Ten years have passed since the current nursing shortage began, and there doesn’t seem to be an end in sight. Now a new book by some of the leading researchers in the field predicts that the shortage is only going to get worse, unless some drastic changes are made.

The Future of the Nursing Workforce in the United States: Data, Trends and Implications, by Peter Buerhaus, RN, Ph.D., Douglas Staiger, Ph.D., and David Auerbach, Ph.D., forecasts a significant spike in the looming crisis. It also outlines some strategies that could lessen the blow.

“In about ten years, things are going to get really serious,” said Staiger, a professor of economics at Dartmouth College in Hanover, New Hampshire.

“That’s when it reaches the breaking point,” added Buerhaus, the Valere Potter Professor of Nursing at Vanderbilt University School of Nursing and Director of the Center for Interdisciplinary Health Workforce Studies at Vanderbilt University Medical Center in Nashville, Tennessee.One of the reasons for the increasing shortage is that, as the current nurse workforce ages, a growing proportion of those nurses will begin to retire, with a sharp increase around the year 2015.

The authors estimate that the nursing workforce will grow at an annual rate of two to three percent, but that won’t be nearly enough to counteract the effect of the increased retirements. Add in a growing demand for registered nurses for an aging general population that needs more care and the shortage of nursing faculty over the last few years, and the deficit will really swell.

By 2020, an estimated 285,000 additional nurses will be needed, and the need could reach as high as 500,000 by 2025.

“The supply is just going to stop growing for about a decade or more,” Staiger predicted, which will have far-reaching consequences.

“That means that access to care is going to be very dependent on the availability of nurses,” Buerhaus said. “Not just in hospitals but in doctors’ offices and nursing homes. You name it, access will be affected, and the quality of care and the safety of care will certainly be affected.”

Buerhaus added, “Clearly the patient is going to notice this in a very direct way.”

At the moment, the nursing shortage is not as dire as it was about six or seven years ago, according to the study’s authors. An influx of foreign-born nurses and older nurses returning to the workforce have helped ease the worst effects of the shortage in recent years. However, the number of visas available to foreign nurses is currently restricted and the retirement of the Baby Boomers is looming on the horizon, which means the shortages are very likely to worsen.

Despite the predictions, Staiger says he’s optimistic. He feels that more people are now aware of the nursing shortage and its implications, thanks to high-profile media efforts like the Johnson & Johnson Campaign for Nursing’s Future and the increased number of health care discussions by the presidential candidates and other policymakers .

With the hope of reaching the people who shape the country’s health care agendas, Auerbach, Staiger and Buerhaus have used their book to outline a series of short-term strategies to cope with the nursing shortage, as well as a set of long-term recommendations for health care employers, educators and policymakers.

Short-term solutions include encouraging hospitals to fill their nursing vacancies as efficiently as they can to reduce any disruptions in patient care and accommodating older nurses who may fill some of those slots. Expanding nursing education opportunities is also crucial to increase the supply of nurses.

Their proposed long-range solutions include finding ways to remove any artificial barriers that may be keeping certain people from entering the profession. For instance, two population groups are particularly underrepresented in the nursing workforce: men and Hispanics. The authors suggest that health care leaders should strive to discover and remove any barriers that prevent these groups from becoming nurses and encourage more to enter the field.

“I worry that unless we get pretty serious as a society and start investing in nursing education programs, and start targeting more men and more Hispanics, we’re not going to make the same gains that we’ve been making,” Buerhaus said.

Another one of the authors’ proposals is to encourage pay-for-performance initiatives. Buerhaus explained that research shows that nurses can prevent many negative patient outcomes that occur in hospitals. So, if hospitals have an economic incentive to avoid those outcomes, they may discover that it benefits their bottom line to support their nursing staff—and to pay them higher wages, which will also encourage more people to enter the profession.

The authors hope their recommendations, which are backed by a wealth of research data, will convince policymakers that they can have a role in helping equalize the nursing supply and demand in the coming years.

“I think we’ve made the best set of arguments yet,” Buerhaus said.

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