Nursing Shortage, or Not?

Nelson, Roxanne BSN, RN

AJN, American Journal of Nursing: May 2009 - Volume 109 - Issue 5 - p 21–23
doi: 10.1097/01.NAJ.0000351500.16639.55
AJN Reports

It comes down to location, location, location.

When Sibyl Shalo Wilmont was deciding whether to attend Columbia University's nursing program, she asked its financial aid officer about the school's job placement record. "Are you kidding?" was the response. "There'll be recruiters at the graduation ceremony." Wilmont thought it sounded too good to be true, and unfortunately, it was.

"I couldn't even get an interview with any of the major hospital networks here, including Continuum Health Partners and NewYork-Presbyterian," says Wilmont. "Not even at Mount Sinai, where I did a medical–surgical rotation and my internship, and I had recommendations from preceptors and the nurse manager."

After six months of searching throughout the New York City area, Wilmont was finally hired for a full-time day-shift position at a facility in the Bronx. But although the job has worked out well, she hadn't expected the search to take so long, or for so many doors to be closed to her, despite the fact that she was a recent graduate. After all, there's a major shortage of nurses gripping the nation.

Or is there?

Even with the currently strapped economy, the word from workforce experts is that the demand for nurses remains high and will dramatically increase in the future. The Bureau of Labor Statistics recently projected that by 2016, employment of RNs will increase by 23%, generating 587,000 new jobs. But the report suggested that the difficulty Wilmont had in finding a hospital position may presage a trend: the growth rates for hospital and nursing home RNs are predicted to be much lower than for nurses in other settings, especially physicians' offices and home health care services.

Still, in February 2008 the Council on Physician and Nurse Supply stated that U.S. nursing schools should be graduating 30,000 more nurses each year to meet the projected demand in all health care industries. Peter Buerhaus, writing in the November 26, 2008, issue of JAMA, predicts that by 2020 the number of open nursing positions will exceed the supply of full-time RNs by 285,000. By 2025 the deficit will reach half a million.

But predictions aside, many RNs say they're unable to find jobs. Like Wilmont, they're having difficulty getting interviews or even callbacks from recruiters. This is especially true for new nurses, who are finding that the facilities that are hiring only want experienced nurses.

"For the last few years, it's been a market where an experienced nurse could get a job anywhere," says Amy R. Morton-Miller, a nursing instructor at College of Lake County in Grayslake, Illinois. "Nurses would job hop, and they had a lot of flexibility. But with the current economy, things are changing."

Although the evidence is only anecdotal so far, it appears that nurses are holding on to jobs longer or delaying retirement. "Maybe some who were part-time are now full-time—because a spouse is unemployed or they're staying at a job for the benefits," says Morton-Miller, who also serves as an advisor on RealityRN, a Web site for new nurses. "Job hopping is slowing down, so turnover is lower."

And she adds, "Hospitals may also be tightening their belts, and that influences everything down the line. It's expensive to orient a new graduate, more so than an experienced nurse."

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The decade-long nursing shortage may have eased up somewhat, at least in some regions. According to the Buerhaus article, the number of full-time– equivalent RNs rose from 2 million in 2001 to 2.35 million in 2007, with hospitals taking on 63% of the increase. Rising RN salaries are credited with stimulating nurses to enter, remain in, or reenter the field, especially in the face of the nation's economic troubles after September 11, 2001, and now.

Postings on online nursing forums have increasingly reported a woeful lack of jobs, especially for those fresh out of school. Some report monthslong searches, with barely a nibble. One nursing student who was about to graduate reported that only two of her 44 classmates had jobs lined up. A new nurse in Chicago said she'd applied at 12 facilities, but only one had called her for an interview. Still others reported that hospitals in their areas were eliminating new-graduate programs, instituting hiring freezes, and even laying off nurses.

"We've heard anecdotal reports and don't know yet if this is a trend," says Robert Rosseter, associate executive director of the American Association of Colleges of Nursing. "Nursing programs haven't reported that this is a problem as of yet."

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For the moment, the shortage of jobs appears to be a problem only in some regions of the country. For example, Morton-Miller says that most of her students in Illinois are finding jobs. "But there are rumors that some hospitals aren't hiring. And several facilities are restructuring, so the situation may be different by tomorrow," she adds.

The job market appears to be very tight in New York City, northern New Jersey, and northern California. Massachusetts also is not the best place for a nurse to be job hunting, says David Schildmeier, director of public communications at the Massachusetts Nurses Association.

"We have seen a lot of hospitals going under, and other facilities are more likely to leave positions unfilled," he says. "The Cambridge Health Alliance, for instance, which is a network of three hospitals, is going through a major consolidation, and they are going to be laying off nurses."

However, Schildmeier believes that some hospitals are using the economic downturn as an excuse to curtail hiring. "There's no doubt, some facilities are hurting. They have fewer patients, people are putting off surgery, and so on. But that's not true for everyone."

"The current situation is reminiscent of the 1990s, when managed care was the culprit, but now the economy is the culprit," he continues. "We're looking at a long term shortage down the road, but right now a good part of that is caused by a reluctance to staff appropriately. Having an adequate nurse–patient ratio gives nurses assurance that they can have a safe patient load. Hospitals are now using the economy as an excuse to cut back, and they feel that they don't have to be competitive."

The situation in northern New Jersey is also difficult for job seekers. Both new nurses and recruiters are frustrated, explains Nancy DeLapo, president of the New Jersey Association of Healthcare Recruiters. "Several hospitals have closed, others have cut back [on the number of] positions because of the economic crunch, and they have cut back on training programs," she says.

The association is trying to do what it can to help new grads, such as providing contacts for out-of-state jobs. "We are trying to help them think outside the box and look at alternatives to hospital work," says DeLapo. "They can try insurance companies, physicians' offices, outpatient clinics, and long-term care facilities, and if possible, think about relocating—at least temporarily."

Hospitals in parts of Pennsylvania, Virginia, and Georgia are hiring, DeLapo says, but she also recognizes that relocation is not an option for everyone, especially for second-career nurses who may have strong ties in an area. "We're trying to gather together faculty and nursing schools to discuss the situation," she says. "But there are a lot of nursing programs in New Jersey, and right now we're swamped with new graduates and a limited number of jobs."

Releasing contracts here … Some new graduates who believed they had jobs waiting for them are finding out otherwise. Hospitals that have already paid thousands of dollars for students' tuition in return for their agreeing to work at the facilities for a specified number of years are reportedly releasing graduates from those contracts.

Last December, according to the January 4 Arizona Daily Star, Tucson Medical Center in Arizona was unable to hire all 27 of the students it sponsored, blaming its diminished need for new nurses on lower turnover in nursing staff and a dip in patient numbers. Officials there declined AJN's request for comment on this issue, stating only that it was a "personnel matter." In Los Angeles, another December graduate reported that she and a number of her classmates had been released from their contracts after initially being told that they'd been hired and waiting three months to begin working.

… But plenty of work there. In contrast to these reports, however, are others from nurses who say jobs are readily available. Nurses have said there are "plenty of jobs" and hospitals are recruiting new graduates in Dallas. According to the August 28, 2008, North Carolina Sun Journal, in the summer of 2008, Craven Regional Medical Center in eastern North Carolina hired 54 newly graduated nurses and continues to offer scholarships and relocation assistance. Florida hospitals are also hiring and some are willing to train new graduates, according to firsthand reports by nurses and job advertisements.

"Basically," says Morton-Miller, "this situation is evolving and will continue to evolve."

Roxanne Nelson, BSN, RN

© 2009 Lippincott Williams & Wilkins, Inc.