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Online Journal of Rural Nursing and Health Care, 12(1), Spring 2012 1 

Editorial 

RN Labor Supply Bubble: What Does it Mean for Rural Health Care? 

Pamela Stewart Fahs, DSN, RN 

A recent article in the New England Journal of Medicine (Staiger, Auerbach, & Buerhaus, 

2012) noted that the Registered Nurse (RN) labor supply is likely in a bubble with an oversupply 

of full time RNs. These authors note that health care employment is often countercyclical in 

nature. This means in times of a poor economy the number of health care positions grow, since a 

larger labor force is available. Those nurses who are employed may delay retiring or leaving the 

job market to continue their education since they have a steady source of income. The nurse may 

be the sole bread winner if other family members are unemployed, and those who were part-time 

are more likely to want to work full time to increase income stream in a poor economy. What 

does this mean to rural nursing? 

It may mean that rural health care facilities have a larger supply of RNs to choose from and 

they can be more competitive with their urban counterparts. However, extreme caution is 

advised. As the economy improves, and it always does, the pressures to stay in the work force 

will ease for current RNs. We know there will be a large number of RNs retiring in the next few 

years. In addition, those of us who are Baby Boomers are aging and will have increased health 

care needs in the future. If plans for the changes in healthcare with the Affordable Care act hold 

through the Supreme Court challenges, many more Americans will have health care coverage 

and it follows that they will use that coverage to seek care. This is expected to lead to more 

health care positions including those for RNs in all levels but particularly in advanced practice 

positions. 

Nursing is one of the most flexible types of health care disciplines in terms of types of 

positions. Nurses work in clinics, home health, public health, nursing education, school and 

industry as well as acute care. In rural nursing there is a need for what I term the “Consummate 

Generalist”. The role of the rural nurse is broad and you need a broad and deep knowledge base 

to practice in this environment. The Future of Nursing: Leading Change, Advancing Health 

report from the Institute of Medicine (IOM) and Robert Wood Johnson foundation (IOM, 2011) 

discuss several ways to ensure a strong role for nursing in advancing health care in this country. 

They specifically address rural nursing in a number of ways, chief among these the use of 

residency programs to assure a smooth transition from education to practice settings in rural 

environments, easing educational transitions to baccalaureate and higher education, and assuring 

that nurses can practice to the full of extent of their education and experience particularly in 

advanced practice roles.  

This time of a more abundant supply of RNs is a time for rural areas to strengthen the ranks 

of rural nurses. I would implore rural facilities and those of you in leadership positions in rural 

areas to use the time when RNs are available to look ahead and make plans that ensure an 

adequate supply of RNs in the future for your facilities and communities. Use this time to reduce 

professional isolation, provide training that assists both individual nurses and the organization in 

growth to provide the best possible health care. 

Staiger and colleagues (2012) predict that over the next several years this bubble of 

abundance of RNs will deflate if not burst. As nurses we have seen it before, the cycle of a nurse 

shortage replaced with predictions that the shortage is over, only to find the next cycle of 

shortages even worse. Hopefully those that employ RNs will be able to look at history and use 



Online Journal of Rural Nursing and Health Care, 12(1), Spring 2012 2 

this time of adequate nursing labor supply to prepare for the future, to prepare for a role for 

nurses that allows them to use their skills to the full extent of their scope of practice. 

References 

IOM (Institute of Medicine). (2011). The future of nursing: Leading change, advancing health. 

Washington, DC: The National Academies Press. Retrieved from 

http://www.nap.edu/catalog/12956.html  

Staiger, D.O., Auerbach, D.I., & Buerhaus, P.I. (2012). Registered nurse labor supply and the 

recession — Are we in a bubble? New England Journal of Medicine, 366 (16), 1463-5 

[MEDLINE] 

http://www.ncbi.nlm.nih.gov/pubmed/22436050