Is the nursing profession causing its own RN shortage?

[RNDave]

With all the RN's going to NP school, is the profession significantly contributing to the RN shortage? Between retirement and RN's in line to become NP's it seems our unit is on a constant hunt for staff.

[homecaresurvivor]

Judging by the travel nurse market, there are enough medsurg nurses. Where there is a real shortage is cath lab, operating room (and CVOR), and L&D. Medsurg has been declining for over 20 years with the introduction of DRGs and vastly shortened hospital stays. It is likely that the new entry level jobs post ACA passing will be home health. LTC is likely to continue to grow as America ages.

There IS a shortage of home care RNs, but these positions are not typically considered entry level jobs. The few times I've seen a new RN get employed as a field nurse, they have really struggled. I've been an RN for 31 years, have practiced in home care for 23, and there are days I still feel challenged by situations I find in the home setting. An entry level nurse simply doesn't have the knowledge and judgment gained through experience to safely practice independently. In addition, many nurses, even experienced ones, are surprised by how challenging home care is clinically and physically, and shocked at the level of documentation required. High rates of turnover are a challenge in this specialty as well. So basically, you have the irony of fewer med-surg jobs which is where a nurse would gain the experience required for the increasing numbers of home care jobs.

[PMFB-RN, RN]

There IS a shortage of home care RNs, but these positions are not typically considered entry level jobs.

What is the evidence for that? Inability to fill open positions with qualified staff tells us nothing at all about the qualified nurses who are available to fill those positions.

Employers can be unable to fill positions amongst plenty of nurses.

[NedRN]

What is the evidence for that? Inability to fill open positions with qualified staff tells us nothing at all about the qualified nurses who are available to fill those positions.

Employers can be unable to fill positions amongst plenty of nurses.

Only because or if they are not willing to pay enough. Any position can be filled for the right price.

[PMFB-RN, RN]

Only because or if they are not willing to pay enough. Any position can be filled for the right price.

Exactly.

[homecaresurvivor]

What is the evidence for that? Inability to fill open positions with qualified staff tells us nothing at all about the qualified nurses who are available to fill those positions.

Employers can be unable to fill positions amongst plenty of nurses.

The evidence? Positions are advertised that go unfilled. It doesn't matter why. The need is there, jobs are available, but there aren't enough nurses applying to fill them. There's a big difference between a hospital hiring inadequate numbers of staff because they choose not to (when there are plenty of nurses who would want and be qualified for those positions if they'd just open up) vs. a home care company attempting to hire more staff but finding itself unable to do so because there aren't enough nurses wanting or qualified to take the positions. An article I read recently in Home Health Nurse magazine, shared results of a Visiting Nurse's Association survey stating that on the average, Visiting Nurse Agencies (VNAs) had a 10% vacancy rate of registered nurse positions, and 59% of VNAs who responded indicated that they are forced to decline patient referrals weekly due to staffing limitations. I know my experience bears this out.

I'd also add that there are lots of positions I'd never take no matter how much money was offered. You couldn't pay me enough to work in a hospital again; the eight or so years I spent in inpatient oncology about killed me. I'd venture to say there are plenty just like me. $$$ isn't always the number one factor for filling a position.

[CHESSIE]

Hahhahahahaa. Me? Naïve? I may not have been a nurse for "a million years", but honestly, you talk as if you are cornering the market.

"No, you don't understand..." Really?

There will always be SICK people. Sicker than anyone can imagine. And there will always be a patient story that trumps everyone else's.

The patients never change. They just keep coming.

A good manager? You never forget.

Your last statement was absolutely correct. A good manager is one in a million and will always be remembered. In the fifteen years that I worked in a Pedi unit, before moving on to patient education, we had nine managers, called "directors." Only one director was stellar. She would pitch in when staffing was short, which was often, and not her "call," but one made from above. She advocated for her staff, and was pursuing courses to be a NP. She all ready had her Master's degree and had come from a larger city to marry her long time companion. We were blessed with her leadership for two years, when she was told that "her services were no longer needed," unless she would take an additional directorship. She agreed, and then was told that they had "found someone else," to fill those positions. No one before or after her directorship has had her success with staff retention. I left shortly after she was dismissed. Before her two years as a Pedi director, RN turnover was rapid, and after she left, the same situation occurred.

The moral to that sad tale is that upper management will not tolerate a director/middle manager who advocates for her/his staff, or works clinically along with the staff when additional hands are required. This is a sad but true situation in our area, maybe in other areas, as well.

[Eschell2971, BSN]

Nothing wrong with that thinking. Earning and obtaining your license means YOU are in control of your career. There are many areas of need for nurses. I think more nurses, nursing schools, administrators, companies, and policie, need to think outside the box even more. Stop trying to box-in nurses into one way or traditional roles.

[Butterflyxx0621]

I didn't read every post (but I did read many), so I'm not sure if anyone has mentioned this, but I personally feel like many nurses are going for advanced degrees not just because they want to but because they feel like they have to. Take LPN's for example. Not one hospital where I live employs LPN's. I'll never forget a few years ago my grandmother who has been an LPN for 45 years decided to retire, and 2 months later the hospital she worked at announced in the paper all LPN's had been let go. It's hard now for ADN's to find a job. There is a constant push for more and more education. That is one of many reasons I am working on my BSN and then going on to MSN.

I think the patient population and work conditions have to do with it as well for several reasons.

In my experience, thanks to google and webmd, there are more and more patients that constantly try to tell nurses and doctors how to do their jobs. Like we, the healthcare professionals, didn't go to school and get a degree for this.

And personally, this focus on patient satisfaction is making working conditions even more difficult than they already are (at least at my hospital).I agree we want patients to have a good experience, but sometimes being unsatisfied is what's best for them. Where I work, we aren't even allowed to keep the hallway lights on at ALL at night so that it's darker and patients can sleep better. We just have the exit lights to see by... That is unsafe for both the staff and patient in so many ways!

The list of reasons nurses are seeking higher education are endless and differ from one person to the next, but those are a few of mine!

[birdwhisperer]

When you have a CEO who is now earning million dollar bonuses for keeping the hospital above water, who NEVER will let nursing staff DIVERT patients to other hospitals when the hospital is busting at the seams despite the fact there are day long waits for beds, no ER staff and other patients in beds in the halls, exceedingly high patient to nurse ratios, very high nurse turnovers high nursing assistant ratios, brand new nurses working intensive units with little to no experience and management too afraid for fear of their own jobs despite the ethics and danger. to say anything .... you are screwed who does one turn to who does one get help from ? and from all I can understand this is a national issue...

[PyridiumP]

Add those those conundrums, is the issue that there are insufficient numbers of nurses to mentor the new grads. New grads, especially from the BSN colleges/universities do not have the clinical skills necessary to "hit the ground running," unless they have been ADNs, diploma grads or LPNs with several years of clinical experience prior to entering the BSN programs.

lets be clear that *no* new grad is more than minimally competent to hit the ground running. New direct entry ADN grads are no more competent than new grad direct entry BSN grads. They all have the same amount of clinical time as students, this is regulated by their accrediting agencies and boards of nursing. Inconvenient fact in this argument but there it is.

[PyridiumP]

RuralRN07: That has been my experience exactly. Our young folks want to work bedside only long enough to get into grad school, CRNA school, NP school, etc. I don't blame them, in fact I admire a lot of them. But it does leave a big hole at the bedside, and for those of us who plan to be life-long bedside nurses, it leaves us chronically short-staffed and a little frustrated.

This is a problem that will solve itself. It stands to reason that there is a limited number of spots both for those programs and for their graduates, even if there will be more in the future there will still be alot more staff jobs than advanced jobs. Even now the CRNA programs take experienced nurses not just 1-year grads. Alot of those new grads will still be in those staff positions in five years.

[SubSippi]

Don't forget about the fact that with bedside nursing, there isn't a lot of room for promotions, or moving up the chain of command. The only way to get more responsibility (while still taking care of patients) and/or broaden your scope of practice is to go to grad school and become a provider.

Even if I worked in a perfect unit with perfect staffing and got significant yearly wages, I would still want to go to grad school. I could work in the same CVICU for 20 years and be the best nurse in the hospital, but I would essentially be in the same entry level position I started out in. Not that there's anything wrong with that, but I think that lack of promotional opportunities for bedside nurses who aren't interested in management contributes to the urge to go to grad school.

And by the way, I don't consider charge nurse to be a promotion, especially these days when it's becoming more and more common for the charge to still take a full patient load. It seems to be a curse more than anything, at least where I work.

I just wanted to point out... going to grad school isn't always JUST about escaping.