1. Gaston, Teresa A. BSN, RN
  2. Blankenship, Jean MSN, RN, APRN,BC, CDE

Article Content

The shortage of full-time nurses working at the bedside is becoming a national concern. A recently published article in the Journal for Nurses in Staff Development (Blankenship, Winslow, &Smith, 2003) addressed the issue of providing refresher courses to inactive nurses to help alleviate the nursing shortage. The authors clearly defined the process and development of a refresher course in conjunction with a pilot study with positive results. The article supports transitioning inactive nurses back into the workforce by means of refresher courses. However, refresher courses have been available for many years during nursing shortages. By using the untapped resources of inactive nurses (Gottlieb, 2002), some hospitals may feel minor relief of the nursing shortage; although, this is only one strategy worth considering.


To begin, it is necessary to reflect on how the nursing profession has come to this critical point. Some of the reasons for the nursing shortage include increasing age of population, lack of effective marketing strategies, inadequate compensation, increasing cost of education, mandatory overtime, lack of staff retention initiatives, inflexible work hours, and the high stress and physical demands of bedside nursing (California Health and Human Services Agency, 2002). Increased patient acuity levels and the challenges of managed care have become major obstacles to the challenging mission of nursing recruitment (Gottlieb, 2002). According to the Bureau of Health Professions (2000) survey, 2,696,540 registered nurses were licensed to practice in the United States during 2000. Of these nurses, 18.3% were employed in positions outside of the nursing profession. It would be an immense benefit to understand the rationale related to the group of nurses who have chosen positions outside the nursing occupation.


To prevail in this uphill battle of the nursing shortage, it is going to take a much more comprehensive approach. To be able to attract inactive nurses back into the workforce is a great initiative, although until the underlying causes of the nursing shortage are taken more seriously, the shortage will persist. The healthcare profession must value and respect the experienced, inactive nurse population. Nurses need to increase the media attention to focus on the reasons behind the shortage and how to improve the current work conditions. Acute-care hospitals must improve their marketing efforts by directing more attention toward retention strategies versus recruitment strategies. Nurses need to play a critical role in informing the public and policymakers about the critical needs of the nursing profession (Inglis, 2004). Nurses must be more attuned to public policy to bring about change on a national level for the entire nursing profession. These are only a few examples of what the nursing profession can do. Only recently, some state representatives have begun to address the nursing shortage through legislation and funding (Inglis, 2004).


During 2002, the former Governor Gray Davis (D-CA) approved a Nurse Workforce Initiative program worth $60 million to address the current shortage of nurses. The major goal of the program includes recruiting, training, and retaining nurses to help reduce the critical labor shortage (California Health and Human Services Agency, 2002). Another great example of politicians making a difference for the nursing profession is Senator Barbara Mikulski (D-MD). Senator Mikulski requested $63 million for the nursing profession by adding an amendment to the Labor, Health, and Human Services Appropriations Bill, which resulted in the Senate agreement of $50 million of federal funding (Chilton, 2003). These are two immense accomplishments for the nursing profession that need to be recognized and celebrated.


During 2003, several bills were introduced into the 108th Congress in response to the current issue of the nursing shortage (Chilton, 2003). For example, House of Representatives (HR) Bill 501, titled the Nurse Loan Forgiveness Act, entails student loan forgiveness. In addition, HR Bill 920 was introduced this past year. The major goal of this bill is to promote nursing careers. Both of these bills mentioned have been referred to subcommittees for further review. Although these bills are pending, it is a promising beginning to see more legislation geared toward federal and state funding.


While refresher courses do offer an opportunity for inactive nurses to reenter the workforce, the nursing profession needs a multifaceted approach to this issue. Do you ever see advertising directed toward inactive nurses? How often do you see discussions of the nursing shortage by nurses on the news? How frequent do you hear about federal funding geared toward improving the nursing shortage? In 2002, President Bush signed the Nurse Reinvestment Act worth $20 million to increase national awareness of the nursing shortage and to outline several initiatives to help alleviate the nursing crisis (Carbin, n.d.). Will $20 million be enough to make an influence on a national level? The time has come for our nation to take this dilemma head on. According to the Bureau of Health Professions (2002), by the year 2010, there will be a 12% deficit of registered nurses, by the year 2015 a 15% deficit, and by the year 2020 a 29% deficit.


Teresa A. Gaston, BSN, RN


Master's Student of Health Care Systems, University of North Carolina at Chapel Hill, Chapel Hill, NC



We are keenly aware that long-lasting solutions to the nursing shortage will indeed require multiple strategies, as the respondent so clearly detailed. The initiative discussed in the article was not intended as the only solution to a multifaceted problem, but rather, as one of several strategies that we are using to effect change on a local level.


Jean Blankenship, MSN, RN, APRN,BC, CDE


Community Services Coordinator Martha Jefferson Hospital Charlottesville, VA




Blankenship, J. S., Winslow, S. A., & Smith, A. U. (2003). Refresher course for inactive RNs facilitates workforce reentry. Journal for Nurses in Staff Development, 19(6), 288-291. [Context Link]


Bureau of Health Professions, Division of Nursing. (2000, February). National sample survey of registered nurses: March 2000. Retrieved January 31, 2004, from[Context Link]


Bureau of Health Professions, National Center for Workforce Analysis. (2002). Projected supply, demand, and shortages of registered nurses: 2000-2020. U.S. Department of Health and Human Services, Health Resources and Services Administration. Retrieved January 31, 2004, from[Context Link]


California Health and Human Services Agency. (2002, June 4). Nurse workforce initiative: Solicitation for proposals. Retrieved January 30, 2004, from[Context Link]


Carbin, J. (n.d.). Is the Nurse Reinvestment Act enough? Retrieved January 31, 2004, from[Context Link]


Chilton, L. (2003). Legislative pearls: Nursing shortage legislation. Geriatric Nursing, 24(6), 372. [Context Link]


Gottlieb, J. A. K. (2002). Designing and implementing and RN refresher course for the acute care hospital: Development of the nurses' critical thinking skills. Journal for Nurses in Staff Development, 18(2), 86-91. [Context Link]


Inglis, T. (2004). Nursing the trends: Nurses have more employment options that ever. American Journal of Nursing, 104(Suppl. 1), 25-32. [Context Link]