THE NURSING SHORTAGE

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TABLE OF CONTENTS

Where Are We Now? 3

Experience Matters 5

Expanding the Education Pipeline 7

Factors Affecting Supply and Demand 9

About American Sentinel University 11

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WHERE ARE WE NOW?

We’ve been hearing about either an existing or upcoming nursing shortage of crisis proportions for a long time now. In fact, a recent New Yorker article titled “Why Is the U.S. Perpetually Short of Nurses?” excerpted an editorial about the nursing deficit that appeared in print way back in 1965. Is it possible that a major labor-supply shortage has persisted for half a century—and will continue to persist? It seems that no one can quite agree on this.

It seems to be true that the perennially projected shortages don’t always materialize. According to the Robert Woods Johnson Foundation (RWJF), during the recession of 2008-09, many nurses either delayed retirement or returned to the workforce because of a spouse who was out of work. This increased supply of RNs inspired an editorial in the New England Journal of Medicine, in which the authors speculated that the industry was experiencing a “nursing bubble” rather than a shortage. And as recently as January, 2015, a report by the U.S. Health Resources Services Division forecasted a surplus of 340,000 nurses by the year 2025 (although it conceded certain geographic areas will likely see shortages). Yet at the very same time, researchers at Georgetown University concluded a national shortage was once again imminent—they predicted a deficit of 92,810 RNs by the year 2020. Who to believe?

No statistical model is foolproof. Whether the future holds an actual surplus or a shortage depends on a number of fluctuating factors, including staffing policy, education capacity, wages, working conditions, and the general economy, to name a few. (These will be explored in more depth later in the following articles). Geography also plays a role, with rural hospitals facing greater staffing challenges than their urban counterparts. However, there are currently whispers in the industry about a “new nursing shortage” that is defined by a lack of sufficiently experienced professionals. When Health eCareers surveyed healthcare recruiters, hiring managers, and human resource professionals for its 2015 Healthcare Recruiting Trends Survey, 43 percent of respondents reported that they face the most difficulty finding qualified candidates.

As the skilled RNs who delayed retirement during the recession begin leaving the workforce in droves, we’re likely to see a “knowledge gap” that newly graduated nurses cannot fill. So this new version of the nursing shortage means hospitals may find themselves with a high proportion of young, inexperienced nurses, even if their job vacancy rate is low. Clearly this will have an impact on patient care.

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The increasing emphasis on specialization in nursing may also contribute to specific types of shortages. Various industry trends, including those stemming from the Affordable Care Act, have increased demand for nurses with specialized skills in areas like case management, informatics, patient navigation, and infection prevention. As employers seek to fill these specialized roles, they will likely offer attractive wages and benefits, potentially luring seasoned nurses away from the bedside and into these emerging roles, adding to the shortages in direct patient care.

The bottom line? It’s likely to be a job-seekers’ market for experienced and well educated nurses in the years ahead.

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Are you looking for a nursing job? If so, here’s the good news: The Bureau of Labor Statistics has projected 19 percent growth in the job market for RNs between 2012 and 2022, compared to only 11 percent growth for the job market as a whole. But there’s also a twist: the market currently favors highly experienced, seasoned nurses. This became especially pronounced during the recent recession, when entry-level nurses had a difficult time finding work, as older nurses delayed retirement or returned to the workforce. In short, even when there’s an overall deficit of nurses, employers tend to hold out for the most highly qualified candidates.

A 2015 article in Comstock’s titled “Plight of the Novice Nurse” discussed this situation as it is playing out in California, saying “It’s not uncommon for recent graduates to wait six months or more to land a job in a local hospital. Many are still unemployed in the field.” Within the article, a newly licensed RN was quoted as saying, “The acute care hospitals want you to have two years of experience, but you can’t go anywhere to get experience because no one will hire you without experience.” It’s the classic conundrum, and it’s leaving many younger nurses wondering how there can possibly be a nursing shortage if they can’t land a job. As discussed in part one of this series, some staffing specialists are referring to this deficit of seasoned nurses as “the new nursing shortage.”

So what happens when new graduates can’t find work in acute care hospitals? Many take positions that are less desirable to them, often in long-term care or rehabilitation facilities. This segment of the job market is wide open, as hospitals are releasing patients earlier and many aren’t able to go right home. Ultimately, some of these RNs will join the high numbers of dissatisfied young nurses who leave the profession entirely within just a few years of becoming licensed—adding to any shortage that currently exists.

Perhaps a better option is the nurse residency programs that are springing up in hospitals all over. These structured programs can provide a safe environment for novices to gain real-life skills and bridge the gap between education and professional nursing practice. They are typically paid positions that last about a year and result in full-time jobs for those who complete the residency successfully.

New technology-based roles are also presenting good opportunities to young nurses. Industry analysts say there is a massive shortage of health informatics workers, particularly those with a clinical background. By specializing in tech-based care or nursing informatics, new graduates can make this shortage work in their favor. They’ll almost certainly have a

EXPERIENCE MATTERS

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competitive edge over more senior nurses who may be less interested or proficient in technology.

And finally, remember that education also plays into experience. Many, if not most, hospitals now give preference to new graduates with a BSN degree. In its landmark report, The Future of Nursing, the Institute of Medicine (IOM) noted that, “Although a BSN education is not a panacea for all that is expected of nurses in the future, it does, relative to other educational pathways, introduce students to a wider range of competencies in such arenas as health policy and health care financing, community and public health, leadership, quality improvement and systems thinking.” The IOM has called for 80 percent of America’s nursing workforce to be educated at least the BSN level by 2020.

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Despite industry forces calling for a more educated nursing workforce, most state licensure boards have declined to require a BSN for entry-level practice. Why? There’s a widespread fear that more onerous education requirements will only add to projected nursing shortages. Yet, as discussed in part two of this series, newly graduated nurses with an ADN are at a disadvantage in today’s job market and many are unable to land a job right out of school. It seems clear that we’re not just facing a need for more nurses in the face of labor shortages, but for a higher percentage of better educated and more skilled nurses who can quickly move into the workforce.

Studies show a strong link between the BSN and better patient outcomes. Because of this, many hospitals are encouraging (and even paying for) mid-career nurses to go back to school. Yet despite the market demand for more educated nurses, nursing schools are turning away thousands of qualified applicants—a whopping 68,931 of them in 2014 alone, according to a survey by the American Association of Colleges of Nursing (AACN).

Nursing schools simply don’t have the capacity to accept more students, because they lack sufficient classroom space and clinical teaching sites. As reported by the AACN, the healthcare industry is being hit with a double whammy, as it becomes apparent that we can’t avoid a shortage by educating more nurses—because there is also a shortage of nursing educators, as many either retire or move into higher paying jobs outside of teaching.

So what can we do? First of all, we have to fill open faculty positions in nursing schools, by attracting more nurses to a career in nursing education. Secondly, the rising generation of nurse educators will need to look toward non-traditional education models that can scale up the number of students they can accommodate, at all education levels. This includes state-of-the-art simulation centers that can supplement existing clinical training sites in hospitals.

Nursing schools that use a distance learning model, like American Sentinel University, are helping to expand nursing education. Because we’re not tied to a specific location, we can make higher education available to a wider pool of students—including working nurses who have constraints on their time or live in rural areas far from traditional classrooms. We can also hire the best faculty from all over the country and can easily add adjunct faculty as our enrollments increase. And because we leverage technology for more efficient and effective instruction, we’re not locked

EXPANDING THE EDUCATION PIPELINE

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into a traditional semester schedule—so students can start classes during every month of the year, according to what’s convenient for them.

But nursing education must also produce RNs who are better prepared to step into nursing practice and feel comfortable at the bedside. A 2012 article in American Nurse Today titled “Tripping Over the Welcome Mat: Why New Nurses Don’t Stay” reports that:

In a recently conducted survey regarding newly graduated nurses’ readiness to practice in the hospital setting, only 10% of nurse executives believed that new graduate nurses (NGNs) were fully prepared to practice safely and effectively. NGNs agreed with nurse executives that they lack confidence and adequate skills for up to a year after graduation. The perceptions of nurse executives and NGNs seem to be borne out by NGN turnover rates of roughly 30% in the first year of practice and as much as 57% in the second year.

Preceptor-based orientation programs are one way to ease the transition from education to practice. Research shows that a six- to 12-week precepted orientation period can help new nurses gain skill, confidence, and familiarity with protocols and procedures. Nurse residency programs are even longer, ranging from six months to a year, and can significantly boost the retention of new nurses. Expanding the education pipeline to reduce nursing shortages will only be effective if we can make new nurses feel at home—and want to stay—in their chosen profession.

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In a free market, labor supply generally keeps up with job market demand over time, as higher wages and the promise of greater job security attract people to an in-demand profession. So why is this not the case with nursing, if we are indeed plagued with perennial labor shortages?

First of all, let’s remember that predictions about the nursing labor market are not necessarily destined to become fact. These forecasts are tools that industry leaders use to guide policy-making at the national, local, and organizational level. Many factors affect supply and demand within the nursing labor force, and these fluctuate constantly.

Economists consider the nursing job market to be countercyclical in respect to the overall economy. This means employment goes up during recessions, rather than down. Why? During economic downturns, the demand for healthcare does not decline, and hospitals must remain staffed. Nurses who left the workforce during more prosperous times are easily able to move into existing job openings during lean times, to help provide for their families. Of course, this relates closely to the demographics of the nursing workforce: over 70 percent of nurses are married women. They may put a career on hold or move to part-time employment several times in their lives, as family, children, and other interests take precedence over work. All of this makes the nursing workforce relatively volatile. There are about 2.7 million registered nurses working in the U.S., according to the Bureau of Labor Statistics, and nearly another 500,000 who hold a license but are not currently working in the field, according to a 2010 government report.

Unfortunately, job satisfaction plays a heavy role in a nurses’ decision to leave the workforce or cut back on hours. A survey from 2013 found that 35 percent of respondents said they “often feel like resigning” while another 33 percent said if they had a choice, they “would not be working in their current job a year from now.” Over half said they felt their jobs had adversely affected their health—and this appears to be backed up by an NPR news investigation that cited over 35,000 musculoskeletal injuries per year among nurses. Turnover is especially high among young nurses: nearly 18 percent of newly licensed RNs leave their first nursing job within the first year, and about 34 percent leave within two years, according to a study in Policy, Politics & Nursing Practice. It seems clear that issues with retention have a significant impact on the nursing labor supply.

Our ability to educate more nurses has consistently been a roadblock in alleviating shortages. As discussed earlier, nursing schools lack

FACTORS AFFECTING SUPPLY AND DEMAND

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sufficient faculty to increase student enrollment. But geography also comes into play. Some regions simply need more nurses, due to population density and demographics. Rural areas may have a disproportionately difficult time attracting nurses, particularly in certain specialties. Policy interventions like loan forgiveness programs are an attempt to correct nursing shortages among these and other underserved populations. These regional disparities may actually be making the nursing shortage appear worse than it really is—in fact, a report by the U.S. Health Resources Services Division predicted only 16 states would see shortages by 2025, due to a distributional imbalance.

While factors like educational capacity, nurse demographics, geographic distribution, overall job satisfaction within the industry, and a booming economy may arguably be working to suppress the number of nurses in the workforce currently, the demand for healthcare is generally on the rise. The Affordable Care Act has expanded access to care, the population as a whole is aging, and chronic conditions are becoming more common.

Despite all this, an optimistic analysis in Nursing Economics found that the current supply of nurses is probably well balanced with overall job market demand, although there will likely be regional shortages. The author concluded this way:

A small shortage of RNs could quickly be remedied by wage increases, which would draw more licensed RNs to work. Nurse leaders should track their local labor market and think about how they can creatively utilize the nursing resources available to them, while advocating that nursing graduations are maintained so the retiring Baby Boomer cohort will be adequately replaced.

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American Sentinel University delivers accredited online degree programs in nursing (BSN, MSN, and DNP) and healthcare management (MBA Healthcare, M.S. Information Systems Management, and M.S. Business Intelligence and Analytics). Its affordable, flexible bachelor’s and master’s nursing degree programs are accredited by the Commission for the Collegiate Nursing Education (CCNE), of One Dupont Circle, NW Suite 530, Washington, D.C., 20036. The DNP program is accredited by the Accreditation Commission for Education in Nursing (ACEN) of 3343 Peachtree Road NE, Suite 850, Atlanta, Ga., 30326. The University is accredited by the Distance Education Accrediting Commission, DEAC, 1101 17th Street NW, Suite 808, Washington, D.C. 20036, (202) 234-5100, www.deac.org.

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