Today, about 126,000 nursing positions are vacant in U.S. hospitals. By 2020, the United States will be short an estimated 400,000 nurses, predicts the Joint Commission on Accreditation of Health Care Organizations (JCAO), which keeps tabs on safety matters in 17,000 U.S. health care organizations.

Sooner or later, this shortage will translate into higher medical premiums for employers and their workers. Not having enough nurses working in hospitals can increase patients' bills because patients remain hospitalized longer to recover from illness or surgery, reports JCAO in its August 2002 Health Care at the Crossroads report.

Insurers and hospitals take a hit to their bottom lines, also, because the lack of nurses means elective surgeries are canceled, says the American Hospital Association. What's more, the high turnover rate for nurses - 20 percent is the current average for all health care workers-means hospitals have to spend big dollars on recruiting. The cost to fill a vacant slot for a critical-care nurse is about $64,000, estimates the Voluntary Hospitals of America.

Among nurses in manufacturing plants and other workplaces, it's the same story.

"When you look at retirement statistics within the occupational health nursing industry, we can safely predict a shortage," said Jennifer A. McDuffee, director of external affairs at the American Association of Occupational Health. "The average age of our members, for instance, is 48. Broader industry statistics indicate that up to 40 percent of the 250,000 occupational and environmental safety and health workers now employed may retire within the next five years."

AAOHN finds the majority of its members in jobs that fall within traditional manufacturing categories in the following top five states: Ohio, Michigan, North Carolina, Pennsylvania and Texas.

"We don't believe that nursing schools will fill this deficit in occupational health programs quickly enough," said McDuffee.

Some States Aren't on Life Support

Based on calculations from the U.S. Department of Health & Human Services (see chart), there are a few states in New England and the Midwest that are healthier in their nurse populations than others. In Massachusetts, the relatively robust nurse population aids Bay State economic developers.

"Recruiting new manufacturing facilities, especially in the life sciences, is easier for our state, because of the strong health workforce here," says Amanda Theodoropulos, research manager for the Massachusetts Alliance for Economic Development. "The high number of RNs in Massachusetts speaks to the work opportunities offered in the Commonwealth. The 150-plus hospitals and other health care facilities here affords an array of jobs and career development options less available elsewhere."

Prescription to Add More Nurses

The Nurse Reinvestment Act, which aims to boost nurse recruitment and retention, was signed into law on August 1. The measure includes provisions for federal funding for scholarships and loan repayments for nursing students who agree to work in shortage areas after they graduate. It also includes funding for public service announcements aimed at promoting nursing as a career. The American Nurses Association, the American Assn. of Critical-Care Nurses, and other groups are pushing for sufficient federal dollars to support the legislation.

In Minnesota, the Health Care and Human Services Worker Training and Retention Program released a grant for $509,000 in late November to pay for training of nursing assistants and other healthcare workers through the Dakota County Technical College.

"Career laddering, where workers can start training as nursing assistants and then move up from there to become LPNs or RNs, is a concept that's been very well developed in health care projects here in Minnesota," says Rick Caligiuri, director of the Gopher State's Job Skills Partnership Program.

For Caligiuri and Minnesota, the training assistance is coming in the nick of time. In Minnesota, an estimated 2,900 of the state's 44,500 nursing jobs are vacant, says the Minnesota Department of Health. Three of every four vacancies are in the Twin Cities area.

Michael Keating is research editor for Expansion Management magazine. He can be reached at mkeating@penton.com.