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Revisiting the Nursing Job Market

Nelson, Roxanne BSN, RN

AJN The American Journal of Nursing: January 2014 - Volume 114 - Issue 1 - p 17,18
doi: 10.1097/01.NAJ.0000441784.32290.88
AJN Reports

Forecasts based on acute care models may be outmoded.



Nursing has always been pitched as a recession-proof profession with a chronic labor shortage, a vocation in which there's always a job waiting for any nurse who wants one. A decade ago, when hospital vacancies hovered in the two-digit percentages, that was certainly the case.

Then came the recession in 2008, when health care spending dropped to its lowest rate in nearly 50 years. Seemingly overnight, the nursing shortage morphed to a nursing surplus and job vacancies dwindled to nothing. Layoffs and hiring freezes became the status quo. Particularly hard hit were new graduates, who found that it was taking months, if not longer, to secure a position.

With the economy recovering, and the worst of the tough times presumably past, the outlook for nursing jobs is bright, according to many experts. The Bureau of Labor Statistics projects that registered nursing will be the top occupation in terms of job growth through the year 2020. An estimated 26% increase in nursing jobs is predicted between 2010 and 2020.

But that news isn't very comforting to the many nurses who are struggling to find a nursing job. The market remains tight, according to media stories from around the country. New graduates and experienced nurses weighing in on nursing forums report frustration. For example, CNNMoney recently ran a series of profiles of new graduates currently seeking employment, aptly titled “I Can't Find a Nursing Job!” One of the profiled RNs, who previously worked for seven years as an LPN, still can't find work as an RN. Another new graduate, after looking unsuccessfully all over the United States for a nursing position, created a petition on the White House Web site asking President Obama to help new nurses out.

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Tradition holds that when a nurse finishes training, the first stop is a job in a hospital. “But the whole health care paradigm has shifted,” said Donna Cardillo, MA, RN, an expert on nursing careers. “We're in the midst of a major change right now, [but] students and new nurses are still being told that they must get two years’ experience in a hospital before they move on,” she said. “That advice is no longer relevant or practical in many cases.”

The end of the recession notwithstanding, care is shifting away from the acute care environment and the number of traditional bedside hospital jobs is decreasing, Cardillo explained. And although there are a number of factors at play, the downsizing seen in acute cure is one of the major reasons for the lack of hospital jobs. “Both new and experienced nurses really need to look [for jobs] beyond the hospital bedside, but just as important, they need new skills to get those jobs,” she said.

The new skills Cardillo refers to are job-hunting skills. Nurses need to get out and network, she said, with more face-to-face meetings at professional conferences and seminars, for example. And nurses must become active on social media sites, such as LinkedIn. “Many are behind the times with those skills, [but using them is] imperative in today's world,” she said.

Beverly Malone, PhD, RN, FAAN, chief executive officer of the National League for Nursing, agrees that nurses need to start thinking creatively, especially those without RN experience, like new graduates. “There are positions in places where we would not normally think of starting a career, such as nursing homes, prisons, or in the community,” she said. “There are options out there.”

Once nurses get some experience, they have something to negotiate with, Malone said. “But getting that experience may require relocating and moving to another part of the country where the job market is stronger and being open to different job options.”

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But are there any actual numbers to give nurses a sense of what the market is really like, particularly those who've just graduated or students nearing the end of their education?

The National Student Nurses’ Association (NSNA) has been collecting survey data from new RN graduates (NSNA members) for the past five years. According to the January–February 2013 issue of Dean's Notes, an NSNA publication for nursing school leaders, the results of more recent surveys show that there's been a widespread drop in entry-level positions. For the 2012 report, 4,110 new graduates were surveyed approximately four months after spring graduation. Of that group, 66% (n = 2,701) said that they had an RN position. That was a small (2%) increase over the previous year's survey.

When those without a position were asked why they didn't yet have a job, 8% said they hadn't started searching, 14% were waiting to pass their boards, and 28% reported difficulty finding a position in their preferred specialty. But nearly half (49%) said that there were “no jobs for new graduates in my area.”

The surveys also reveal regional differences in the rates of the employment, and as Malone suggested, relocation might be necessary in some cases. New graduates in the South and in the center of the country reported the highest rates of employment (73% in both), and California had the lowest (46%), followed by the West (55%) and Northeast (60%). The 2012 graduates also reported these trends:

  • Positions are being filled by experienced RNs (76%).
  • Older RNs aren't retiring (70%).
  • The market is being flooded by too many new graduates (63%).
  • Graduates holding baccalaureates are preferred over those with associate's degrees (69%).
  • RNs working full-time also hold part-time second RN jobs (56%).
  • Employers are hiring per diem nurses without benefits (52%).
  • Currently employed RNs are working harder (51%).
  • Nurses who previously held part-time positions are now working full-time (50%).
  • Employers are hiring travel and agency nurses (44%).
  • New graduates are able to find jobs in long-term care facilities (44%), and home care and community health agencies are also hiring new graduates (27%).
  • Some hospitals are creating residency programs (41%), although others are discontinuing such programs as well as new-graduate orientation (24%).
  • Hospitals have put hiring freezes in place (34%).
  • Hospitals are closing departments (20%).
  • RNs are being laid off (16%).

Despite the current situation, the Bureau of Labor Statistics still foresees the population of employed nurses growing from 2.74 million in 2010 to 3.45 million by 2020, an increase of 712,000. The total number of job openings for nurses because of growth and replacements is projected to be 1.2 million by 2020. But the work environment in health care is evolving and may look different in just a few years.

“We're seeing significant work devoted to redefining the way we deliver care and how we use our workforce,” said Pamela Austin Thompson, MS, RN, CENP, FAAN, chief executive officer of the American Organization of Nurse Executives. “That's what we're going to be watching most closely: how fast hospitals adapt to the changes that will be required as they move toward integrative care systems.”

As for the projected demand for nurses, those forecasts are based on the care that's being delivered today. “We [will] need to recalibrate those numbers,” Thompson explained, “because they are for acute care; we may have to take another look at that.” In the end, the forms U.S. health care takes will determine where the jobs are going to be. “We may see less employment in hospitals, but that's because employment is shifting to other areas,” she said.

Thompson pointed out that when one is looking at a workforce shortage, many factors have to be considered, not just the number of vacancies. “It's a [whole] system that we're talking about,” she said. “In the model we use, when you talk about the workforce, you have to talk about education, how nurses actually enter the workforce, the use of technology, the impact of regulations, reimbursement, leadership, and the delivery system itself.”—Roxanne Nelson, BSN, RN

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