A (Surprisingly) Sunny Forecast

By Karen Haller, PhD, RN
VP of Nursing and Patient Care Services,
Johns Hopkins Hospital

With the Broadway Garage and the Jefferson Building down, the first dominoes have fallen—bricks-and-mortar evidence that Hopkins’ master plan for the campus is closer to reality.

The planners tell us that Johns Hopkins Hospital will increase the number of patients discharged from 49,477 last year to 55,211 in 2012, an 11% increase. (And that number doesn’t include increases for the Emergency Department or Outpatient visits.)

What does this mean for nursing? Clearly, we won’t be able to care for 11% more patients with the same number of nurses we have now. How many will be needed?

To answer that question, the Department of Nursing conducted a staffing needs analysis. The charge was to forecast RN staffing needs from 2007 to 2016, and then run sensitivity analyses to test the robustness of the forecast.

We were surprised to learn that if we continue to hire nurses at our historical rate of about 350 per year, then we will have a surplus of 300 RNs by 2016. All things being equal, we should be able to meet our staffing needs for the foreseeable future.

Our findings are consistent with a recent national forecast (Auerbach et al., Health Affairs, January/February 2007) suggesting that the U.S. nursing shortage will be less than initially estimated. The original projection that the U.S. could fall 760,000 short of RNs was cut almost in half by the new study. The change in projection is driven by people born in the 1970s and 1980s who are entering the nursing workforce in greater numbers in their late 20s and early 30s, later in life than their predecessors. This is encouraging news.

However, there appear to be three scenarios that could lead to a continued nursing shortage at Hopkins and will need to be monitored carefully:

1. If there are actually more patients than planned for, or they are more acutely ill and will require a higher nurse-to-patient ratio.

2. If turnover increases more than the historic rate of about 270 RN departures per year.

3. If the number of RNs available in Maryland decreases as a result of nursing schools failing to find qualified faculty or other resources.

Regardless of the evolving market conditions, recruiting highly qualified new staff and retaining current staff will be on the top of our priority list for the next decade.

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