift to expand the scope of work from the Hartford Foundation and grants from Dartmouth College, the Patient-Centered Outcomes Research Institute, Health Resources and Services Administration, and National Institute on Aging.
Randy Dotinga is an independent writer and board member of the Association of Health Care Journalists.