Much is being made of the nursing shortage, but the sad fact of the matter is that much of this shortage is a self-inflicted wound. "30%-50% of all new RN's elect either to change positions or leave nursing completely within the first three years of clinical practice"
Much is being made of the nursing shortage, but the sad fact of the matter is that much of this shortage is a self-inflicted wound. "30%-50% of all new RN's elect either to change positions or leave nursing completely within the first three years of clinical practice" (MacKusik & Minick, 2010, p. 335). The reasons are many and varied, but a 2010 qualitative study by Carol MacKusik and Ptlene Minick examine these issues and find three major themes, an unfriendly workplace, emotional distress related topatient care and, fatigue and exhaustion (MacKusik & Minick, 2010).
An unfriendly workplace can be one in which the new nurse is simply thrown to the wolves, expected to "toughen up" by more experienced coworkers, women experiencing sexual harassment from male coworkers and physicians, and lack of support from management and/or administration in addressing these issues.
The emotional distress we as nurses experience is, all too often, related to cases of futility of care. This is where, regardless of how many life support systems the patient has attached to them, the result will be the same...the patient will die. The only question being how much suffering they experience as they do so. This occurs at both the beginning of life in neo-natal ICU's to the end one's years in ICU. In either case, physicians may not be entirely honest with patient families, thus giving them false hope regarding the prognosis. The other side of the coin is families, for whatever reason, cling to the hope that their loved one will somehow arise from the bed and leave hale, whole and healthy. This is often due as much to family dynamics involving guilt as it to unrealistic and unreasoning religious views. The toll this takes on the nurses involved in the direct care of these patients is huge.
Fatigue and exhaustion come into play when, for whatever reasons, management and/or administration are more concerned with filling beds than whether or not the staff is available to safely care for these patients. Nurses are asked, then expected, to "flex up" and take more patients it is safe for them to care for, thus putting patient safety and nurses licenses at risk. This creates a fundamental conflict between the core values and terms of licensure for nurses and the values of the organization. Add to that overtime and calls to work on their days off, and the physical and emotional exhaustion simply becomes too much to bear.
So the projected nursing shortage...some 500,000 nurses by 2025 (MacKusik & Minick, 2010)...seems to be as much a result of nurses fleeing the acute care setting as it is with the lack of sufficient new grad nurses to take up the slack.
References
MacKusik, C. I., & Minick, P. (2010). Why Are Nurses Leaving? Findings From an Initial Qualitative Study on Nursing Attrition. MEDSURG Nursing, 19(6), 335-340.
You're right. Technically, there IS a shortage, but since the economy has tanked, employers aren't filling positions. I don't see it improving anytime soon. In fact, someone recently posted in another thread that a hospital in Miami plans to lay off 400 nurses.
I'm seeing many signs in my area that hiring has improved dramatically. My hospital lifted a hiring freeze last year and new grad residency classes have 40 or so participants.
I graduated in May of 11. During our last semester, my school had a "Reality Panel" where 6 or so recent grads come and talk to the graduating class.
It was terrifying. Almost none of them had jobs. One was thrilled to have been recently hired in a nursing home and another was very hopeful about his chances at landing a hospital CNA job.
This year, I was a member of that panel. We all had jobs that varied from hospital to home health to contract work for insurance companies. In fact every new grad from my class who wants to work is working. Now, many of them aren't working where they want (in a hospital) but they are all working. (One of the grads from the Terror Reality Panel when I was in school was in my orientation class)
I know every area isn't experiencing the job prospect improvements we see in the Twin Cities, MN area, but things sure are looking better here.
I would also like to say that I don't believe there is a nurse shortage at all in this or many parts of the country. I'm in Western New York State and see only a shortage of good jobs as the hospitals seem to think nurses are just an expensive nuisance to keep on staff and much better to have lesser skilled staff take their places since any female in scrubs will be perceived as a nurse by the patients and a nuses is a nurse with no differentiation.
If the hospital gets caught in a bind and actually needs a RealNurse for some reason, then call an agency for one to be sent over. This is not to disparage LPN's or aides as I have worked with many who were just as skilled or smart as any RN, but lacking the paperwork, they are considered less skilled.
Just out of curiosity, I just went to the Indeed web site and put RN in the job search for my region-of the first 30 jobs listed, 18 were for agency/travel positions, 1 RN for dialysis (2 years ex. required), 1 RN for a psych pos. 2 years ex. req., 1 LPN nursing home, 2 RN pos with CCM cert., RN exp. in OB/GYN., RN to train aides for homecare, RN PT for cardiology,, 1 NP pos., 4 for TBI agency that was multiple posting of the same job, and a billing and coding pos.
This is what is out there in my area-either work an agency job, have a experience in a specialized area, or have home care experience so you can direct or train the aides doing the hard work. Where are the jobs for a new nurse wanting to go into a hospital to work?
I have 4 years of hospital med/surg. experience but got downsized out of my last position 2 years ago when the powers to be decided to close departments and cut the number of beds. Since then it has been pick up health screening clinics, flu and Zostravax clinics etc., nothing that is full time and with benefits.
I constantly get calls from agencies wanting me to take a position in Texas or California for a 13 week assignment, so from my observation, those are the states with nurse shortages, but not true of many others as I have two friends who are in a similar boat as myself in New England and Ohio.
Actually, it IS nursing fault that this has occurred. For YEARS, nursing has refused the ONLY solution to the problem-to unionize, en masse, and take control of our professsion.
Without a union to protect you, it is impossible to, "take to the streeets", like other professions, like teaching has. Teachers go right to the parents, when their profession is under fire, and cuts are made to the classroom. The are out in numbers, in the streets to protect their classrooms. Yet, no one has ever died because they could not do long division, or diagram a sentence. How many have died in the hospital because of deliberate short staffing?
The, "martry marys", of the nursing profession, "have nailed us to the cross", to prevent us from being the power we should be with out numbers. They use terms like, "unethical", not fair to our patients if we have to strike", or, my personal favorite, " I could never leave, MY PATIENTS", and walk out on strike.
In the first place, they are NOT, "YOUR PATIENTS". They have not contracted with you for care, they way they do with the hospital or doctors. It is the hospitals' responsibility to provide staff to care for them. Get over it.
It continually amazes me, that nurses have not figured out what is going on. The PTB, terrorize us, to prevent us from taking control, not unlike the slave owners of past centuries. As long as they have the power to control us, the problem remains. If and when we finally decide to take control of nursing, they will not longer have that power over us.
Doctors contract with the hospital to admit patients to the hospital. They have their lawyer, who are on their side, negotiate their services to the hospital, and have legally signed contracts, to uphold them.
Why can't nursing do the same? Because there are TOO many who are afraid to have control over anything. Let alone their practice of nursing.
Make it a priority to change the way you think. Call the NNOC to start an organizing campaign in your hospital. Just say no, to too many patients. Get together in groups on non work hours, and plan the takeover of your profession in your hospital.
Work with the members of NNOC, to make it happen. Remember, no one can take advantage of you without your permission. You can do it.
Actually, it IS nursing fault that this has occurred. For YEARS, nursing has refused the ONLY solution to the problem-to unionize, en masse, and take control of our professsion.
Without a union to protect you, it is impossible to, "take to the streeets", like other professions, like teaching has. Teachers go right to the parents, when their profession is under fire, and cuts are made to the classroom. The are out in numbers, in the streets to protect their classrooms. Yet, no one has ever died because they could not do long division, or diagram a sentence. How many have died in the hospital because of deliberate short staffing?
Make it a priority to change the way you think. Call the NNOC to start an organizing campaign in your hospital. Just say no, to too many patients. Get together in groups on non work hours, and plan the takeover of your profession in your hospital.
Work with the members of NNOC, to make it happen. Remember, no one can take advantage of you without your permission. You can do it.
I do agree with this point. I work in a union facility and the idea of going back to a non-union facility scares the daylights out of me.
Even still, we don't really change things in my facility as we do hang onto our hats and try not to lose our jobs at the whims of management.
The problem I have with the national and state-level advocacy organizations is that they seem concerned only about the needs of RNs and advanced practice nurses.
I am an LPN, and am constantly frustrated, discouraged, and depressed that this dialogue has no room for the voice of LPNs.
We are nurses, we experience the same deplorable work conditions, the same challenges, failures, obstacles, rewards, and disrespect from management as RNs, and we have a lot to say about it, and yet, our voices do not count at all.
I am registered with my state's nursing organization but every single initiative they have taken, every communique, every newsletter, every outreach, is for RNs and above. Not a word of concern for LPNs.
If nurses want a stronger, more cohesive, and more powerful voice, then we need to include the voices of the millions of LPNs out there who are dealing with the same issues.
There is not a nursing shortage, but nurses are still finding jobs better than in almost any other profession.
According to The National Association of Colleges and Employers, only 24% of new graduates across disciplines in 2010 had a job after graduation - My God, look at lawyers. However, new graduate nurses had a 56% employment rate right after graduation and that rose to 88% within 6 months after graduation. Although there is no promise of a job right after graduation, nurses are finding jobs much easier than in other professions. This is regional. I can tell because the coasts seem to have a bigger problem than the rest of the country. Here we had a record number of hires in 3 hospital systems across the state.
Lastly, if we are in fact going to 'fix' the problem, we cannot make sweeping brushstroke statements about the health of nursing. The statement that schools are "pumping out nurses" is not true when compared to census, aging populations, and prior need.
More than 50% of nurse applicants were denied admission into accredited nursing schools in 2010. Furthermore, according to the AACN and NLN, there has only been in increase of about 250 programs across the US in the last 10 years. Seeing as hospitals were begging for nurses in the last 2 decades (until the recession of 2008 hit) nursing schools were trying to provide the workforce with the supply of nurses it said it needed.
Since the US population grew by more than 25 million people since 1995 and the nation's population is projected to increase to 392 million by 2050 -- more than a 50 percent increase from the 1990 population size (U.S. Census Bureau), the rise in accredited programs was warranted. No one saw the massive economic doom of 2008 and as we recover, which I know we will, the system will balance out again.
I know it is horrible to be unemployed, but this a country-wide and even global issue - this is not specific to nursing.
Problem for nursing is that the profession tends to react rather than act, and this comes across on both ends (employers and nursing).
Aside from a few brief periods in the history of modern nursing there has never been *enough* qualified and well trained nurses. This is one of the reasons behind the creation of various UAPs such as NAs, scrub assistants, OR techs and so forth.
Then there is the fact the profession being a mainly female occupation it is very responsive to changes in the world of women.
Up until rather recently there was always a need for new grads because so many experienced nurses for various reasons such as marriage and or having babies, left their jobs or went to part-time status.
However as one has said often on this forum the nursing profession in both the United States and other developed western nations has never recovered from various laws/schemes meant to end employment discrimination against women.
While it may seem a joke to young girls today life before Title IX was *very* hard for women, especially those seeking to enter the medical professions. By *medical* I mean just that, doctors, dentists, etc..., for back in the day you would have had your head handed to you on a plate by including "nursing" under the same heading.
In order to gain entry into med schools one has to lay down educational chops starting almost in high school. Many girls simply were told flat out they couldn't take the required math and science classes because it would displace boys. If a girl wanted to do something in the healthcare field she was directed you know were; nursing. While this was on paper great for the profession as it produced vast numbers of new grads, many of those new nurses hated every minute of their job and quickly found a way out (marriage for instance). Of those that remained provided some of the most passive aggressive care one could imagine.
Once the educational and employment landscape opened up for women enrollment in nursing programs began a slow but steady decline. That coupled with changes in the healthcare system lead to many nursing schools closing. One other nail in the coffin was when the *managed care* craze swept though the USA in the 1980's and 1990's. Hospitals looking to cut budgets began getting shot of experienced senior nurses by the dozens. This despite warnings that from those ranks clinical instructors and professors were drawn. So what many in the profession predicted would happen came to pass. There was suddenly a "nursing shortage" but too few programs and worse instructors/professors as well.
Now things have come full circle as everyone and their mother ran to staff up and or create new programs churning out scores of new grads every six months. However as there always seems to be something, no one could have foreseen the economic meltdown of the past several years and how it would affect healthcare.
Another problem for nursing is what began during the managed care era; hospitals have been examining their business model and determining anything not central to that core has to go or at least be reduced.
Using the popular college class excercise, ask yourself what is the function of a hospital? This is not a purely academic query as the replies have a direct impact on the nursing profession.
Time was most all functions not falling under medicine fell under nursing. Licensed professional nurses did everything from clerical work to running CSS. Hospitals via their schools of nursing were also very involved in the education and training of nurses as well. But over the years for various reasons all that has changed.
I've said this before and though it pains many of you all to hear it am saying it yet again, nurses are labour for hospitals. Labour is a cost that all businesses seek to control. As the cost of providing nursing service (wages, benefits, etc..) increase hospitals are using them only for what is required; direct and or perhaps some indirect patient care. Up and down this country hospitals and their consultants are taking apart the role of a professional nurse to see what is the best use of her/him for their money. What can be done by UAPs for less cost is being farmed out to them. If you examine those rosy predictions about employment growth in healthcare you'll see CNAs, techs, and home healthcare aides make-up a large precentage of those numbers, indeed in some areas outpacing the hiring of nurses.
Patients by and large aren't that aware of whom is providing care at the bedside, and many probably do not care long as they are treated properly. Now that nurses by and large no longer wear caps and whites, but dress in most cases like everyone else from housekeeping to techs it is kind of hard to tell whom is doing what. This of course is not lost on hospitals and "patient care" then becomes a very large umbrella and not just restricted to "nursing services" provided by RNs and LPNs.
From my side of the world I have to say there still is a Nursing Shortage.
My hospital is constantly hunting for staff, every graduate I know had a job once completing their bachalor.
So in Australia there still does seem to be one, I'm from an industrial town. I think it's the economy if I had to make any guesses in America that killing job opportunities. Hard for me to say as I don't live there nor know how hard things are financially other than what I read and hear on AN and the news.
I personally just hope staffing improves over there and they allow budgeting for more staff it always sounds horrible when I read all the articles of nurses waiting for that postgrad job, interviewing and searching.
I wonder does the universities/collegues that way assist in placing nurses? Into jobs like they do here? It would be some help for new graduates maybe?
Specializes in Peds/outpatient FP,derm,allergy/private duty.
There is so much turbulence and misinformation regarding the nursing job outlook, any statistics cited that are 2010 or older can't be relied upon. This article:
may have been the first to acknowledge "the unexpected surge" of young women (their words) graduates who are impacting statistical projections for employment written by an acknowledged expert in the field, Peter Buerhaus.
Another thread here is based on a more recent opinion by Dr. Buerhaus published in the NEJM. A poster there pointed out that even the Bureau of Labor Statistics has very optimistic projections that don't seem to take the new reality into account. It is incredibly bewildering - they are supposed to be the ultimate "go to" source, aren't they?
I do agree with this point. I work in a union facility and the idea of going back to a non-union facility scares the daylights out of me.
Even still, we don't really change things in my facility as we do hang onto our hats and try not to lose our jobs at the whims of management.
The problem I have with the national and state-level advocacy organizations is that they seem concerned only about the needs of RNs and advanced practice nurses.
I am an LPN, and am constantly frustrated, discouraged, and depressed that this dialogue has no room for the voice of LPNs.
A new union was born as a result of the fight for safe staffing ratios in California, which defines a "nurse" as either an LVN or an RN. The fight was waged by both. The new national union excludes LVNs and LPNs.
Still and all, there is still a concerted effort to make a delineation between BSN RNs, and ADN RNs as far as title and scope of practice, as well as other forms of internecine warfare between nurses, and that is the self-inflicted wound that will most likely continue unabated.
From the NEJM -"The countercyclical nature of the health care industry, in which job gains occur faster in recessionary than in nonrecessionary periods, was revealed once again during the 18-month recession that officially began in December 2007. Whereas the national economy lost 7.5 million jobs, the health care industry gained 428,000 jobs.1 In particular, hospital employment of registered nurses (RNs) increased by an estimated 243,000 full-time equivalents (FTEs) in 2007 and 2008-the largest increase during any 2-year period in the past four decades.2Because of this increase at the beginning of the recession, the decade-long national shortage of RNs appears to have ended."
It tis almost ironic that the perfect storm created by a surge of new grads added to the surplus created by experienced nurses returning to bedside and or not leaving (due to the economic condition), has turned a nursing "shortage" into boon times for hospitals/facilities.
Probably not in ages has there been so many highly qualified applicants chasing after so few nursing gigs. Hospitals are finding themselves spoiled for choice while a painful reality is gripping new grads and even experienced nurses; their chances of landing full time hospital gigs can range from good to nil. Notice I said "good" not excellent, and there is a big difference.
Something needs to be done for these *surplus* nurses or mark my words there is going to be trouble. Unlike other professions nursing today tends to require recent active experience in order to be considered for most employment. New grads whom have little to nil experience find themselves "aging" out of being considered fast.
Speaking as someone who has NOT YET begun nursing school, I do believe there is a nursing shortage.
Some background: I live in a very large state that is very sporificely populated. The nearest "community college" (with a nursing program) is 25 miles away (about 45 minute drive one-way). The (Associates) Nursing program has a two year wait-list. The problem isn't necessarily too many applicants for A NURSING program, just too many for THAT college's program. They only allow 20 students per year. This is FAR too low for a community college system that has 5 locations statewide. Only two of the 5 locations have a nursing program. Imagine a state, lets say, the size of Texas, with only 40 positions open to nursing students! Crazy right?
Our state isn't immune to the less-than-perfect economy, and politics aside, WE are still hiring. The learning hospital in the town the comm college is located in had 15 pages of openings for RNs, LPNs, CNAs, Er techs, Unit Secs, etc. All positions (going back as far as January) are still unfilled. After speaking to a Paramedic who is a frequent customer of my present workplace, he suggested I get involved with the healthcare industry. After some research on the job market, I decided the best (and unfortunately most affordable to me) way to introduce myself to healthcare was to pursue CNA certification (Cost= $1100+, no financial aid available), and use my experience to decide if I'm capable of being successful in that environment.
I've found a position paying (CNAs) $15/hr wkdays and $17/hr wkends. This is in a city (where I live) that the average rate of pay is $7.75-$8/hour. The need is there, but I wonder if due to educational limitations, interested individuals aren't able to become nurses. Just my 2 cents.
" I live in a very large state that is very sporificely populated."
There you have the answer to much of your post. Rural areas have all sorts of healthcare shortages including doctors and nurses.
Even when offering better than local wages rural living isn't for everyone. Even local doctors and nurses often leave their home towns for the bright lights.
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MN-Nurse, ASN, RN
1,398 Posts
I'm seeing many signs in my area that hiring has improved dramatically. My hospital lifted a hiring freeze last year and new grad residency classes have 40 or so participants.
I graduated in May of 11. During our last semester, my school had a "Reality Panel" where 6 or so recent grads come and talk to the graduating class.
It was terrifying. Almost none of them had jobs. One was thrilled to have been recently hired in a nursing home and another was very hopeful about his chances at landing a hospital CNA job.
This year, I was a member of that panel. We all had jobs that varied from hospital to home health to contract work for insurance companies. In fact every new grad from my class who wants to work is working. Now, many of them aren't working where they want (in a hospital) but they are all working. (One of the grads from the Terror Reality Panel when I was in school was in my orientation class)
I know every area isn't experiencing the job prospect improvements we see in the Twin Cities, MN area, but things sure are looking better here.