Monthly Archives: October 2003

Understanding the Nursing Shortage

The United States is facing a severe nursing shortage that threatens the underpinnings of our health care system. We can take steps now that can provide short and long term solutions to this looming crisis.

The United States employs over 2.2 million registered nurses (RNs) – the largest professional category in America. There are currently over 120,000 unfilled nursing positions. By 2015, another 400,000 nurses will be needed. The RN shortage hurts patient care and already leads to thousands of unneeded deaths per year.


1. Direct Health and Human Services to use some of the already-earmarked Nurse Reinvestment Act dollars to market nursing as a second career. With less than a two-year degree, one can make a good living working just part-time. A concentrated marketing effort will attract more Americans to the nursing profession and help solve the long-term shortage.

2. Allow foreign nurses to take the National Council Licensure Examination (NCLEX), the test that accredits nurses in the U.S., in their country of origin. Today, qualified nurses from abroad can only take the examination on American soil, which is a significant barrier to attracting new talent. Making it easier for foreign nurses to come to the U.S. will ease the short-term burden.

Justification …

Key imbalances

• In 1980, the average age of a nurse was 38 compared to the current 45 year old average.

• The current average age of retirement for a nurse is just 52.

• The average age of an RN is increasing more than twice as fast as all other occupations in the U.S.

• The number of students graduating from nursing school is smaller than the number of nurses that are retiring each year.

• Fewer nurses entering into the nursing field resulted in experienced nurses retiring or cutting back on hours due to the increased stress.

• The nursing profession is effectively pulling from half the population – only 10% of nurses are men.

• While the number of new nurses increased 3.7% in 2001 and 8.0% in 2002, there were still 10,000 fewer nurses in 2002 than in 1995.

Demand is increasing

Two main factors cause heightened demand for nurses:

1. Aging population. In 2000, there were 34.7 million people in the U.S. over 65 years old. By 2020, there will be over 53 million people over 65.

2. Regulatory burdens. In 2001, six new states limited overtime for nurses. Also, states like California now require all hospitals to have a one-to-five nurse to patient ratio (the average is one-to-seven today).


Nursing salaries average $47,000/year and wage increases have significantly outpaced inflation each of the last six years.

The wage increases have unexpectedly resulted in a backward-bending supply curve where many nurses have actually cut back their hours because they only want to earn a specific amount per year annually. Therefore, while higher wages attract new nurses in the long term, they create greater shortages in the short-term due to less total nursing hours.

A looming healthcare crisis can only be averted if we act now and act resolutely.

Books: A History of Knowledge: Past, Present and Future

Books: A History of Knowledge: Past, Present and Future by Charles Van Doren

Well … my friend Doug Kilponen has done it again … another stellar recommendation. Doug, the same guy who recommended Generations and the same guy who recommended Against the Gods (two of my favorite books) has topped himself again …

A History of Knowledge is just that — a history of humankind and our quest for knowledge. Van Doren, the former editor of Encyclopedia Brittanica writes this like a mini-encyclopedia — everything you need to know about history in 412 pages.

I must confess … I could not put this book down … people on the plane were looking at me funny as I stumbled to me seat because I insisted on reading this book while walking the aisles … no, it is not a novel with an original plot — but it does plot out human history and makes some extremely interesting observations along the way. Van Doren not only tells us what happened, but gives us his view on why it happened and links events to past and future events. He does all this with a lot of wit and humor.

Van Doren, you may remember, was the former Columbia professor that got cheating on “Quizz Show.” That happened well in the past.

This book, written back in 1992, is a must read for anyone who forgot the lessons of Aristotle, Newton, Napoleon, and the Ming Dynasty.

Summation: Read this book.

GDP – per capita — Rank Ordering the World

Check out:
CIA – The World Factbook — Rank Order – GDP – per capita reveals a ranking of 231 territories/countries and their rank order in terms of GDP per capita.

Luxemberg is first with $44,000 … followed by the U.S., Bermuda, Cayman Islands, San Marino (a random country of 28 thousand located within the borders of Italy), Norway, Switzerland, Ireland, Canada, and Belgium.

The lowest GDP is East Timor (with $500) … followed by Somalia, Sierra Leone, Gaza Strip, Mayotte (near Madagascar and run by France), Burundi, Congo, Tanzania, and Malawi.

Books: Bias: A CBS Insider Exposes How the Media Distort the News

Books: Bias: A CBS Insider Exposes How the Media Distort the News by Bernard Goldberg

A CBS Insider Exposes How the Media Distort the News

This is an interesting and extremely provocative book recommended to me by Rob Bailey. Though Goldberg seems to be on a vendetta of sorts, he makes some extremely good points about the left-wing bias of the news at the three major networks.

ABC/CBS/NBC news are in steady decline. every year their viewership goes down as people turn to more trustworthy news sources (Fox, MSNBC, talk radio, the Internet, etc.). Goldberg explains why it happens and how it happens — and he gives a lot of good examples on media bias.

It is hard to read (or listen — I actually listened to it on tape) this book and come out with a good opinion of Rather, Brokaw, and Jennings. It will be interesting to see how news changes in the next few years as all three are expected to retire in the near future.

Do You Have a Bizarro?

Do you have a bizarro?

A couple of years back i had an eVite bizarro. eVite is a service that people use to invite you to parties and then you can RSVP to them effectively.

I kept going to parties and “Ron Abta” would always RSVP to them. I kept seeing his name and wondered who he was. Then I started going to parties and asking if he was there. Invariably I’d get a response like “he’s in the living room” and then I’d make my way to the living room and I’d get “he already left.” I started thinking that maybe this Ron Abta guy didn’t exist.

Well … soon enough, Ron heard I was doing this at parties and he started doing it to — asking people if they saw “Auren Hoffman”. We went six months like that before finally meeting (and then I introduced him to Arinel’s — the best pizza in San Francisco)…

Books: No Such Thing As a Bad Day: A Memoir by Hamilton Jordan

Books: No Such Thing As a Bad Day: A Memoir by Hamilton Jordan

Yet another book on tape. Good book from President Jimmy Carter’s Chief of Staff. Hamilton Jordan talks about his experiences with three different bouts of cancer — all effecting him before he turned fifty.

It is a good book about cancer — something that will affect almost 50% of all Americans in our lifetime.