Active State-Level Engagement With the Nursing Shortage: A Study of Five Midwestern States

he current nursing shortage, or “nursing crisis, ” involves all regions of the country and affects nurses, employers, patients, and consumers. The factors contributing to the shortage are complex and relate to both a strong growth in demand for registered nurses (RN) and constraints on their supply (Kimball & O’Neill, 2001; U.S. General Accounting Office, 2001). Although prior nurse shortages have been cyclical with market-related recovery, analysts predict that this shortage will be long lasting and more difficult to correct (Buerhaus, Staiger, & Auerbach, 2000). Factors contributing to the short-age include declining nursing school enrollments for several years in the late 1990s (Bednash, 2000), an aging workforce that will be retiring (Buerhaus et al., 2000), declining job satisfaction and flat 102 This study explores state-level efforts from 1999 through mid-2003 to address the nursing short-age in five midwestern states (Illinois, Iowa, Kan-sas, Missouri, Nebraska). The authors conducted interviews with 25 representative nurse leaders and others involved with state initiatives; this firsthand perspective provided useful insights on the interplay of various factors within states. For example, taskforce groups appointed to study the shortage were seen to evolve into broad-based and influential nursing coalitions. These coalitions advocated for establishing permanent state nurs-ing centers to collect and analyze nurse workforce data and to improve nurse recruitment, reten-tion, and the nurse practice environment. Expan-sion of educational programs faced barriers (nurse faculty shortages, limited clinical educa-tion sites) that were not readily amenable to solu-tions, in part because of state funding crises. This study illustrates how strategies are evolving in these states while highlighting the role of collabo-ration, creativity, and flexibility in solving this critical problem