How America's aging population will affect nursing

Just as a large population will begin needing care, an exodus of skilled nursing professionals due for retirement is projected to occur. When these experienced nurses—who have accumulated invaluable knowledge and skills over many years—leave the workforce, organizations will face multiple risks.

The knowledge experienced nurses have to assess, identify changes, and respond to evolving medical conditions can only be learned over time. Patient care organizations and care settings will need to train and monitor novice nurses, as well as ensure the workplace morale is safe and effective in promoting professional growth. Those in leadership roles can develop programs to have older nurses mentor new nurses to assure consistent, quality patient care.

Before the pandemic, several statewide initiatives were underway to address the impending shortage of nurses and nurse educators. Among them is the University of Wisconsin's $3.2 million Nurses for Wisconsin initiative to provide financial assistance for nurses who become educators within the state. The initiative comes from a state-funded grant—the UW System Economic Development Incentive Grant—which was launched in response to the projected shortage of 20,000 nurses by 2035.

Nurse practitioners share in the foundational principles of nursing, providing an integrated approach and unique perspective on total health. As the fastest-growing primary care provider professional, nurse practitioners focus on health promotion, education, and disease-preventive care. According to the U.S. Bureau of Labor Statistics, the number of employed nurse practitioners is projected to grow by 114,900 by 2030 to reach an estimated total workforce of more than 335,000.

According to the American Association of Nurse Practitioners, four of the top certifications for nurse practitioners were in primary care: family (65.4%), adult (12.6%), adult-gerontology (7.8%), and pediatrics (3.7%). As part of the Coronavirus Aid, Relief, and Economic Security Act, nurse practitioners were permanently authorized to order and provide care for Medicare-eligible home health patients, many of which are within the aged population. Currently, 43 states now allow nurse practitioners to practice independently without physician oversight.

As the aging population requires more acute and chronic care management, they will need more geriatric services and long-term care services. Between March 2020 and January 2021, the demand for in-home caregivers (also known as home health aides), certified nursing assistants, and personal attendants grew by 125%. At this time, home care agencies are struggling to retain staff due to low wages, which are comparable to entry-level positions that assume far less responsibility.

According to the Bureau of Labor Statistics, licensed practical and vocational nurses had a median annual wage of $48,070 compared to registered nurses, who earned a median annual wage of $77,600.  Recent data from the Bureau of Labor Statistics showed that registered nurses in long-term care settings earn lower wages (average $72,420) compared to hospital nurses (average $78,070), and the general median wage for all nurses is less than other diagnostic and treatment positions in the health care industry.

Regardless of the care setting, nurses report feeling underpaid and undervalued. A Brookings report showed that while home health and personal care aides outnumber RNs, their wages are nearly two-thirds lower on average. Although better wages are part of the solution, federal and state actions are required to sustain the nursing workforce. Targeted efforts are creating wage boards, stable and predictable shift scheduling, and consistent access to personal protective equipment for safety. Employer investments such as career progression, tuition aid, and ongoing training are also being considered.

When a patient agrees to hospice, they relinquish medical care to treat their illness. The focus is shifted to ensuring comfort care and other personal goals. As the aging population with life-threatening conditions increases, the demand for hospice services also increases. Medicare costs for hospice care coverage increased by $5 billion between 2015 and 2019, reaching more than $20 billion for hospice-covered benefits.

Hospice benefits include nurses, health aides, social workers, chaplains, and counselors to support patients and their families. Aside from staff, hospice benefits include medical equipment, drugs for pain and symptom management, rehabilitation therapy, and—in some cases—room and board at a specified care setting.

With the growing demand for medical care—including for activities of daily living—nurses would benefit from the ability to delegate certain tasks to supplemental staff. Human-like robots can be programmed with artificial intelligence capable of navigating clinical decisions and may assist patients with personal care tasks.

Stanford University reports that Japan's aging population is reaping the benefits of adopting robots to address health care worker shortages. The National Bureau of Economic Research confirms that robot adoption in Japanese nursing homes enhanced staff retention and reduced burnout. Technological breakthroughs are bound to happen to transform health care and wellness.

In areas where therapeutic and diagnostic errors are correlated with nursing staff shortages, artificial intelligence systems can aid in retaining large volumes of health data and clinical information, as well as improve accuracy in reporting. Technological advancement can aid in restoring a nurse's ability to actively engage and develop rapport with their patients.