How Can Hospitals Afford Not To Hire?

[European]

Everything leads to believe that new nurses are needed. The aging population, the baby boomers, the aging nurses working, longer lives lived, more chronic diseases present etc....

My dilemma and question is, how can hospitals and health care facilities afford not to hire newly graduated nurses. They should be getting the manpower from somewhere. Are they relying only on overworking the experienced staff only. If they rely only on experienced nurses they are using a constant amount of people for a growing population of people with diseases.

This is what I do not understand, either the hospitals are using workers from some obscure source that I am not aware of or there is a mystery going on here.

Let me know what you think or know, Thanks....

[TheCommuter, BSN, RN]

Demand for healthcare is down in the U.S. because too many bankrupt people cannot afford to pay for it. This translates into less patients, and the end result is that less nurses are needed to care for fewer patients.

Contrary to popular belief, nursing is NOT recession-proof. During this particular recession, demand for healthcare services has decreased because more people are unemployed and underemployed. The unemployed typically have no health insurance and minimal or no cash reserves to pay for their healthcare, so they stay away from hospitals, clinics, doctors' offices, and other providers unless it is an emergency that absolutely cannot wait. Even the insured and employed people are not seeking out elective surgical procedures because they are reluctant to take the time off work that is necessary for recovery.

Less patients = less nurses

I've previously mentioned that healthcare facilities are businesses who count money down to the last penny, and they view experienced nurses as more cost-effective than the new grad with no nursing work experience. However, this train of thought is going to bite the facilities in the butt years down the line, because we're graduating a generation of nurses who will not acquire important experience and will not be able to fill the shoes of the experienced nurses who will eventually leave the field.

[llg, PhD, RN]

No mystery. With tough economic times, more experienced nurses want to work -- and work more hours to compensate for the fact that their husbands' incomes are less than they used to be. The nurse who used to work 1 day per week is now working 2 shifts per week. The nurse who used to work 2 shifts per week is now working 3. etc.

So, employers have a ready supply of experienced nurses to tap into -- and that's what they are doing. Those experienced nurses are cheaper at the moment because they are already on staff and don't need oriented. Others are nurses who used to work for the hospital and need minimal orientation. Why take a risk on a new grad who needs lots of orientation, but who might not work out, when you have a ready supply of experienced nurses available who you already know are competent?

[joanna73, BSN, RN]

Yes except that people seem to forget that everyone had to start somewhere. So in the end, these facilities are just going to screw themselves, and sooner, rather than later. I am a new grad, and my intention is to gain experience and move to Australia. That was always an idea anyway, and Australia is not facing this crisis. Thankfully, a nursing degree is very portable for those of us who like to travel. And for those of you who are struggling, I hope things improve in another year or so.

[SummerGarden, BSN, MSN, RN]

yes except that people seem to forget that everyone had to start somewhere. so in the end, these facilities are just going to screw themselves, and sooner, rather than later.

i have had new grads mention this to me in person. however, in-person i just nod my head because i know they feel angry and hurt and i do not want to add to that frustration. however, i will respond to you because this is a forum...

i do not agree with your assessment. the reason being, the only way facilities will lose out on new grads in the future is if hopefuls stopped graduating from nursing school. since that is not the case and probably will not be the case for decades to come, facilities will not lose out. when facilities start to hire again, there will be a crop of new grads plus experienced nurses (we are not all planning to retire in the next few years or even the next few decades) from which to choose. honestly, the only people being burned by the hiring practices of employers right now are the nurses working (because our working conditions are poor) and new grads who have little to no hope of finding employment. future new grads 10 years from now may be fine.

[joanna73, BSN, RN]

As you pointed out, the people who are affected by the current situation are the nurses who are overworked, and, of course, pt care is affected, aside from new grads. In any case, this is not beneficial to anyone, except the organization who is saving money. I, personally will not allow this to deter me. I spent a lot of time and energy in school. Furthermore, since nursing is my second, and last, career, I will make it work. Somehow. While the situation may not be ideal, there are still jobs available, even for new grads. I plan to do whatever I need to do to wait this out, because giving up is not an option. And since I prefer working abroad anyway (not the US), I'm not concerned.

Happy holidays :)

[elkpark]

No mystery. With tough economic times, more experienced nurses want to work -- and work more hours to compensate for the fact that their husbands' incomes are less than they used to be. The nurse who used to work 1 day per week is now working 2 shifts per week. The nurse who used to work 2 shifts per week is now working 3. etc.

So, employers have a ready supply of experienced nurses to tap into -- and that's what they are doing. Those experienced nurses are cheaper at the moment because they are already on staff and don't need oriented. Others are nurses who used to work for the hospital and need minimal orientation. Why take a risk on a new grad who needs lots of orientation, but who might not work out, when you have a ready supply of experienced nurses available who you already know are competent?

In addition to this, many hospitals were starting to balk at hiring new grads even before the economy tanked -- I had conversations about this with nursing administration folks all over my state when I worked as a hospital surveyor for my state several years ago, and heard the same thing all over my state, in hospitals large and small: Nursing administrators in hospitals feel like a) new grads are not at all well-prepared to enter practice, and they are tired of (from their perspective) having to invest a ot of time and $$$ in teaching new grads most of what they need to know to function on a nursing unit, stuff that the hospitals feel (rightly or wrongly) they should have learned in nursing school, and b) new grad turnover is at the highest point it's ever been -- hospitals hire new grads, invest the aforementioned significant amount of time and $$$ in orienting them, and then those people often leave that facility long before they become an asset rather than a financial liability. A lot of hospitals feel they have been "burned" by new grads and have responded by becoming a lot more hesitant about hiring them, totally apart from the current economic conditions -- the economy is just exacerbating the existing problem.

I'm not saying this as a criticism of any particular individual (esp. anyone posting here) -- just sharing what I've heard from nursing administrators in lots of hospitals in my state. There were also quite a few threads here about how hospitals in many larger cities across the US were putting up "new grads need not apply" statements on their job posting websites even before the economy tanked.

I'm not sure that is a situation that is going to change just because the economy improves -- I think it's a larger issue than "just" the current economic conditions.

[SonorityGenius]

The "mystery" is the influx of foreign nurses brought in by the hospitals. I know mine hired 10 last year before the "great recession" - and they are all still there, working mad long hours and no breaks.

[MtBpsy9609]

Agree. In my area the hospitals started hiring freezes and huge staff lay offs well before the economy tanked. They fired all LPN's and cut back on most of our support staff. Many unit units started working with out a secretary and with fewer CNA's. You are right in that there is something bigger going on. I don't think the hospitals will drastically increase hiring once this recession eases.

It could be what the poster above said, over saturation of nurses, new grad and foreign. I know in my state there are 22 nursing programs cranking out new grads and CONSTANTLY recruiting new students! They never consider where all of these new students will work once they have paid taken their tuition.

In addition to this, many hospitals were starting to balk at hiring new grads even before the economy tanked -- I had conversations about this with nursing administration folks all over my state when I worked as a hospital surveyor for my state several years ago, and heard the same thing all over my state, in hospitals large and small: Nursing administrators in hospitals feel like a) new grads are not at all well-prepared to enter practice, and they are tired of (from their perspective) having to invest a ot of time and $$$ in teaching new grads most of what they need to know to function on a nursing unit, stuff that the hospitals feel (rightly or wrongly) they should have learned in nursing school, and b) new grad turnover is at the highest point it's ever been -- hospitals hire new grads, invest the aforementioned significant amount of time and $$$ in orienting them, and then those people often leave that facility long before they become an asset rather than a financial liability. A lot of hospitals feel they have been "burned" by new grads and have responded by becoming a lot more hesitant about hiring them, totally apart from the current economic conditions -- the economy is just exacerbating the existing problem.

I'm not saying this as a criticism of any particular individual (esp. anyone posting here) -- just sharing what I've heard from nursing administrators in lots of hospitals in my state. There were also quite a few threads here about how hospitals in many larger cities across the US were putting up "new grads need not apply" statements on their job posting websites even before the economy tanked.

I'm not sure that is a situation that is going to change just because the economy improves -- I think it's a larger issue than "just" the current economic conditions.

[againmlg]

i have had new grads mention this to me in person. however, in-person i just nod my head because i know they feel angry and hurt and i do not want to add to that frustration. however, i will respond to you because this is a forum...

i do not agree with your assessment. the reason being, the only way facilities will lose out on new grads in the future is if hopefuls stopped graduating from nursing school. since that is not the case and probably will not be the case for decades to come, facilities will not lose out. when facilities start to hire again, there will be a crop of new grads plus experienced nurses (we are not all planning to retire in the next few years or even the next few decades) from which to choose. honestly, the only people being burned by the hiring practices of employers right now are the nurses working (because our working conditions are poor) and new grads who have little to no hope of finding employment. future new grads 10 years from now may be fine.

finally someone said what i've been thinking. given the over saturation of new nurses.... and the many still trying to get into nursing schools.... i think it will take about 10 years for the employment prospects of nurses to improve. i also don't see working conditions for nurses improving much until the nurse glut is over. it will take about 10 years to turn this situation around.

[Music in My Heart]

Regarding the expectation that things should get better as the economy improves and experienced nurses leave the field in droves:

1) There are a great many people who are skeptical that the economy will significantly improve any time in the next few years. There remain enormous challenges in debt, employment, currency valuations, and trade imbalances - not to mention the drain of the endless Bush/Obama wars.

2) I know several experienced nurses who state that they have no intention of ever retiring - and these aren't even the late-to-the-party folks like me.

[chuckster, ADN, BSN, RN, EMT-B]

I have not seen any data indicating a significant drop in the overall numbers of patients treated in the US or in the aggregate number of employed nurses (in fact, I believe that nursing employment has actually risen slightly). Just prior to the recession, there was a drop in the overall number of hospital beds, and I would suspect that there is now a good match between patient demand and the number of available beds. What I suspect is behind the apparent slowdown of hiring is:

1) the desire of hospitals to maximize the productivity of their workforce and

2) an oversupply of qualified personnel.

In many and probably most parts of the country, nurse-patient ratios are not regulated by law or governed by union agreements, freeing health care institution to set their own levels. Hospitals always walk somewhat of a tightrope trying to balance the needs of patients with the need to run a financially healthy organization. The recession has put more strain on hospital operations and in response, they are trying to run as lean as possible. This means that they do not have the extra staff needed to train and oversee new grads - these experienced nurses are much more productively used to care for a larger number of patients. The recession has also increased the numbers of qualified and experienced nurses available to hospitals with large numbers of nurses postponing retirement or coming out of retirement and nurses who formerly worked part-time seeking to increase their hours.

At the same time, nursing schools are pumping out increased number of graduates. In the past, hospitals would have attenuated the oversupply by effectively reducing wages for nurses by hiring those new grads - who would have displaced the older, more highly paid nurses. Again however, the recession has worked in favor of the hospitals. The high unemployment level means that there is little upward wage pressure, so hospitals can hold the line on nursing salaries and retain their experienced personnel at the same time.

One partial solution to this problem is for nursing schools to decrease the numbers of new students. However, schools need to be worried about their bottom line too, so it is not in their financial interest to do that. In addition, the demand by customers (i. e., students) for nursing degrees has not decreased during the recession - if anything, demand has actually increased. So nursing schools will continue to pump out ever larger numbers of new grads into an economy that will not be able to absorb them, exacerbating the problem for years to come.

Unless the recession is short-lived - and there is no indication that it will be - it looks to me that the US will have large numbers of non-practicing RNs for the foreseeable future. Some of these nurses may immigrate to under served countries (ironic, given the large number of foreign nurses only recently recruited to work in the US) but the majority are likely to simply seek non-nursing employment. As an aside, I'd like to predict that nursing schools will react to the large numbers of non-practicing RNs by offering new certificate programs designed to keep nursing skills sharp.

Just my 2¢ - YMMV.