Nursing Shortage

Nurses General Nursing

Published

"The nursing shortage lies--local major hospital corporations are not hiring nurses, despite continuing to falsely post job openings"

Knoxville, Tennessee

December 1, 2013

After deciding to go to school to become a Registered Nurse, many had the hopes and promises of never being unemployed or ever having to worry about finding a job. So many figured this would be a good investment in their future--but it may be time to reconsider that idea.

For as long as I can remember, and most definitely for as long as I had aspired to be a nurse, I had been hearing the term 'nursing shortage' tossed around by the multiple media streams as well as from other healthcare professionals. It was brought up everywhere. If you looked for example, in the newspaper, you would find ads boasting huge sign on bonuses for Registered Nurses with excellent wages and benefits-- some even paid continuing education opportunities.

Many people began to jump on the bandwagon to obtaining their nursing degrees. With many opting to do BSN programs, there were also many ADN programs that offered nursing education and the 'RN' title after only 2 years of study. This made it appealing to a lot of already employed individuals looking for a stable, steady career change. All kinds of nursing programs began to spring up, with as many as 6-10 nursing programs per city or region. Most of these programs here in Knoxville are producing roughly 60-100 nurses every 2 or 4 years depending on the program, but with a job outlook growth projected at "faster than average" and the "shortage of nurses", it seems like a no brainer! With quotes like this plastered all over the American Nurse's Association's website, where could you possibly go wrong?

The Shortage Isn't Stopping Soon
You've likely heard about the "nursing shortage" for years now, and perhaps you think it's been resolved. However, registered nurses are still at the top of the list when it comes to employment growth (BLS, 2010).

What we have failed to see as a society is the impact of market saturation. With so many local nursing programs producing a steady supply of new graduates, it's not difficult to see that eventually the supply is going to exceed demand in any given geographical region, as it has already done here in Knoxville. But this isn't the only contributing factor in and of itself. This is just one of the complicating factors in a multiple faceted, bigger issue.

At the same time we saw such an increase in the amount of nurses that were being turned out into the job market, we also began to see some political changes within the healthcare industry itself, in particularly with the hospitals. Many of the smaller market hospitals began to merge or be 'bought out' by larger corporations, such as Covenant Health and Tennova Healthcare Systems. These larger corporations have ended up owning many smaller hospitals and dominate the job market in the Knoxville area. This is a great investment for the corporations, but can be pure disaster for the nurse seeking employment.

If those two strikes aren't enough to put nurses behind the eight ball, then add in the fact that many jobs that used to be held only by Registered Nurses are now being filled by Licensed Practical Nurses, Certified Nursing Assistants, and Medical Assistants. This is in part due to an increase in the availability of educational programs for these careers. Also, the job descriptions have changed which allow these individuals to do more than the previously could, thus eliminating the need for RN's. This also eliminates the need for a company to pay RN wages for the same tasks that can be done by a CNA or LPN.

This leads to another problem that is wreaking havoc on nursing job opportunities--the greediness of these large corporations. The idea of "doing more with less" has caught on BIG with employers. In jobs, such as retail, this only hurts the employee by working them to a personal limit and exhaustion. In the employer's eye, if they can get one person to do the work of three people, then why would they want to pay three people? This idea has really taken a hold on the nursing industry as well. The employers however, have neglected to see the real problem with this. When you implement this ideology, not only do you work the employee beyond his or her limits, but you also endanger the lives of patients. I have found this to be the case first hand, working for Covenant Health. This is especially true on medical surgical units and critical care units. It is not uncommon for one nurse to carry the load of 7-8 patients per shift on a medical surgical unit and 3 patients at a time in a critical care unit. This patient to nurse ratio has increase drastically over the past few years and is simply unsafe practice. I can remember having traveling nurses come to our facility, see our nurse to patient ratio and make comments about how 'unsafe" they felt working with that load. The employers are slowly increasing the workload per person until they find a "breaking point", which usually consists of a patient harm event and/or a subsequent lawsuit involving patient harm. Unfortunately, patients must be injured or harmed before the issue is viewed in any other light aside from a "bottom line" or "money" issue. Despite bringing these issues up in staff development meeting numerous times, it was always "blown off" as not important. These large corporations are able to get away with such treatment of their employees because of the very thing they are creating--the saturation of nurses and the fact that they dominate the market. If you have nurses that are seeking jobs so desperately, then they are willing to "put up" with harsher working conditions and lower wages in spite of having a "job". At the same time, the reason for those harsher working conditions is greediness from the employers by not hiring additional nurses to spread the workload out and make conditions safer for everyone. It's a vicious cycle and until the healthcare corporations such as Covenant and Tennova realize this, they may be facing more patient dissatisfaction and lawsuits than they bargained for.

Interestingly enough, employers do a great job of "masking" the fact that they aren't hiring new nurses too. Just go to any large hospital website and view the job opening boards. You would be amazed at the amount of "open" positions that are posted there. I have heard from numerous nurses, that even after applying for upwards of 30 positions, they have yet to receive one call for an interview. I have experienced the same thing first hand. After speaking with one local Human Resources agent, it was apparent that their facility had only hired five RN's over the past 5 months, despite countless pages of open job postings. I have spoken with several managers who have informed me that hiring is just 'dead' and there are no plans to hire additional nurses, especially before the beginning of the year at the earliest. In addition, you never see those attractive 'sign on' bonuses that once were a commonplace among nursing positions.

If these large hospital corporations are not going to hire new nurses, and we have in fact seen the end of the 'nursing shortage era", then they at least need to stop feeding the public a constant stream of lies by continuing to post job openings daily. This is a very misleading and dirty way to do business in the community.

I always love to see how 'defensive' people become on these forums. You would think I wrote this article specifically about them and they take it so personal. This is the same reason politicians can't get anything accomplished in Washington they can't get past taking issues 'personally' and just have a civil discussion. It's sad.[/quote']

YOUR ARE SOOOOOOOO RIGHT!!! Well said!!!

On another note, when you are here reading other people's post and you feel like it doesn't pertain to you, then why even bother to comment? Obviously now you state that you don't know what my point is or whom its addressed to….although your first comment suggests that you understood just fine, in fact, enough to leave a passive aggressive comment like:

Yes, we are all quite aware. You do realize that you're preaching to the choir?

WE NEED MORE PEOPLE LIKE YOU ON THIS SITE ZACK1110!!! And even if you are "preaching to the choir" preach on brother!! Its always some people like me who dont mind hearing/reading it again.

Is there a nursing shortage?

Obviously not.

Neither do I think that there ever was.

There is, however, a shortage of high-end, hardworking, experienced nurses willing to certain jobs.

Are there jobs?

Obviously. I have one... and had two others.

And my department is hiring... all the time... continuously...

And people are leaving other hospitals to come to us so there are positions opening behind them.

Are there new-grad jobs?

Yes... though admittedly not nearly enough for all the people who want/need them.

Though the truth is, many new grads are simply not up to par.

I'm not even referring to simply things like starting lines (That's just a matter of practice) or knowing all the meds (which, until you see them applied in real life is difficult). I'm actually speaking more of core intelligence, logic, critical thinking skills, communication skills, core-science knowledge, and math competency.

This is, IMO, a reflection of too-low admission standards and an insistence on spending time on things like nursing theory and writing papers.

Nursing is taught as a social science (APA, right?), not as a hard science (ACS/AMA) nor even as a trade.

There's nothing new about pushing for increased productivity. Productivity is a core economic measure and has been increasing, generally, forever...

Hospitals are businesses...

And even not-for-profit businesses need to continually become more productive in order to be viable. Every business will - and should - push their employees to become ever more productive...

However... the employees (and the government) have a role to play in pushing back... in defining what is acceptable and what is not.

One way this is done is the establishment of workplace rules regarding safety (e.g. OSHA, etc), wages (min wage, OT, etc), and work conditions (mandated breaks, etc).

Another way is through worker solidarity and collective bargaining... supported by laws which recognize and promote worker rights as to employer rights.

OP, to your core point, however, you are absolutely correct... there is no nursing shortage... I'm not aware of anybody stating otherwise.

The same can be said of jobs for engineers, cops, teachers, firefighters, soldiers...

I firmly believe, however, that the cream rises to the top and that excellent people will find success if they work for it.

Many people began to jump on the bandwagon to obtaining their nursing degrees.
Full disclosure... I am one of those bandwagon jumpers... and very happily so.
where could you possibly go wrong?
Ah yes, the 'magical thinking' of youth...
However, registered nurses are still at the top of the list when it comes to employment growth (BLS, 2010).
Which, perhaps, is more a commentary on the lousy prospects in many other fields than it is a commentary on nursing...
What we have failed to see as a society is the impact of market saturation.
Yep, a lot of people don't understand basic economics... and I've noticed that it's not a core requirement of many nursing programs... which is unfortunate...
Interestingly enough, employers do a great job of "masking" the fact that they aren't hiring new nurses too.
I think you're kidding yourself... there's no benefit of "masking" anything... plenty of places just aren't hiring... or are hiring just the right person...

And having been a hiring manager, it's not all that easy to find high-end candidates and a lousy-hire is worse than having open positions...

I have heard from numerous nurses, that even after applying for upwards of 30 positions, they have yet to receive one call for an interview.
You know, I hear this a lot.

I wonder how many of those positions for which they apply are ones for which they are minimally qualified let alone highly competitive. I believe not many.

I routinely see new grads complaining of filing "hundreds of applications" without getting call-backs. Having been a new-grad nurse in 2009, and having applied for many jobs - as a nurse and otherwise - I've observed that there are rarely more than a select handful of jobs for which I'm really qualified.

Have I done the shotgun thing, too? Yes...

Do i think that really counts? No...

Job seekers are often counseled - here, other websites, and career counselor - to apply for any job that they want, even if they're hardly qualified. I think that's why more postings are blunt about saying, "No new grads."

they at least need to stop feeding the public a constant stream of lies by continuing to post job openings daily.
Why do they need to do that?

I'm of the opinion that, were blue-chip candidates to apply for those jobs, that they would be hired.

Think of those postings as 'wish-list' postings...

Just as candidates have dream-jobs, employers have dream-hires.

Specializes in Med/Surg, Ortho, ASC.
On another note, when you are here reading other people's post and you feel like it doesn't pertain to you, then why even bother to comment? Obviously now you state that you don't know what my point is or whom its addressed to….although your first comment suggests that you understood just fine, in fact, enough to leave a passive aggressive comment like:

Yes, we are all quite aware. You do realize that you're preaching to the choir?

Passive aggressive??:sarcastic:

That doesn't even make sense. For your future use:

Passive-aggressive

adjective

1.

of or denoting a type of behavior or personality characterized by indirect resistance to the demands of others and an avoidance of direct confrontation, as in procrastinating, pouting, or misplacing important materials.

Specializes in Family Nurse Practitioner.

For the record I was not trying to be "mean" when I pointed out the spelling errors. So thank you for taking the time to go back over it. It truly was making it more of a challenge to get through. I agree with several of your points. I know that there is not a nursing shortage in my area. We have so many schools churning out RNs that there really aren't enough jobs. I typically don't recommend nursing if someone asks me. If they insist I recommend shadowing a nurse first and getting the BSN to be more competitive in this area.

I never said nurses would be 'replaced' by CNAs or MAs. Trust me, CNAs are a great asset. I worked in CCU for 2 years and my CNAs helped me so much and were some of my best friends! No need to get all defensive on me. What I am referring to is more in the 'clinic' setting or doctor's offices. In the past, when you went to the doctor, an RN came in to do your triage (BP, P, Temp, took your history, ect.). I am not saying that CNAs are 'taking over', just making the point that a doctor's office is NOT going to hire and pay an RN to do these things now as they used to years ago, which means that's one less job opportunity for the RN that used to be available.

Ok I guess I understand better what you were trying to say.... Though I think you are still wrong in putting CNAs into the mix of taking over RN job opertunities. MAs can work in Doc offices but not CNAs. We only had a 6 week class and do not have the skills that would be required to work in a Office. Our job is stickly to be nurses helping hands. Also if a RN really wanted to she has all kinds of options to work in these feilds. She is more then qualified to take a medical office job if she wanted and I would think that a medical office would hire them. My kids peds office has RNs that work in the office. They are not seen by a MA. It is just that the medical office is not going to pay top rate for that RN. They also work and can take jobs in LTC and retirement homes along side the LPNs which again they might not get the highest paying RN job avaliable but they are able to work there if they choose to. Matter of fact my sister in law did that. She has worked for years in the hospital, but with her family life she felt she wanted to slow down and took a job in a retirement home which she is making a lot less then what she was making working in the hospital but she is still happy. The LPNs did not stop her from being able to get the job. She simply is doing the same work that a LPN has been trained to do.

Sorry if I came acrossed as being defensive in my previous post. I just did not see or understand why you thought that a CNA was taking over RN job opertunities. It just did not make sence to me is all.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

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Well, you neglect to comment on the real 'issues' that I discussed, but rather want to point out that used the term "passive aggressive" incorrectly? Though I do agree that I did not use the term in the correct context, nobody is perfect I suppose, even English professors.

But, anyway, on the ACTUAL issues,

#1 Do you feel like you better understand the content of my original article now that I elaborated on it?

#2 What were your intentions when you posted your links to the "nursing shortage" topics and the "layoffs" of nurses? Were you intending to get the same message out there as I am? If so, why would you think my intentions are any different?

Its nice to see a hiring manager chime in on this because it gives an inside look at why some of this is happening. I would ask you a few questions in response to your post..

1. How do you determine a dream hire without interviewing them first, especially when the job posting states very vague qualifications such as:

"Applicant must have one year nursing experience, critical care experience preferred, but not required." If the applicant for this job sent you a resume that showed they worked for one year in a CCU as an RN, then how would that not meet the minimum qualifications for an interview?

2. From personal experience, I am an RN, have worked 1.5 years in CCU. I went straight to the unit as a new graduate and have done fabulous. I wanted to concrete my nursing skills and get some critical care experience so that if I decided to go on to NP or CRNA school, I would be set. Before I was an RN, I worked five years as a surgical technologist. I have been applying for OR circulator positions at several of these hospitals I mentioned. With my experience as a surgical tech AND being a nurse, why wouldn't an OR hiring manager be looking at me as VERY qualified and valuable, because not only could I circulate, I could also scrub if they were short handed on techs.

Can you shed any insight on what goes through a hiring managers mind when getting applications like this?

It also tells me that if managers are posting jobs looking for "dream-hires", then the facility or department isn't really "needing" employees. If you are truly in need of workers, then you can't be as "choosy" when it comes to hiring.

Just a note on how new graduates feel, even though I am not one now, but I was not so long ago...

Most positions call for "experienced" nurses, however, when you are a new graduate, how do you get "experience" if no one is willing to give you the chance to get it??

You also bring up a good point about how nursing schools focus too much on theory and writing papers. I have my ADN and my manager says she would rather hire an ADN than a BSN any day because they have MORE clinical experience. In addition, she states what she has discovered is that, after a year on the floor, you can not tell an ADN from a BSN in terms of 'nursing' skills, unless of course you want your employees to write some reports or papers for you. ;)

Yet, time and time again, I see hospitals moving toward requiring BSN. This makes it even more obvious that its all political or so that the hospital can state "we only hire BSN nurses". Its a way to get the community to think they are the cream of the crop, but thats just my take on it.

Full disclosure: While I have participated in nursing interviews, I was a hiring manager outside of nursing...

1. How do you determine a dream hire without interviewing them first, especially when the job posting states very vague qualifications such as:

"Applicant must have one year nursing experience, critical care experience preferred, but not required." If the applicant for this job sent you a resume that showed they worked for one year in a CCU as an RN, then how would that not meet the minimum qualifications for an interview?

Meeting the minimum qualifications would never render one a "dream hire" unless they had other things to offer. For example:

- Being multilingual

- Holding specialty certifications

- Substantial experience at a higher-level facility than mine or something about their pre-nursing life/work experience which I found compelling

How to learn these things? From the resume... the quality of which dictates whether they make it through the 10-second screening as I zip through the mountain of applications.

Someone with 1 year is hardly going to be the dream-candidate... instead just one who's minimally qualified... and who's only going to get interviewed if we're having trouble getting enough highly qualified applicants.

2. From personal experience, I am an RN, have worked 1.5 years in CCU. I went straight to the unit as a new graduate and have done fabulous. I wanted to concrete my nursing skills and get some critical care experience so that if I decided to go on to NP or CRNA school, I would be set. Before I was an RN, I worked five years as a surgical technologist. I have been applying for OR circulator positions at several of these hospitals I mentioned. With my experience as a surgical tech AND being a nurse, why wouldn't an OR hiring manager be looking at me as VERY qualified and valuable, because not only could I circulate, I could also scrub if they were short handed on techs.
So you've been a nurse for 18 months... right off, you're not VERY qualified... you're progressing well along your chosen specialty but you're not even an OR nurse. At 18 months in, I would consider you competent in the CCU but not even and expert there.

Honestly, though, I'd look askance at an application from someone who went from new grad straight to the unit but is looking to dramatically change specialties after such a short time.

~~~

I hardly find your experience of not getting interviewed for OR jobs after 18 months in the CCU from new-grad status as evidence that those postings are 'ghost jobs' -- I just think you're not a competitive candidate for them at this juncture.

Why would a hospital look at you if they're getting apps from qualified OR nurses? Or from internal candidates known within the system?

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