Is the Nursing Shortage Ending?

Home Health Columnist / Guide · Dec 3, 2003

Gee with ANOTHER insurance company instituting copays this year for homecare ( IBC's Key Care and Personal choice plans), I can kiss any pay increase goodby...

oramar · Dec 3, 2003

There is no way wages are going to go up the way that article says they must go up in order for supply to meet demand. That is not to say that I do not wish they would. Recently the newspapers have been carrying articles decrying the rapid increases in healthcare cost. About 10 weeks ago, where I work we were called into meeting and in very vague terms were told that some change in emphasis was coming. I thought "OH OH". A new grid appeared in the staffing book, the watch words have become, "do more with less". Like I said the squeeze is on. PS Karen what ever they pay you is could never be what you are worth.

Sheri257 · Dec 3, 2003

Here's an interesting link on nursing shortage projections for the next 20 years:

ftp://ftp.hrsa.gov/bhpr/nationalcenter/rnproject.pdf

It even breaks down shortage projections by state.

Geeg · Dec 7, 2003

The only way I see it ending is when hospitals successfully lobby to replace RN's with lower paid LPN/LVN's or worse totally unlicensed personnel at the bedside-trained right off the street for 2 weeks or so and let loose to do assessments, make judgment calls and admininster meds.

pieWACKet · Dec 7, 2003

I suspect, after reading your post, and the abstract of the article [the full article being unavailable without subscription] , that you know the answer to this question.I will ,however, take the abstract piece by piece.

Before doing so, I will mention that I am unable to view this current Crisis shortage apart from the shortage in nurses exerting its influence since the post WW II era. All my answers involve the understanding of our shortage as longstanding since that period, with occasional heightened identification [ the current Crisis shortage being part ] exerting influence during the occasionally obfuscated entirety. Briefly recounted,the nursing shortage is longstanding, not isolated, and it experiences occasional periods of alleviation. This view is entirely opposite to the concept of shortages occurring sporadically within an environment of nursing abundance interrupted by periods of need which is the view found much more commonly in the literature.

The abstract says "Although hospitals have experienced many shortages of registered nurses [RNs], most have not lasted as long as the current shortage, which began in 1998."

Right, and in any PAST crisis shortage the [temporarily succesful] attempts at correction have focused on the then more succesful, but now more woeful, short term acquisition of foreign nurses in tandem with the reintroduction and/or cultivation of nurses from the native environment into the arena by dangled carrot. NONE of these attempts have proved to be longstanding, none has been truly correctionally viable, and every attempt is an echo of previous, ineffective attempts to address a longstanding shortage exerting influence for now 50 years. It is an unfortunate fact that current attempts to improve the native species of nurses echo attempts made 50 years ago without significant difference but always self exultant at incipient [short lived] crisis shortage alleviation.

The positive results are always short lasting.The only thing which is consistent, besides the shortage, is a lack of creative innovations addressing any shortage. This lack of innovation reaches criticle mass with the Acute Crisis Shortage so much in the press, a shortage which is merely a far more resilient hybrid of its antecedent predecessors.

What is consistent since the post WW II period is the ineptitudes in the shortage handling exerted each crisis shortage more forcefully. What is evident is the lack of nursing voice exerted upon our legislators throughout the period.

For the difference exerting influence most palpably at present is a nursing shortage identified as worldwide in nature and responses which are able to accomodate the moral, political and fiscal ability to transport foreign nurses to the US. Even the Philippines, the ONLY country formerly with nurses as an export commodity , is describing a nursing shortage.All countries, our own included, worldwide and with no nation excluded, can not describe a nursing population able to meet the needs of its native population. This raises grave moral and political implications.

"Hospital RNs employment and earnings increased sharply in 2002, which suggests that the shortage may be easing."

Oh how woeful the abstract, perhaps. It neglects to mention that nursing salaries US nationwide ERODED [that is, be it not misunderstood, that from the period of the last temporary alleviation of the shortage until the most current expression of the shortage, salaries were each year LESS than the one preceeding] . That RN Employment and earnings have increased does NOT suggest an alleviation of the current Crisis Shortage; it merely implies a delayed response to market demand on the part of the market barterers.

Just like in the early 90s[the period following the last crisis shortage during which a woefully misperceived nursing glut occurred in tandem with the erosion of salaries] this response can not be longstanding but will certainly be confusing.

"Two-third of the increase in employment came from older RNS, with the remainder supplied by RNs born in other countires. The employement response of older and foreign-born RNs indicates how the labor market is likely to repond to future shortages, and it emphasizes the challenges confronting policy makers as the Rn workforce ages and eventually shrinks in size"

Like this is new news. Really. Foreign acquisition of greatly needed nurses from their impoverished home countries is NOT new. The argument that global market demand makes this courtship moral is NOT new. The fact that there are not, in the global arena, as many nurses able to be enticed IS new.The idea that new and domestically trained nuses, regardless of age, might be encouraged by misdirected alleviation of educational cost to the continued employment in an arena that fails to consistently meet market demand is NOT new.

One only has to take a look at http://thomas.loc.gov/home/thomas.html, and enter the keywords "nurses" "Legislation" to understand the manner in which our legislators are dealing with the current Crisis expression of the shortage. NOTHING there is different from the same old, lame old, utilized since the 1940s, attempts exerted during that and any crisis shortage [ie: import forein nurses now and make the domestic training of nurses cheap]. NOTHING there exerts pressure to assure that the domestically trained nurse remains in her work environment once brought to its caudifying grasp, while evident are efforts to impoverish the nursing suppply of nations dependant on nurses utilized far more creatively than the US, to which they are enticed [despite their native nation's own endemic physician shortage AND the subsequent frame of the nursing practice in the home country] .

To end,

When faced with a doctor shortage, the US congress responded with a DIMINISHED access to US visas, and an assurance of competitive wage source for doctors practicing within its borders through limited market resource [ all to positive end]. So WHY does congress insist on FLOODING the market for RNs during any period of crisis shortage by diminishing the cost of education to become an RN, the use of the now inarguable immorally obtained foreign nurses, and continue, just as they have for 50 years, to neglect meaningful attention assuring RNs gain the place they demand [as evidenced by market] and deserve [ by evidence of job description] to beome and REMAIN economically viable?

-jt · Dec 8, 2003

as long as the healthcare industry continues to manufacture it, the "shortage" is never going to end.

I just read about a hospital whose nurses recently obtained improved working conditions and compensations, staffing ratios and limits on mandatory ot and saw their vacant RN positions beginning to be filled by other nurses attracted by those improvements. Now this same hospital is announcing that it's freezing hiring, eliminating the remaining vacant RN positions, and laying off more than 220 employees from all areas - including employees working in direct patient care - so nurses may be included in that too. It blames market losses and rising healthcare costs as the reason it has to lay off people just before Christmas - but doesnt say a word about its own mismanagement of other facilities that it lost millions on and ran into the ground. Or the cost of its executives salaries and perks. Yet it gave the employees till Tuesday to offer givebacks worth $35 million or be laid off. Its just balancing its books on the backs of the workers. It already was shortstaffed and despite that fact, its now deliberately cutting more. How can anyone call that a "shortage"?

PS

Last week this hospital praised its employees for their work in achieving a 96% evaluation grade from JCAHO. This week those same employees are getting pink slips. Nice way to say thanks.

roxannekkb · Dec 9, 2003

Peter Buerhaus has his head in the clouds. I've read several articles he's written, and he tends to view the nursing shortage as something that has little to do with nurses leaving the profession--or workplace conditions.

You make excellenet points, PIE. I don't know how many of our so-called nursing leaders and experts seem to think that this nursing shortage is something new, or was caused by the lay-offs of the early 1990s, and can be easily solved by just stuffing more nursing students into schools.

My favorites are the ones who think the nursing shortage is caused by the poor media image of nurses. All we have to do is show super nurses on television shows, and voila, no more shortage. Do they really believe that nurses are leaving the profession in droves because of the way nurses are depicted on ER?

Anyway, my belief is that industry doesn't really want to solve the problem. Doing so would cut profits. What they want is a good excuse to bring in cheap foreign labor, use lesser trained staff, and keep their fingers crossed that they don't get sued.

Long Term Care Columnist / Guide · Dec 9, 2003

You said it, roxanne! Colleges across the country can graduate ten million people from their nursing programs, but if healthcare facilities are only willing to put five million of them out on the floor, there will STILL be a shortage.

Agnus · Dec 11, 2003

hospitals refusing to hire does not = a shortage of available people for hire.

RNs who refuse to accept working conditions that are offered and therefore refuse to work does not = a shortage of RNs.

The shortage is an artificial one created by the hospitals. If they can convince people there is a shortage then they can pump up things to get more people to become nurses, and bring in foreign nurse and flood the market thus reducing the bargaining power of nurses.

DebbieS · Dec 11, 2003

I agree, there will be a shortage if they continue to import nurses. They are only doing this to undermine the bargaining power of the US nurses. It's terrible how we get the short end of the stick.

suzanne4, RN · Dec 12, 2003

Why is there such a negativity developing about bringing in foreign nurses? I remember working with foreign nurses when I finished school back in the 70's and they were wonderful. And guess what???? Most of them are still working full-time now. If you look at it, foreign nurses do not change your salary, or working conditions. They can actually only help you. Since the new requirements are going into effect within the next six months, foreign nurses will no longer be able to go to the US to work on a temporary visa and with minimal English skills. The new immiagration act requires a Visa Screen be completed by each nurse, which includes English skills almost equal to that of a native-speaker. So, be realistic, how many foreign nurses will immediately fit into that picture? I own a school overseas to teach Conversational English to nurses and doctors so that when a "foreigner" over here gets ill someone will be able to understand them. I would be proud of any of my students that were able to make it though the new stringent requirements to be able to practice their profession in the US.