Is there still a nursing shortage?

Multicollinearity, BSN, RN · Jan 25, 2009

In the end, there are advantages to both new grads and experienced nurses, and a good ER will have both, but the argument that it is too expensive to train a new grad is a shallow one indeed.

Well tell that to the hospitals because in a few months I'll be applying for new grad jobs, and I want a job, dammit...

Overall, I think new grads have a higher rate of crashing and burning (i.e. quitting, changing jobs, not passing preceptor-ship, etc) in the first year.

Also, I don't think you considered the cost of classroom training, cost of nurse educators, extra wages paid to preceptor, etc. In addition, even after preceptor-ship, new grads cannot carry a full load like an experienced nurse can. Heck - this isn't even factoring in that new grads probably make more errors that can cost the hospitals.

Also, hospitals offer higher pay to attract nurses with experience when they need to retain and lure experienced nurses. In times of recession, wages stagnate and can even deflate. So experienced nurses may not get paid very much of a premium, either. If a hospital has several experienced nurses applying for one position, it's not like they need to increase the wage offer at all.

There's a reason why hospitals are shying away from hiring new grads during this recession. The numbers must tell them it's best for their bottom line. In fact, I bet most hospitals have calculated cost/benefit ratios that tell them how expensive it is to hire a new grad v. experienced nurse, considering persistency rates.

MsBruiser · Jan 26, 2009

AZ Central story on new grad job finding difficulties...
http://www.azcentral.com/business/articles/2009/01/25/20090125biz-nursing0125.html

I saw this in today's paper. The title of the article says it all "Arizona's Nursing Enigma". Huge demand for nurses but fewer jobs for new grads.

Things will get better - but it will take time:

a) Nurses as a demographic group are older - they will retire when they can

b) Demand for health care is rising and rising

c) US population as a whole is graying.

Put that together - and demand for nurses will skyrocket. But if hospitals are not making money - they will delay staffing up units. Experience will always trump inexperience. Just like in any other job. So the long-term looks great for nursing - the short-term sucks.

At the end of the day, today's new grads will have stories for new grads 10, 20 years from now "back when I graduated we could not go straight to the ICU, get a day shift job, etc, etc." Also - it is better to be a new grad in nursing than in business and a myriad of other fields right now...

sassiebaz · Jan 26, 2009

Has anyone one been to the movies lately? Or to your local resturaunt? They are always packed, if we are in such a terrible recession, how are people still able to eat out? Just a thought......

MsBruiser · Jan 26, 2009

Has anyone one been to the movies lately? Or to your local resturaunt? They are always packed, if we are in such a terrible recession, how are people still able to eat out? Just a thought......

I was thinking the same thing. I think the drop-off in business is gradual and insiduous - same with hospital admissions. Places are packed but not quite as packed as before. A 10 minute wait for a table rather than a 20 minute wait. In other words, a 10% drop in business rather than something more drastic. Just like surgeries may be off by "only" 10%. Unfortunately, some businesses run on 10% or less profit margins. So that 10% drop can be their death - as they are not making any money.

fromtheseaRN, BSN, RN · Jan 26, 2009

Has anyone one been to the movies lately? Or to your local resturaunt? They are always packed, if we are in such a terrible recession, how are people still able to eat out? Just a thought......

credit cards.

i think that although these places are still busy, it doesn't mean that the people going there can or actually should be going out. i work with someone who is losing his house and going through bankruptcy, but just spent 4 days gambling in Vegas.

markas214 · Jan 26, 2009

Actually, let's do the math: If you take a nurse with 5 years experience, then you are going to have to pay a lot more because every hospital that I'm aware of uses experience to determine pay. So if we start with a hospital that starts the pay scale at 25 per hour as a nice round number. If you hire a new grad and put them through a three month (13 week) residency program, then you are going to pay them 25*36*13 or 11,700 dollars for their residency training. It can be argued that during that time, they are non-productive, as they always have a preceptor with them. This means that for one year of employment, the nurse will be paid 46,800 dollars (assuming a 36 hour week) for 9 months (39 weeks) of productive time. That comes out to 46,800/36/39 or 33.33 per productive hour for the first year.
Now I don't have any hard numbers to run with for how much money a nurse with 5 years experience makes, but based on talking to a couple of my colleagues who are in that range right now, I would say it averages between 8 and 10 dollars per hour more when you consider the yearly increases and the extra pay for certifications and BSN degrees that are common with more experience.
So that said, In the first year, you are going to be paying about 34 dollars per hour for the experienced nurse and a little over 33 for the new grad nurse. In the second year, you are going to pay 35 or 36 dollars per hour for the experienced nurse and 26 or so dollars per hour for the new nurse. Average out a two year commitment and you get about 35 dollars per hour for the experienced nurse and about 29 dollars per hour for the new nurse.
Of course, arguments can be made for why each is better for the ER as a whole - experienced nurses bring in a solid knowledge base to start with and are more likely to be able to handle stressful situations; new grads bring fresh perspective and excitement to the team and are not already set in their ways.
My particular ER has a very active residency program - 10 nurses in the last residency and 4 more in this one - and it works out quite well for the ER due to loyalty. With the exception of a handful of nurses here and there, almost every nurse that works in my ER (myself included) were products of a residency program. My preceptor had been precepted by another nurse still working there, who had been precepted by yet another nurse who is still employed there. I have found that the nurses who come and go tend to be the nurses who hired on based on their experience. Of the nurses in the last three residencies, only one has left, and that because he needed to go per diem due to school, and we had no per diem assignments.
In the end, there are advantages to both new grads and experienced nurses, and a good ER will have both, but the argument that it is too expensive to train a new grad is a shallow one indeed.

That experienced nurse can generate 10s of thousands of dollars during the time the orientee is being trained. In tough times near term profit wins over long term investment.

quotetheraven · Feb 11, 2009

Nurses are coming out of retirement or back into nursing from other jobs. Quite a few of my friends are back on the floor somewhere. Many reasons due to the horrible economy right now. Husband lost job, or took a pay cut, (like mine; he was hit with a 5 dollar a hour paycut, take it or goodbye) Kids losing jobs, moving home, sometimes the kids and their spouse and kids! Schools all across the nation are turning out new grads every semester. So probably not a new grad shortage. With all the cutbacks, freezes, less people going into hospital, a experienced nurse will get the job over a new one that needs money and time spent on training. New nurses still find jobs, we are just not experiencing the gravy days of yesterday, now it's more difficult and seems to be so many more looking for fewer openings at places still able to spend the time and money on them. My parents survived the great depression, I have heard all the stories. It's a scary time right now. But we bounced back before, and will again. Life comes full circle. It took awhile to get in this mess and it will take time to get out. Maybe by the time I graduate things will be coming around again. Maybe it will take longer. But don't give up. Use the time to get more education, if you can. That will always help somewhere, somehow, down the road. I don't see us turning into a third world country (I pray not anyway!) We have a new President, who hopefully will get crackin on things and try and get things improving before we hit the word; depression. On the safe side, we have put in a good garden in our small backyard here in the desert. May have to feed the kids and their kids and husbands.

markas214 · Feb 11, 2009

. It's a scary time right now. But we bounced back before, and will again. Life comes full circle. It took awhile to get in this mess and it will take time to get out..

What is scary is that from the market crash of 1929 until the end of WWII in 1945 was 16 years. 16 years of tough living. No matter how bad things get remember that. We are so much better off today.

quotetheraven · Feb 11, 2009

Yes, and we have the advantage of that history lesson so we are not totally blindsided.

Multicollinearity, BSN, RN · Feb 11, 2009

Yes, and we have the advantage of that history lesson so we are not totally blindsided.

I wonder about that. We seem to repeat the same or similar types of errors over and over again. With hubris, too.

I know economists have said previously that another Great Depression could not happen again because the Fed would flood the market with capital. And yet we just saw the US Federal Reserve do that, and it didn't help even a smidgen. The economy is still in a free-fall.

Kabin · Feb 12, 2009

I wonder about that. We seem to repeat the same or similar types of errors over and over again. With hubris, too.
I know economists have said previously that another Great Depression could not happen again because the Fed would flood the market with capital. And yet we just saw the US Federal Reserve do that, and it didn't help even a smidgen. The economy is still in a free-fall.

Exactly and we don't have many, if any, bullets left in the chamber. The national debt is over 10.7 trillion dollars and we need to spend 2 to 3 trillion to have a chance to get out of this mess. Many problems, of course, first - we don't have the cash so the government needs to print it and that drives inflation up. Could the horrible days of 18% home loans make a comeback? Second problem- we couldn't pay off the 10 trillion before so how could we pay off the 13 trillion and still grow the economy?

Americans need to save money but that's counter to our consumer-economy. I bet we never see the same good old consumer-economy days. Just another bubble and we all know in bubbles we trust.

Multicollinearity, BSN, RN · Feb 12, 2009

We agree on a lot, Kabin. I waver between being positive and looking long-range and planning my immigration to Canada. At least the Canadians have smart fiscal policies, are paying down their debt, and have a very *clear* bright future.

Working on getting my points up to 67 for immigration. Look at how smart the Canadians are about who they'll let into their country:

http://www.workpermit.com/canada/points_calculator.htm