For decades, the shortage of nurses has been a source of anxiety for both patients and healthcare employers. With multiple contributing factors including large numbers of nurses reaching retirement, a dearth of faculty to train new nurses, and the accelerating healthcare needs of the aging baby-boom generation, the nursing shortage has stubbornly persisted.
Estimates of the magnitude of the long-term nursing shortage problem range from the journal Health Affairs' projection of 260,000 vacant nursing positions by 2025, to the Health Resources and Services Administration's forecast of a staggering one million vacancies by 2020. In March, President Barack Obama called the shortage of RNs alarming. In response, funds have been allocated to boost nursing education as part of the American Recovery and Reinvestment Act.
So how can it be that in 2009, new grads of nursing schools aren't all writing their own ticket to a first job? That nursing vacancy rates have plunged at many healthcare employers? That some hospitals have actually laid off fully credentialed and experienced nurses?
These abrupt changes in the nursing labor market are due to a perfect storm of employment clouds, fanned by the ill winds of the 2008-2009 recession.
"The lockdown on hiring came as the economy fell apart," says Patricia Chute, dean of the School of Health and Natural Sciences at Mercy College in Dobbs Ferry, N.Y. "It's been exacerbated by the fact that no one knows what will happen with healthcare reform."
Let's take a look at why the nursing shortage has abated this year, the long-term outlook for nursing staffing and how some healthcare employers continue to build their prospects for adequate nursing staff in these anomalous times and beyond.
Why the Current Glut of Nurses?
The first cause of the easing of the nursing shortage is simple: budget shortfalls largely caused by the economic recession. Some 53 percent of hospitals operated at a loss in the fourth quarter of 2008, according to a survey by the American Hospital Association. Hospitals that are losing money are much less likely to hire, and may even be forced to reduce their workforces.
"Because of budget constraints, we're in a predicament," Kathy Paskewitz, a nurse recruiter at Greater Baltimore Medical Center. "We have grown our own and hired student nurses. We have an excellent extern program where they work one-on-one with a preceptor. But we're grooming and growing only to find we can't hire everybody. In 2008 we hired 58 new graduates; in 2009 we hired 35."
"In Columbus, the major hospitals are pretty well saturated," says Samantha Zulliger, who expects to graduate from the Chamberlain College of Nursing with a bachelor's degree in March 2010. "For the last six months, it's been hard for graduates to find jobs."
At some hospitals, the change in the labor market has been a boon – at least for current nursing staffing needs. "Two years ago, our vacancy rate was 14 percent; currently it's less than 1 percent," says Paskewitz.
The tide of nurse retirements, long the bane of managers charged with maintaining adequate staffing, now sometimes flows in the other direction. Many senior nurses have postponed their retirement; others have returned to work fearing that their shrunken 401(k)s won't suffice.
However, in some areas of nursing, the long-term shortage hasn't taken a hiatus. "Because we're so specialized, we're looking for more experienced nurses," says Laura Gallagher, corporate clinical executive director at Progressive Healthcare Inc., a provider of long-term acute care.
Best Practices for Nursing Recruitment Going Forward
What can hospitals and other healthcare employers do to staff optimally for these volatile times while continuing to build recruitment sources for when the nursing shortage resumes?
The first step is to recognize the danger that complacency, bred of the short-term ample supply of nurses, could eventually exacerbate the long-term shortage.
A key step is to continue to build relationships with top nursing-school graduates, even if they can't be hired right now.
Zulliger, an ambitious student, earned a State Tested Nursing Assistant certification to work at Riverside Methodist Hospital in Columbus while she completes her BSN. She's interested in a career in the neonatal ICU, and she's already in touch with a local hospital about her prospects there. "The hiring manager said, ‘I may have open positions, but I also have seasoned nurses who may want to transfer to NICU from other hospital departments.' "
What more can nurse recruiters do or say? "When we identify stellar students, we keep them in mind," says Paskewitz. "We don't want to let our best go. So we have a recruitment pipeline with a waiting list that describes their areas of expertise."
Recruiters may also gain loyalty from recent graduates by helping them finding short-term alternatives to the care settings they ultimately aspire to. "Some graduates can temporarily go to long-term facilities," says Paskewitz. This alternative can provide new nurses with valuable experience because "there are more medical challenges at these facilities than there used to be."
The more healthcare employers work with nursing schools and other organizations, the better prepared they will be to deal with fluctuations in nurse supply and demand. "You need to be partnering up," says Chute. "It never helps to work in a vacuum."
Some employers with relatively healthy balance sheets are continuing to hire now, while talented nurses are easier to come by. "Some hospitals are trying to maintain a bit of excess capacity because at some point there will be an excess of baby boomers retiring," says Chute.
"We never turn away a fully qualified nurse applicant," says Gallagher of her company's long-term acute-care facilities. "They are still in shortage."
Will the nursing labor market really return to shortage? Most experts believe it's only a matter of time. "Right now we don't have positions, but there could be a boom in two or three years," says Paskewitz.