the RN workforce is reported to be in the grips of a decade-long nursing supply shortage that is poised to worsen with the impending exodus of a substantial number of retiring baby boomers. Looming large among these retirees are nursing faculty whose departure will impede the replenishment of the depleted RN ranks.

Historically, the U.S. health care system has been able to absorb the entire available supply of RNs. The wide geographic availability of nurses, their deep and nimble skill set, and lower wages relative to physicians and other health care professionals have contributed to their employment in every setting where health care services are delivered. Between 2001 and 2008, total RN FTEs rose roughly 25 percent (Buerhaus et al., 2009) while the general population grew only 7 percent, continuing a decades-long pattern of rising RN-to-population ratios (Figure F-1). The behavior of health care institutions—the main employers of nurses—influenced by government and health plan reimbursement policies, appear to be the main driver of RN demand, a demand that appears to be all but inexhaustible. The education sector has responded to that demand, producing nurses well prepared to deliver acute care services largely in acute care settings, with a shallow skill set and thin distribution in other areas such as ambulatory care, home-based and community-based care, and geriatrics and long-term-care services.

If the demand for RNs changes in response to the system changes and incentives embodied in the health reform legislation and related initiatives, what will

FIGURE F-1 RN-to-population ratio, 1980–2008

SOURCES: HRSA, 1982, 1986, 1990, 1994, 2002, 2006, 2010.