New Grad RN’s Paradox on the West Coast (or others), What is Your Opinion?

[FatsWaller, BSN, RN]

I realize this is a fairly often talked about topic, but I just wanted people's opinions, frustrations, vented feelings, and outlooks.

I am from the West coast but found that nursing programs were too saturated and competition too stiff so I opted to move out of state and complete my ABSN. I moved to Kentucky and have less than 27 days until I graduate, but during my time here I found instructors and Nurses scoffing at the idea that I would find a job out in California, Oregon or Washington upon my return. I had no clue about the hardships so many new gradate RNs were facing to even land an opportunity or even find a job in acute care to apply to that didn't say New Grads not Accepted”. I learned quickly the prospects of landing a job in my home state of California was unlikely, but was curious the reason as so many have said there's a nursing shortage”. Now I don't think that's a lie, as I have looked for jobs in California and Oregon, and there is most definitely no shortage, in any department, of job postings for RN's, but with the caveat that you must have 1 year of acute care experience in that specific unit.

The sad part is, how does one get this experience? There are new grad RN programs/residencies, but these are a joke. They seem to just be a cover for hospitals to be able to say they are new grad friendly”, but their programs don't even make a dent. Many only have 10-20 spots for thousands of applicants. UCLA's program generally offers around 100-120 spots a year spaced among differing departments, but receives upwards of 5000+ applications, many of whom aren't even from the state to begin with. Other hospitals are similar; one article stated that six hospitals in the Daughters of Charity Health System in Los Angeles aims at hiring 10 new grads (at each hospital) and receives more than 1,000 applications for each position. In Oregon, Portland hospitals are also saturated with experienced nurses. OHSU has history of hiring freezes and only places the opportunity to apply to the new grad program for just seven to 10 days due to the high number of applicants”, similar stories with Legacy Health. Washington hospitals continue the trend. This is leaving thousands of students to come out of school and have nowhere to go.

Another caveat is the new grad RN programs are only for those who have been out of school for a year, yet one study showed that 43-48% of newly licensed RNs still did not have jobs within 18 months after graduation. To me that is an insane number. So what happens to these people? They can no longer attempt to get hired through a new grad residency, but will also not be competitive (or even looked at) in the general nursing job pool which requires minimum 1 year (sometimes 2) in acute care. Much of the remaining percentage move to clinical/private settings, nursing homes, rehab clinics, corrections facilities, or have to take a different job all together (CNA, tech, waitress, etc), where they aren't getting acute care RN experience and once again aren't building their resume for the job they really wanted. To top it off, most have loans to pay off within 6 months of graduating, so some type of job is needed.

I stated earlier many nurses and professors here in the East South-Central US knew of the difficulties of new grads obtaining jobs out West, but also shared with me their confusion of so many travelers heading out that way, citing if they take so many travelers isn't there a shortage?”. My reasoning was that travelers now must have at least 2 years experience and that looks very appealing to West coast hospitals, thus they would much rather take a seasoned nurse and pay them more (even if temporary), then spend the money and risk to train a new nurse.

I looked up articles on the issue but it was difficult to find any written after 2013. It seemed most projected this lack of new grad hires would be forced to end in just a few years, but 3 years later it seems no movement has been made. Many articles cite the recession as a cause. Because so many nurses returned to work who were set to retire, who had left after having children, etc there is now a saturation of experienced nurses and hospitals only want to replace them with experienced nurses. But is this forever possible? A quarter of nurses in the US are over 50, and that is a lot of nurses who at some point WILL have to retire due to age/health or leave due to improved economy. So when all of these nurses leave, will there be another shortage? Will there be a dumping of inexperienced nurses into the hospital setting because there is no other choice? One article predicted in 2020, it would all hit the fan as hundreds of thousands of nurses are set to turn 55-60 then.

My solution, I'm staying here in Kentucky at least another year. I landed a job I know I could never get in California as an ER nurse at a University trauma one hospital, and hopefully with a year of that under my belt, I can return home to my family and get a job. For others I'm not sure what the best course of action is.

So…

What are your thoughts?

Are you a new grad who is frustrated and if so tell us about it (can be any part of the country as there may be other areas experiencing similar hurdles I don't know about)?

Are you a current RN who landed a job against all odds? What did you do differently?

Are you a seasoned RN who sees this issue and agrees, disagrees, or feels differently about it?

Any other comments, opinions, ideas, etc?

[Pangea Reunited, ASN, RN]

New grads have to go to where the jobs are. Employers don't exist to give new grads opportunities and it makes perfect sense that they want experienced nurses over inexperienced ones when they have a choice.

I would like to have moved to California immediately after graduation, but I worked in Texas for two years before attempting to find work in California. It's an employer's market here (in CA).

[willowita, ADN, RN]

I keep reading about the doom and gloom of California and it has not been my experience, though it definitely was in Oregon and Hawaii where I used to live. One of the level 1 trauma centers in L.A. is a county facility and they only require you have a license and a BLS card to get to take their entrance exam. That is it. Got two job offers from them. That's how I and others with no prior acute care experience and new grads got in. I guess the caveat for some people is that the pay is lower than a private hospital and the patient population is predominately not English speaking and/or homeless. Those are the people I want to serve so for me it was no problem. I know other hospitals and areas of the state are maxed out on available jobs but there are opportunities.

[FatsWaller, BSN, RN]

One of the level 1 trauma centers in L.A. is a county facility and they only require you have a license and a BLS card to get to take their entrance exam.

May I ask what hospital.

[willowita, ADN, RN]

LA County DHS operates LAC+USC Medical Center, Harbor-UCLA, Olive View UCLA, and Rancho Los Amigos Rehab Center. Passing their entrance exam allows you to interview for any of those hospitals.

[AJJKRN]

There is absolutely NO shortage of new grads, I repeat, NO shortage of brand-spanking new grad nurses! (With the exception of areas that no one really wants to live in)

Now experienced nurses...you betcha! It's starting to get scary again at my work due to turnover, again.

My hospital has all of the bells and whistles too but most new grads are not wanting to stay at the bedside for longer than 1-3 years...if not 6 months to nil.

[Dogen]

There are new grad positions in Oregon, they're just competitive or not where people want to live. You could apply to a smaller hospital outside of Portland, for instance. Places like Salem, Eugene, and Beaverton are more friendly to new grads. If you want to go rural - and qualify for sweet loan repayments - then there are a lot of towns (like Medford and Grants Pass) where you can walk into a community hospital on graduation day and walk out with a job.

You can also apply to residencies. Legacy health system uses Versant, which is only available to nurses with less than 1 year of practice. Salem also has a well-regarded residency program. Both of these require a 2-year commitment in exchange for the expensive extra training. OHSU and Providence both hire new grads, but they're a limited number each year, typically posted twice a year (spring and fall), Providence likes to do hiring fairs (difficult to attend if you're in KY), and OHSU has a strong preference for graduates of their nursing program.

When I went to school it seemed liked a lot of people who didn't land a job in the ICU or ED right out of the gate felt like they were failing and some of them held out for ages hoping to get a sweet gig, while others sent resumes to every hospital within 100 miles until they found something to get them experience and had jobs within weeks of graduating. The greatest thing about nursing is that you can start in med-surg and end up doing anything if you apply yourself. At least, that's my experience on the west coast.

[FatsWaller, BSN, RN]

I called a few recruiting managers for LA+USC and UCLA and they were confused by entrance exam. They also told me any postings for new nurses will be few and far between. Guess it's back to square one.

[willowita, ADN, RN]

There are many hospitals with UCLA in the name not associated with the County so not sure which one you called. The exam at the County is still open. I can't copy and paste a direct link but here is the search for the job board: Job Opportunities | WELCOME TO THE COUNTY OF LOS ANGELES

Search for "nurse" and look for Registered Nurse I/Relief Nurse