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.

Specializes in Critical Care & Acute Care.

Just have to add this. I work in the Knoxville area for a large company that owns multiple hospitals. After applying with little experience I had a job within two weeks, oh and I'm not even from Tennessee. I commute 90 miles to the facility. They were well aware and were so happy to have someone ready to work. Not at all over saturated. I know some places are over saturated with new grads but most will find work and are going to be fine in nursing. However, schools need to stop churning out so many new grads in some areas. Just wanted to add this quip.

Well, then I guess it sounds like if all you are looking for are those dream hires, then maybe you should list all those "dream hire" requirements on the job postings when you put them up. That way you won't have to waste your time going through mountains of "unexperienced" and "novice" nurses who aren't worthy of your time. Sounds like you've never have any problems finding those candidates, so why not just advertise for them and they should all come running! :)

Sorry, I couldn't finish it, so I skipped to the end. I agree totally with your last paragraph.

There is a local shortage where I am that is d/t the local hospitals laying people off to reduce wages paid out.

I don't really understand how it's working for them, since they keep having to hire new people and pay to train them.

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.

Sure... there's no shortage of nurses... if that's your primary point, nobody's arguing... that's been stated and restated in thousands of posts on AN over the last 4 years...

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??
That's not the problem of the hospital at this point. My facility selectively hires a small number of new grads and then fills the rest of the openings, of which there aren't many, with external hires who already have relevant experience.

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.
The ADN programs are just as guilty as are the BSNs for the relative lack of math and science competence and training... Nursing is taught as a social science which is mistake.

It's a fallacy, though, to presume that ADN grads have MORE clinical experience than do BSN/MSN candidates. I've met plenty of ADN grads who'd never started a line prior to graduation.

And the reality is, even 100 or 200 more hours of general clinical experience does not produce a more competent nurse... the job is primarily learned by doing the job for real.

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
Well, obviously...

The primary differences between nurses with varying educational levels are in communication skills, general education, and overall reasoning and logic skills.

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.
Yep, just your take on it. I happen to hold a different view. Whether one values a broad education in nurses is a whole other discussion beyond the one which you've initiated in this thread.

Well I am so happy that you found that job, even if you do have to drive 90 miles to get there. I'm surprised you couldn't land a job within walking distance given the fact that you seem like such a well qualified candidate. :)

Well, then I guess it sounds like if all you are looking for are those dream hires, then maybe you should list all those "dream hire" requirements on the job postings when you put them up. That way you won't have to waste your time going through mountains of "unexperienced" and "novice" nurses who aren't worthy of your time. Sounds like you've never have any problems finding those candidates, so why not just advertise for them and they should all come running! :)
Nope, that's exactly the point... there is a shortage of 'dream-hire' candidates... they don't tend to jump around too often but generally stay where they are.

The reason for posting minimum requirements is precisely so you *can* scan through a mountain of applicants to look for those who offer something unique.

In your case, once you get some more years under your belt (really, you shouldn't be surprised to be ignored while applying after only a year or so as a nurse), your technologist background will probably be an asset in helping you jump to the OR, as long as you're not competing against experienced OR nurses.

You'd probably have a better shot getting into the OR at your current hospital, though...

Specializes in Critical Care & Acute Care.

I had a job and it was great but too small of an ICU. I applied north and south since the other hospitals were not as large or had financial trouble due to fraudulent billing. Left my awesome job for one that has been less than stellar, but it did what I wanted it to do. My point is that the Knoxville area seems to not be over run with nurses if I can land a job so easily. Even yet some of my coworkers surprise me more that they landed jobs, since they drool or at least appear too.

I have had students that come to do their externship with us in the unit. I have had an equal number of ADN and BSN students. I have found many of the BSN students who couldn't start a line, but they can tell you all about the founders of nursing. ADN students, from what I have seen, are generally competent in the "tasks" of nursing. I do agree with you in the sense that a lot of it is learned on the job. Its just way too much to teach in school.

Specializes in ICU.

I don't get why you would think employers can't be choosy over who they hire. Of course they can. I was extremely choosy when I hired. I would rather work extra hours myself than hire a bunch of incompetent people that I have to babysit. That's one of the most frustrating parts of human resources, finding people who are not only qualified, but don't have attitudes, are literate, don't call off at the drop of a hat, basically reliable people. That's hard to find these days. Maybe these schools are churning out tons of graduates, but that doesn't make them competent graduates. And most hiring managers know what schools are good and bad. Maybe there is no shortage in your area but there is in many others.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Well, then I guess it sounds like if all you are looking for are those dream hires, then maybe you should list all those "dream hire" requirements on the job postings when you put them up. That way you won't have to waste your time going through mountains of "inexperienced" and "novice" nurses who aren't worthy of your time. Sounds like you've never have any problems finding those candidates, so why not just advertise for them and they should all come running! :)
Zack....you are right that there is no nursing shortage. Hospitals are not hiring many new grads because they don't have to. Even if there is a hiring freeze a manager will post the positions to keep them in their budget considerations....not because they are really hiring. Thoise pages of nursing jobs probably are never going to be filled in the near future.

Hospitals are using any excuse on the book to blame low staffing on anything instead of the real reason....they are just simply cutting costs by cutting their biggest expense that brings them no revenue....nurses. They lay off seasoned nurses for they can hire 2 untrained new grads for the price of one....if they hire anyone at all. There is a plethora of new grads in most areas of the country with many areas of job density in the plus column. Nurses Schools, Salaries, and Job Data

Hospitals are hiring BSN grads because they can. They are not hard up for nurses. Many facilities are very careful about new grad hires, especially in critical areas, for they are all wanting that one year experience and then they move on to the "BIG PAY" jobs once again leaving the facility in a lynch for experienced trained staff. They figure let someone else train them if they are serious then the new grads can come back with that one year and we will consider you. It's a no win situation.

No one said "novice nurses" aren't worth anyone's time...it is expensive to train a new grad only to have them leave and you are no better off that you were before you spent the money. I don't look for the "dream hire" I look for someone who wants to give longevity and loyalty.

With the proliferation of all the nursing programs recently who are cranking out new grads every 6 months the market has become saturated...it is simple supply and demand. A higher surplus decreases the demand. The media, and some nursing schools, insist on spreading this urban legend to keep their classes full and revenues high.

I believe the shortage will return but not for a few years and not like it was before. The "experts" say somewhere around 2020.

But if you aren't going to hire someone who isn't a "dream-candidate", then why waste their time and yours by advertising "minimum" requirements? If you want to be choosy about who you hire, that is YOUR choice as a facility, so why not be proud of it and own it by advertising these "dream candidate qualities"? I mean, its pretty clear from what you've said that you won't settle for less than these stellar candidates, unless of course your facility is having trouble getting applicants, which you clearly stated was not an issue. In fact, you stated that you have plenty of applicants that are "dream-candidates" and thats why you can just overlook all the ones who are only "minimally" qualified.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I have had students that come to do their externship with us in the unit. I have had an equal number of ADN and BSN students. I have found many of the BSN students who couldn't start a line, but they can tell you all about the founders of nursing. ADN students, from what I have seen, are generally competent in the "tasks" of nursing. I do agree with you in the sense that a lot of it is learned on the job. Its just way too much to teach in school.
This is another subject discussed for the last 35 years or more. Diploma vs ADN vs BSN entry.

I have found after many years experience that it really isn't the ADN or BSN but the quality of the program itself I have come across poorly trained/schooled ADN and BSN grads I feel in part it is the proliferation of these schools capaitalizing of the rush for a good paying job that is open wide with little regard to the quality of nurse they are graduating.

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