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Most healthcare professionals and public officials are aware of the current nursing shortage and the impending crisis that this shortage will present over the next 10 to 15 years when demand far exceeds supply. However, many are much less aware of how the nursing shortage will affect each healthcare service provider individually. Based on demand and growth projections, home healthcare could feel the impact of the nursing shortage more acutely than any other healthcare sector.


Between 2006 and 2016, the U.S. Department of Labor (2007) projects that registered nurse job growth in the home healthcare sector (39.5%) will be larger than in the hospital sector (21.6%). Contributing to this heightened demand are several variables including an aging population, the increasing prevalence of chronic disease, and longer life spans. As the percentage of seniors increases in combination with longer life expectancies, home health is expected to experience a 36% shortfall in demand by 2020 (U.S. Department of Health and Human Services, 2004).


The Visiting Nurse Associations of America (VNAA) conducted a membership-wide survey in July 2008 to assess the impact that the nursing shortage is having on nonprofit home health agencies (VNAA, 2008). On the average, Visiting Nurse Agencies (VNAs) had a 10% vacancy rate of registered nurse positions, and 59% of VNAs who responded indicated that they are forced to decline patient referrals weekly due to staffing limitations.


Furthermore, VNAs expressed that recent nursing school graduates generally are not prepared adequately for the field of home care at graduation. Therefore, the significant amount of additional training the VNAs must give slows down the productivity of the existing clinical staff, prompting the need for more field nurses, and so the vicious cycle continues. Nonprofit home health agencies that provide a disproportionate amount of uncompensated care face a unique additional challenge in that the larger their mission is, the less margin they have for offering competitive salaries and benefit packages.


In response to this dire situation, VNAA is advocating for legislation entitled the Home Healthcare Nurse Promotion Act, expected to be introduced to Congress by Senator Robert P. Casey (D-PA) and Representative Steven Kagen (D-WI). The VNAA also is actively involved in 2 advocacy coalitions in Washington, DC, whose primary agendas are gaining congressional support for addressing healthcare workforce issues.


Finally, as the President and Congress are expected to take on healthcare reform in the first 2 years of the next administration, home health nurse advocates must be organized, vocal, and persistent in making sure that healthcare reform prioritizes investment in the workforce.




U.S. Department of Health and Human Services: Health Resources and Services Administration. (2004). What is behind HRSA's projected supply, demand, and shortage of registered nurses? Retrieved July 18, 2008 from [Context Link]


U.S. Department of Labor, Bureau of Labor Statistics (2007, November). National employment matrix, employment by industry, occupation, and percent distribution, 2006 and projected 2016. Retrieved July 20, 2008 from [Context Link]


Visiting Nurse Associations of America Survey. (2008). VNANUBE Development Program, Washington, DC. [Context Link]