Nursing Shortage

[zack1110]

"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.

[zack1110]

I agree with the part of your post where you said that hospitals like to make one person do the work of three people. My unit at my hospital is always short staffed but that's the way they want it. There could be jobs for other nurses if the hospital wasn't too cheap to pay to keep the place staffed adequately. But it's a business and the dollar is all that matters...apparently much more than patient safety, good nursing care, and employee satisfaction and retention. It's a sad situation. The patients are the ones who suffer the most because they don't get the kind of care they deserve thanks to cheapskate staffing.

I couldn't agree more with this! Unfortunately, the only time most hospitals view under staffing as a problem is if there is a patient harm event, which they do their "root cause analysis" crap which isn't really needed because most all the staff can tell you its because we are expected to do an amount of work that is really unreasonable for one person to do. But, like you said, money is the main issue with these places, not patient safety. In an ideal world, it would be great if you could continue to increase productivity and not lose anything in the process, but unfortunately, it catches up to them at some point. That would be like me saying I am going to open a restaurant, and after a couple years of building a good customer base and making huge profits, now I am going to start cutting corners and serving the lousiest food I can get away with serving until I start losing business, then I will consider that the 'standard'.

You know these hospital corporations are making BIG BIG MONEY! We are talking billions per year. But due to greediness, 10 billion isn't enough this year, so in order to get it to 15 billion next year, we are going to cut wherever we can, if that means getting rid of employees (that we supposedly value) then so be it. Until, of course a patient gets hurt from understaffing, then they will be wondering why they have to pay out millions in lawsuit settlements.

You know these hospital corporations are making BIG BIG MONEY!

Sure, some of them are...

Though of course, that's why they exist and they have a fiduciary responsibility to their shareholders to maximize shareholder value in the way of equity and dividends.

And if you have a 401k or 403b or pension... that's what you want them to do... that's the way that retirements are funded.

And really, the profit MARGIN on full-service hospitals is terribly low. My system earned $546 million last year... which seems like a lot... until you consider its size and revenue, and the profit of similarly sized companies in other fields...

Without increases in productivity, an institution will ultimately fail and the economy as a whole comes to a screeching halt... remember, the economy is all about GROWTH...

[zack1110]

Once again, that's all great and good to grow and prosper but when it starts affecting patient safety, it becomes a problem. Why don't you explain why the CEO of these hospital corporations are taking home ridiculously large salaries. I know our CEO continues to make more and more each year, so the hospitals are NOT suffering financially. Maybe they are suffering in their eyes because they dropped a few million in profit this year, but they are still doing DAMN good and making HUGE profits.

[zack1110]

And don't even get me going on pensions...haha. My dad worked for a major candy company for 26 years and was promised a pension. Then 2 years ago they came along and told him he was getting cut because he was too old. No pension either. Imagine that. But by god the company continues to see increasing profits every year and they turn around and screw their employees out of benefits because of pure GREED!

[zack1110]

Used to be, if a business was prospering and making a decent profit, they shared that with their employees by increases in wages, ect. Now, it's become a game of 'how much can we make, then how much can we take from our employees'. That means RIDICULOUSLY HIGH profits and its just never enough. The companies always want more and are willing to put the screws to anybody to get it.

[BrandonLPN, LPN]

While the myth of the nursing shortage has mislead many a nursing student about job prospects, we should remember that personal responsibility still plays a role.

It's really pretty easy to take a "pulse" of your local job market. Call local human resources departments. Talk to actual licensed, working nurses. Do an online job search, and see which local facilities are actually hiring. Read online nursing messege boards, like this one. Ideally, do all this before you so much as set foot in an admissions office. Those people are paid to sign you up, not to give you the straight dope.

Before my first day of PN school, I knew my future lay not in the hospital, but in LTC. I knew which LTC facilities were hiring and which ones were government ran and unionized and which ones were private sector and non-union. On the other hand, some of my fellow students were under the impression that they'd be working as LPNs in the ICU, L&D or the ER upon graduation. They were in for a rude shock.

Working in a nursing home, I have seen more than a few new grad LPNs and RNs (ADN and BSN) come through to work the floor and push a med cart with their hopes dashed and their egos bruised. While I really do feel sorry for them, I also can't help but feel that they failed to really explore their realistic options.

Where I live a new grad nurse who doesn't already have their foot in the door in a hospital (as a tech or something) simply has no chance of being hired there. Just not going to happen, unless nepotism or some other really good connections are involved.

[ausrnurse]

I don't know if "nursing shortage" is the correct phrase to describe what happening. Nurses work dangerously understaffed every shift, but nobody can get a job. That is the reality.

[mmc51264, BSN, MSN, RN]

It's similar to education. They keep cranking out new teachers to replace the ones that are burned out too soon and leave the profession 3-5 years in. There are positions out there for nurses, just not new grads. I counted 50+ vacancies at my facility, but most are specialized fields and/or >1 year experience

[dnsonthego]

I am glad you posted this. There is no nursing shortage. In many areas there is a glut of nurses.

In certain regions (rural area), there are still some jobs.

In the big cities and the surrounding region, it is really tight job market. I am in NYC and it is a nightmare for new grads and even tough for experienced nurses. I know of new graduates who have been out of school several years but can not get a job as a nurse. Even LTC and HH is not hiring in NYC. VNA of NY recently let go over 500 employees after the papers wrote that they admitted patients who did not met criteria for their services. VNA tightened its admission process and it soon realized it had too many staff.

Hospitals have closed in NYC with two hospitals in Brooklyn to close next year and rumors of another NYC hospital closing are floating around. Hospitals are closing units, consolidating services and expanding clinics. Jobs for nurses are being lost in the shuffle.

A big push by the large hospital systems in NYC is to expand clinics and community services. The doctors have their jobs but the RN opportunities are limited as the custodial care is/will be done by aides, medical assistants and clerks. This is helping with cost saving as these type of workers are low wage and low benefits.

Healthcare is a business. Big Business. Nurses are an expense to the operating budget. As hospital struggle to find fully insured patients to provide high margin services for, managers must look at ways to reduce costs/expenses. Less nurses on the floor, more patients per nurse and less support staff are some of the ways management has attempted to reduce costs and expenses.

I think every applicant to a nursing program should be required to read Zack 1100 posting...twice. I have said before and I will say it again, nursing education is expensive, time consuming and too vocationally oriented to sign up for without thinking about what awaits when you graduate. I can not tell you the number of new graduates who have come looking for work only to be told we have no opening and we are not taking new graduates. I have met with nurses who have graduated as far back as 2007 who have yet to obtain their first job as a nurse. In NYC a new graduate will not be considered without a BSN yet the schools pump out Associate degree nurses, Why??? Even with a BSN, the possibility of getting a job as a new nurse is remote as the area has a glut of experienced nurses.

I spoke with a nursing professor about the NYC glut and she stated her job was not to get them a job but to train them. I told her that it is unfair to take in too many students into vocational training when jobs are not available. Nursing is not a liberal arts type subject but a vocational trade. The schools do a poor job "training" new nurses with the hospitals really being responsible to do the real hands on training via new nurse orientation. The new nurse training is too costly for hospitals to maintain. If the schools had done a better job in training nurses in how to be a bedside nurse, new graduates would not be in the place they are...unemployed and having to pay off large student loans.

Thank you Zack 1100 for posting this article. For those considering nursing...please be aware and think before you sign up for a nursing degree.

[elkpark]

I spoke with a nursing professor about the NYC glut and she stated her job was not to get them a job but to train them. I told her that it is unfair to take in too many students into vocational training when jobs are not available. Nursing is not a liberal arts type subject but a vocational trade. The schools do a poor job "training" new nurses with the hospitals really being responsible to do the real hands on training via new nurse orientation. The new nurse training is too costly for hospitals to maintain. If the schools had done a better job in training nurses in how to be a bedside nurse, new graduates would not be in the place they are...unemployed and having to pay off large student loans.

^^ This, this, this, this, this! However, a big part of the problem is that the academic community in nursing has gone to a great deal of trouble over the last few decades to convince everyone that nursing school is not vocational training and is deeply offended by the very suggestion; and the fact that pretty much any school that wants to (spend the money) can open a nursing program has produced a tremendous glut of nursing programs, many of them of v. poor quality and cranking out poorly prepared graduates.

I'm an old diploma grad, and I'm really saddened by how nursing eduation has been watered down over the last few decades. It's not surprising that hospitals are reluctant to hire new graduates, since they then have to turn around and invest a lot of time and money in teaching them stuff that the hospitals believe (rightly or wrongly) they should have learned in nursing school.

[Guest757854]

i do also believe some nursing schools are not preparing graduates as they need to be prepared.

[CrossCountryRN2008]

The shortage is of highly experienced well trained extra certification nurses not new grads. The new grad market is over flooded. Then there is CMA staff in clinics and blood donation centers. Dialysis clinics use dialysis techs.ALF places use med techs now. These are all jobs that once went to LPN staff and new RN staff. For every experienced and certified nurse there may be 20 new grads depending on your area. Plus old nurses are not retiring or came out of retirement due to the economy