Much of the debate about health care in this country has focussed on physicians and patients, and the extent to which managed health care affects their relationship. Yet there are armies of health care workers who also figure into the formula for our health and well being, and none figure more prominently than nurses. The shortage of qualified nurses looms large as a threat to the already over-burdened health care system in our country, and its impact could be catastrophic as the baby boom generation ages and demands for health care services balloon in the next 20 years.

The average age of working registered nurses is now 45 years old, and within 10 years, 40 percent of working RNs will be over 50. Half the RN workforce will reach retirement age in 15 years, and by the year 2020 it is projected that the number of working RNs will fall to 20 percent below the requirements of our health care system. The trouble is that nurses are not waiting until retirement age to leave the profession. Those nurses who remain on the job have more patients to care for and often must work mandatory overtime. While most other professionals are home sleeping, shifts of nurses are working through the night. It is hard work, and increasingly nurses are feeling overwhelmed and under appreciated. Often at the urging of their own family members, these critical care givers are opting to finally care for themselves by getting out of nursing. (For more on this issue, see our Health section this week.)

Hospitals, professional groups, and legislators are all searching for ways to address the nursing shortage. Under consideration are educational incentives for those entering the profession and professional development opportunities for existing nurses, in addition to better pay and benefits. The laws of supply and demand have already driven up salaries; registered nurses with associate’s degrees can command $35,000 to $40,000 a year, and recruitment bonuses of several thousand dollars are not uncommon. Yet salary “compression” still sets in after several years on the job as pay increases get smaller and smaller and work schedules get more and more exhausting.

There is no magic formula that will replenish the ranks of qualified nurses short of the basic requirements for any rewarding career: adequate compensation, opportunities for personal and professional growth, and the recognition that the work is valued and respected within the industry and throughout society. With these as our goals, the prognosis for nursing is good. Anything less will only further debilitate the profession and our own health care right along with it.