1Volume 31, No. 1 • September/October 2009

F or the second consecutive year,the National Student Nurses’Association (NSNA) collected data

from new RN graduates (NSNA mem-bers) describing their experiences in find-ing entry-level RN positions. Data fromthe first study was reported in Dean’sNotes last year (Mancino, 2008). Resultsof the 2008 study revealed the lack ofentry RN positions primarily in the north-east (especially New Jersey andMassachusetts). Findings of the 2009study reveal a more widespread declinein entry-level RN positions. The implica-tions of these “real-time” findings presentnew challenges and opportunities thatmust be swiftly and effectively addressedby the nursing profession. Real-time datadenotes information that is deliveredimmediately after collection. There is nodelay in the timeliness of the informationprovided (Wikipedia, 2009).

In late June, NSNA collected datafrom 2,112 new RN graduates, 85% ofwhich had completed nursing school inSpring 2009.* Surveys were completedby students in all types of RN programs:baccalaureate degree (52%), associatedegree (42%), diploma (4%), other (2%).Forty percent of respondents hold atleast one previous non-nursing degree(42% diploma, 39% associate, and 28%baccalaureate). A total of 8% werelicensed practical/vocational nurses.

When these students were asked ifthey have an RN position in place, 56%said “yes” and 44% said “no.” By pro-gram type, the data revealed that 62% ofthe baccalaureate graduates, 50% of the

associate degree graduates, and 49% ofthe diploma graduates had entry RNpositions. New graduates that did not yethave a position by program type were:diploma 51%, associate degree 50%,and baccalaureate 38%.

Those responding that they did nothave a job gave the following responses(choosing all that applied) (N=1404): 5%did not yet try to find a job, 13% werewaiting until they passed state boards,29% were having difficulty finding a jobin their preferred specialty, 41%answered that there are no jobs for newgraduates in the area, and 17%answered “other” and described reasonsin a narrative section of the survey.

When this question was brokendown by program type, 41% (N=261) ofthe baccalaureate, 41% (N=255) of theassociate degree, and 41% (N=28) of thediploma graduates reported that thereare “no jobs for new graduates in thearea.” Although new graduates had diffi-culty in finding an entry level RN positionin all states, the highest response to thisquestion came from those in the follow-ing states: Arizona, California, Colorado,

Florida, Georgia, Massachusetts, Mich-igan, New Hampshire, New Jersey, NorthCarolina, Ohio, Pennsylvania, and Texas.

New graduates that did not have anRN position reported the followingtrends in their narratives:

• Hiring freezes;• Employers filling positions with

RNs having 1-3 years experience;• Many hospitals discontinued new

graduate orientation and residen-cy programs;

• Hospitals are hiring foreign nurses;• Hospitals are hiring travel and

agency nurses;• Hospitals are closing;• RNs are being laid off;• Too many new graduates are

flooding the market;• Hiring BSN graduates over associ-

ate degree graduates;• Older RNs are not retiring and

nurses who were working part-time are now working full-time;

• RNs who are currently employedare working harder;

• Hiring per diem nurses withoutbenefits.

When asked to comment if there isa nursing shortage in their area,

Entry Level Positions for New Graduates:Real-Time Dilemma Requires Real-Time Solutions

Diane J. Mancino, EdD, RN, CAE

Volume 31, No.1 • September/October 2009

*Percentages are rounded. The list used to col-lect the data contained only email addressesfor NSNA members who indicated Spring2009 as their graduation date on their mem-bership record. Although the list contained12,055 email addresses, some email address-es were no longer valid. The estimated uni-verse was 10,000; 2,112 responses representa return of 21%. The author wishes to recog-nize Carol Fetters Andersen, MSN, RN, NSNADirector of Governance and ProgramDevelopment, for her assistance with datacollection and analysis.

Diane J. Mancino, EdD, RN, CAE, is ExecutiveDirector of the National Student Nurses’Association and the Foundation of the NSNA.Write to her at nsna@nsna.org, with “AttentionDiane Mancino” in the subject line.

2 Volume 31, No. 1 • September/October 2009

responses revealed an understandingthat the recession is largely responsiblefor the change in the RN job market.New graduates commented that, “Thereisn’t really a nursing shortage – there is ashortage of money,” and “There is noshortage of new graduates.” Job seekersreported that most openings were inmedical-surgical nursing (61%), followedby intensive care (31%) and emergencydepartments (28%), long-term care(25%), psychiatric-mental health posi-tions (18%), and oncology nursing (17%).

When asked about their interest indifferent specialty nursing areas (select-ing multiple areas), most indicated aninterest in intensive care (39%) andemergency nursing (36%), followed bymedical-surgical (32%), maternity-labor/delivery (28%), cardiac intensive care(25%), pediatric nursing (23%), andoncology nursing (16%). Eleven percentspecified an interest in travel nursing and9% are interested in psychiatric-mentalhealth nursing. Eight percent of newgraduates are interested in community/home health nursing. Only 3% indicatedan interest in long-term care and 4%indicated rehabilitation nursing.

Plans to Advance EducationQuestions regarding new graduates’

plans to continue their formal educationwere added to this year’s survey. Thirtypercent (N=261) of associate degree and23% (N=20) of diploma graduates indi-cated that they would immediatelyreturn to school, while 43% (N=305) ofboth associate degree and diploma grad-uates responded that they would returnto school in one year. Six percent (N=49)of associate degree graduates and 5%(N=4) of diploma graduates indicatedthat they had no plans to get anotherdegree. Sixty-six percent (N=649) ofdiploma and associate degree graduatesindicated that the RN to BSN completionprogram was their next educational step;21% (N=197) selected RN to MSN com-pletion.

When asked to indicate the highestdegree that they are planning to achieve,60% (N=1258) chose a masters degreein nursing and 21% (N=439) plan toachieve a doctorate. Fifty percent(N=480) of those graduating with abachelors degree indicated that a mas-ters degree for advanced practice wouldbe their next educational step, 18%(N=169) indicated a masters of science innursing, 6% (N=58) indicated a mastersin education, and 5% (N=45) indicated amasters in administration. Seventy-sevenpercent (N=1505) indicated that theyplan to achieve certification.

Discussion: Real-Time SolutionsNeeded

New graduates unable to findemployment as RNs are desperatelyseeking ways to gain nursing experience.Many are looking for residency andextern programs and one new grad whoresponded to the NSNA survey wrote, “Iwould be willing to pay to participate ina hospital-based new grad program. I amdesperate to get the acute care experi-ence required before I feel I can continuewith my advanced education or alterna-tive nurse careers.”

In the NSNA survey, many com-plained that their job applications are noteven acknowledged and that advertise-ments for RN positions state that “newgrads are not eligible.” In some regions,hospitals that provided work-commit-ment loans and scholarships for tuitiondo not have RN positions for the newgraduates who received the funding.

Turnover rates for newly licensedregistered nurses, coupled with an over-supply of new graduates, may also beassociated with the decline in positions.The expense of new graduate residen-cies and extended orientation programswith no guarantee that the new hire willbe retained makes it difficult for employ-ers to justify hiring new graduates, espe-cially when the market is flooded withexperienced RNs.

Variables that may not be possibleto factor into the discussion of thedemand for registered nurses include fluepidemics and disasters – both naturaland manmade. The potential impact onthe health care and registered nurseworkforce could be substantial if theH1N1 pandemic materializes. The num-ber of flu-related hospitalizations alonecould overwhelm the health care system.In addition, “RN Vacancy Creep” couldincrease the demand for RNs as theeconomy rebounds (Nursing Solutions,Inc., 2009a, 2009b).

No data is available on the potentialimpact of losing new graduates to otherfields of employment. New graduateswho are licensed RNs may not be permit-ted to practice in the health care systemin any other capacity. One survey

respondent wrote, “Thank God I have aBA and am employed as a teacherbecause after four years of night schoolgetting my AAS in nursing, there are nojobs for me out there.”

We are faced with the challenge offinding quick, real-time solutions toaddress the creation of entry-level oppor-tunities for newly licensed RNs, as well aslong-term solutions to retaining them inthe nurse workforce. The establishmentof government and privately fundednurse residencies in all areas of healthcare delivery (acute and non-acute set-tings) will provide access to the clinicalexperience that new graduates are crav-ing. Now is the time to tap into the wis-dom and mentorship of seasoned nurseswho will be retiring once the recessionabates. We must all be alert and sensitiveto potential opportunities for new gradu-ates, such as involvement in immuniza-tion and flu vaccine clinics. The creationof a Newly Licensed Nurse Corps throughnursing school and health care deliveryagency partnerships could address thetransition into practice needs identifiedby the National Council of State Boardsof Nursing (2009).

It would be wise for the nursing pro-fession to capitalize on the desire of newgraduates to advance their education.Priority should be given to graduateswho quickly enter RN to BSN or RN toMSN programs on a full-time basis.Federal, state, and private funding wouldbe a catalyst to support this effort, as wellas funding for nurses to become nurseeducators. Generating an interest in long-term care and community-based nursingwill help ease the potential for disastrousshortages in these areas as the popula-tion ages. Once the health of the U.S.economy is restored, the nursing short-age will be compounded by the suddenexodus of retiring nurses and increasedhospital census. We will have to compen-sate for the nurses lost to other fields andthe possible decline in nursing schoolapplications and enrollments.

As leaders in nursing education andpractice, we must accept responsibilityfor finding real-time solutions to thesechallenges. Deans, directors, and chairs

Once the health of the U.S. economy is restored, the nursingshortage will be compounded by the sudden exodus of retiringnurses and increased hospital census. We will have to compen-sate for the nurses lost to other fields and the possible decline innursing school applications and enrollments.

Volume 31, No. 1 • September/October 2009 3

Thursday, October 29, 20097:00 a.m. – 6:00 p.m.Registration

2:00 p.m. – 3:30 p.m.Healing Nurse to Nurse Hostility

Kathleen Bartholomew, MN, RN, RC

5:00 p.m. – 6:30 p.m.Opening Session: Keynote AddressTips and Scripts for a Grand Entrance

Kathleen Bartholomew, MN,RN, RC, Consultant, SwedishMedical Center/ConvergentKnowledge Solutions,Seattle, WA

Friday, October 30, 20097:00 a.m. – 6:00 p.m.Registration

8:00 a.m. – 11:00 a.m.Leadership University:Consultants andAdvisors CertificateProgram (Part I)

Pre-registration andPre-assignments

Required to attend both Part I and Part II(nsna@nsna.org)Continental breakfast provided

4:00 p.m. – 5:30 p.m.Fostering Innovation in NursingEducation: The Regulatory Perspective

Nancy Spector, PhD, RN, Director ofEducation, National Council of StateBoards of Nursing

Saturday, October 31, 20099:00 a.m. – 10:30 a.m.

Leadership University:Consultants andAdvisors CertificateProgram (Part II)

Pre-registration andPre-assignments

Required to attend both Part I and Part II(nsna@nsna.org)

1:30 p.m. – 3:00 p.m.Real World Issues in Advising andConsulting for a Student Nurses’ Association

Dr. Cheryl Taylor, NLN appointed consult-ant, and Dr. Cheryl Schmidt, ANA appointedconsultant

3:30 p.m. – 5:00 p.m.Healthcare Policy and Nursing Students:Getting Involved

Rosemary Mortimer, MS, MSEd, RN, 2008Leader of Leaders recipient

5:45 p.m. – 6:45 p.m.NSNA Association Roundtable Discussions

(includes Faculty Roundtable)

Sunday, November 1, 2009Enjoy the many activities inPhoenix on your own!

An Invitation to Coach Tomorrow’sNursing Leaders in Phoenix

For Faculty, Consultants, and Advisors attending the 2009 MidYear ConferenceStudents attending the 27th Annual NSNA MidYear Conference are invited to participate

in the 2009 Exhibit Hall Career Counseling Center during open hours. Students participatingin the 2009 Career Center are encouraged to bring a print copy of their resume using theDecision Critical, Inc. e-portfolio tool that is available to NSNA members at no cost throughNSNA Leadership University’s Critical Portfolio™ (go to www.nsnaleadershipu.org andselect Critical Portfolio).

Friday, October 30, 200911:00 a.m. – 1:30 p.m. Exhibit Hall and Career Counseling Center

Grand Opening4:15 p.m. – 6:30 p.m. Exhibit Hall and Career Counseling Center Open

Saturday, October 31, 200910:45 a.m. – 1:15 p.m. Exhibit Hall and Career Counseling Center Open

If you are available to provide leadership coaching and lifelong learning recommenda-tions to NSNA members attending the 2009 MidYear Conference in Phoenix, AZ on Friday,October 30 and 31, 2009, please send your name, contact information, and date and time(s)available for coaching to nsna@nsna.org and list “2009 Career Center Volunteer” in thesubject line. DN

2009 NSNA 27th Annual MidYearConference Highlights

(Go to www.nsna.org/whats_new.asp for updates on the MidYear Faculty Sessions)

of nursing programs along with chiefnursing officers can collaborate at thelocal level to devise demonstration proj-ects for new nurse graduates, givingthem access to professional develop-ment and nursing practice opportunities.State funding for workforce develop-ment, where available, can be redirectedto create new graduate programs and tosupport scholarships for RN degree com-pletion education. At the national level,nursing organizations can advocate forfunding and legislation to support work-force and nursing education initiativesfor new graduates. Those who mentornew graduates need to provide guidanceand encouragement during these diffi-cult times. Together, we can implementreal-time solutions to address the urgentneeds of newly licensed nurses. DN

ReferencesMancino, D.J. (2008). The nursing shortage:

Predictions and predicaments. Dean’s Notes,30(1), 1-2.

National Council of State Boards of Nursing. (2009).Transition initiatives. Retrieved August 30, 2009,from https://www.ncsbn.org/363.htm

Nursing Solutions, Inc. (2009a). Compensationstudies. Retrieved August 30, 2009, fromhttp://www.nsinursingsolutions.com/Administrators/admin-research/compensation-studies.aspx

Nursing Solutions, Inc. (2009b). RN vacancy creep.Retrieved August 30, 2009, from http://www.nsinursingsolutions.com/Files/assets/library/industryupdates/RNVacancyCreepAnalyzer2009.pdf

Wikipedia. (2009). Real-time data. Retrieved August30, 2009, from http://en.wikipedia.org/wiki/Real-time_data

4 Volume 31, No. 1 • September/October 2009

© Anthony J. Jannetti, Inc., 2009

EditorCarol A. Fetters Andersen, MSN, RN

President, NSNAKenya Haney

Executive DirectorDiane Mancino, EdD, RN, CAE

Art DirectorJack Bryant

Managing EditorKatie R. Brownlow

Graphic ArtistMelody Edwards

PublisherAnthony J. Jannetti

Advisory Board 2009-2010G. Rumay Alexander, EdD, RNMichael L. Evans, PhD, RN, NEA-BC, FACHEFlorence L. Huey, MS, FNPMary P. Tarbox, EdD, RNRebecca M. Wheeler, MA, RN

DEAN’S Notes is indexed in Cumulative Index toNursing & Allied Health Literature.

DEAN’S Notes is published five times a year (September/October,November/December, January/February, March/April, and May/June) byAnthony J. Jannetti Inc., East Holly Avenue Box 56, Pitman, New Jersey08071-0056. Telephone 856.256.2300. FAX 856.589.7463. All rightsreserved. No part of this publication may be reproduced without theexpress written permission of the publisher. Address changes shouldinclude mailing label and be forwarded to the publisher.

Volume 31, No. 1 • September/October 2009

NSNA and the Disaster PreparednessCommittee invite faculty, Deans/Directors, and Program Chairs to joinNSNA student members and participatein the 6th annual National PreparednessMonth (NPM) in September 2009. NPMoccurs each September to encourageAmericans to take simple steps to pre-pare for emergencies in their homes, atwork, and in schools. It is a nationwidecoordinated effort sponsored by the U.S.Department of Homeland Security Readycampaign. NSNA is proud to be a 2009Coalition Member of the Ready cam-paign.

This year, initiatives will provide fac-ulty and students with a variety of oppor-tunities to learn more about emergencypreparedness. How can you help prepareyour community, your campus, yournursing program, and your families to beReady when disaster strikes? Find fre-

NSNA Joins the 2009 Ready Campaign as a Coalition MemberPrepare, Plan, Stay Informed

quently asked questions and informationabout the Ready campaign, short andinformative video clips, as well as funactivities for the whole family on theNSNA Web site (www.nsna.org/activities/disaster_prep.asp). The video clips includeimportant information to help you planand get Ready for the needs of children,adults, elderly relatives and neighbors,persons with special needs, and pets inthe event of a disaster.

NSNA encourages all nursing pro-grams, faculty, and students to assembletheir Emergency Supply Kits and makeFamily and Campus Emergency Plans thisSeptember. Become informed about thedifferent types of emergencies that couldoccur in your area, local resources thatare available, and appropriate responsesto prepare yourself, your family, yourchapter, and your community to beReady.

Throughout the year, the Depart-ment of Homeland Security and NSNAwill promote individual emergency pre-paredness updates through the Readycampaign. Ready is a national publicservice advertising campaign producedby The Advertising Council. The Readycampaign’s Web sites provide free disas-ter preparedness information in English(www.ready.gov) and in Spanish (www.listo.gov). Toll-free numbers in-clude 1-800-BE-READY (in English) and 1-888-SE-LISTO (in Spanish). DN

PRSRT STDUS POSTAGE

PAIDPitman, NJPermit #33