Nursing and healthcare in the United States are at a crossroads.

A broad view of the issues at hand are required in order to address the future of the nursing profession, the American healthcare system and an aging population. Questions regarding the potential existence of a nursing shortage, the number of nurses and nurse educators poised to retire, and the lack of hospital-based employment for new nurses are just some of the conundrums facing us at this juncture.

One thing is for certain — the conversations we are having all point to the fact that changes are afoot, and an expansive 10,000-foot view is desperately needed.

Is there a shortage?

Questions about the nursing shortage or lack thereof abound, as do predictions regarding how many nurses we currently need and how many will be required in the decades to come. These often-confusing and heated conversations occur daily in boardrooms, break rooms, ORs and nursing stations across the country.

Whether we have an actual nursing shortage is open to debate, and this debate may continue to rage within the profession, the blogosphere, and the wider healthcare community until such time as there is a modicum of agreement about the subject.

Actual shortage or not, the American Nurses Association stated clearly in a recent article on their website that we will need to produce 1.1 million nurses between 2014 and 2022. And in terms of a 10,000-foot view, I think the ANA is on the right side of this conversation.

What about the new nurses?

In a recent MultiBriefs article, I pointed out the fact that many newer nurses cannot find entry-level med-surg positions, even as most employers outside of the hospital setting require one to two years of med-surg experience.

New nurses require mentoring and opportunities to find their "sea legs" in their new career. Concurrently, there is no question that our need for these nurses to serve our aging population will increase in the years to come. Thus, an intelligent response to new graduates' difficulty in finding appropriate employment is a cause for concern and action, as well as a relaxation of "old world" requirements of med-surg experience.

To add fuel to this fire, a recent study published by Policy, Politics and Nursing Practice states that turnover rates for new nurses are extremely high, with 1 in 5 new nurses leaving their first job within a year of hire. Further study delving into the reason for such turnover rates would be helpful, especially if new nurses cite bullying, intimidation, low salaries or inadequate staffing or training as reasons for taking their leave.

Take aging into account

We can safely assume that the nursing workforce is a microcosm of the wider society, with nurses aging and retiring at roughly the same rate as the general population.

Many of us in the profession have elucidated that the recent economic downturn has led some older nurses to delay retirement, but we can still count on a certain number leaving the workforce each year. The ANA has indeed estimated that 1 in 5 nurses may be retiring in the near future. If that holds true, the profession will most certainly need a shot in the arm in terms of new recruits.

Meanwhile, the savvy (and generally economically comfortable) baby boomers will continue to demand increased quality, quantity, breadth and depth of healthcare services, and it is the industry's job to meet that demand.

Aging is impacting nursing and healthcare on all fronts, and it behooves us to read the writing on the wall.

Recruiting educators

The ANA is extremely direct in its call for increased recruitment of nursing educators, especially since a plethora of nurse educators are over 50 and likely to retire in the years to come. But with lower salaries and an inadequate number of clinical training sites, the incentives to leave clinical practice in order to enter the world of nursing academia are few and far between.

Perhaps it is time for key institutions to more thoughtfully and rigorously contribute to the conversation about the growing need for nurses. These conversations should closely consider how those nurses will be educated and provided with mentorship that will prepare them for the needs of a rapidly aging population.

A bird's eye view

A bird's eye view is indeed useful in this situation, and if more key stakeholders were to adopt the "10,000-foot view" position, we might more easily come together to resolve some of the issues facing the nursing profession and the healthcare system.

Truly, many factors contribute to the calculus of the current healthcare/nursing environment, and many voices and resources will be needed to move us collectively forward in a positive, coherent direction.