While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
Kimberly Steinriede is one of the lucky ones. A senior at the University of Cincinnati in the College of Nursing, Steinriede hasn’t even graduated but she already has a job offer from her top-choice employer at nearby Good Samaritan Hospital. But many of her peers in nursing school—including her best friend—find themselves in the same boat as other seniors graduating this year: struggling to land a first-time job during an economic downturn. “Graduating right now is not the time, even for nursing,” Steinriede said.
The changing market conditions have Steinriede and others in the health care field wondering what happened to the nationwide shortage that until recently meant nurses were inundated with job offers that often included perks like signing bonuses and covered moving expenses.
Susan B. Hassmiller, Ph.D., R.N., F.A.A.N., the senior adviser for nursing at the Robert Wood Johnson Foundation (RWJF), has an answer at the ready: The recession may have given some hospitals a temporary reprieve from chronic nursing shortages, but it isn’t curing the longer-term problem—and it may even be making it worse. “Ironically, the current economic crisis might be provoking a short-term set of changes that mask the nursing shortage temporarily, yet exacerbate it a decade from now,” Hassmiller said.
Because of the recession, state nursing schools are facing budget cuts, which renders them less able to hire enough faculty members to train enough new nurses to meet projected needs, Hassmiller said. At the same time, health care philanthropies are crunched for cash and, as a result, are less able to give nursing students and universities the same levels of financial support that they had provided in recent years. As a result, fewer students may now be preparing to become nurses—the opposite of what needs to happen to fill the projected need for as many as half a million nurses by 2025.
On top of that, news reports that some nurses are having trouble finding work is creating the false impression that the nationwide nursing shortage is over, which may prompt students to think twice about careers in nursing and generate complacency about what experts say is a looming crisis.
“The risk is that the awareness we’ve achieved nationally with regard to the need for nurses could be somewhat undone by the concern about the availability of jobs,” said Susan Bakewell-Sachs, R.N., Ph.D., P.N.P-B.C., dean of the school of nursing at the College of New Jersey. “If our applications drop or if we have a reduced capacity to educate nurses, that could contribute to significant decreases in our ability to meet the demands for health and health care.”
That isn’t to say nurses aren’t having a harder time finding work these days. “Many nurses graduating today are surprised that employers are not lining up to hire them and that employment incentives, including hiring bonuses, are no longer on the table,” said Fay Raines, Ph.D., R.N., president of the American Association of Colleges of Nursing.
The job market is more competitive in some regions because of temporary changes in the supply and demand for nurses, she said. On the supply side, working nurses are picking up more hours or putting off retirement to compensate for lost income from laid-off spouses or shrinking retirement accounts. Some retired nurses are returning to work. Demand for nurses, meanwhile, has eased as people have lost their jobs—and their health insurance—and opted out of elective procedures. Trimmed budgets have forced some hospitals to freeze new hires, cut staff or, in some cases, shut down entirely.
As a result, some areas—especially in states like Arizona, California, New Jersey, New York and Ohio—are experiencing a temporary stabilization of the nursing workforce that has made it harder for nurses to find jobs, Raines said. To find those jobs, she advises nurses to broaden their job search to include openings across city, county or even across state lines. Texas and Florida are among the states that continue to have high nursing needs, she notes, and Rhode Island faces a shortfall of 1,800 nurses next year, according to a recent news report.
Raines also encourages nursing graduates to look beyond academic health care centers—a popular target for many new nurses—and pursue positions in alternate settings with higher vacancy rates, such as community health, ambulatory care, nursing homes, schools and businesses. Now is also a good time for nurses to consider pursuing advanced degrees, she said. Nurse educators will be in especially high demand as states scramble to train the next generation of nurses in time to care for aging baby-boomers.
“It’s not a buyer’s market any more,” said Brenda L. Cleary, Ph.D., R.N., F.A.A.N., director of the Center to Champion Nursing in America, a joint initiative of the Robert Wood Johnson Foundation (RWJF), AARP and the AARP Foundation. But the shortage, she was careful to note, still looms.
The average age of registered nurses was 47 in 2004, according to the U.S. Department of Health and Human Services. And while many may put off retirement for a few years for financial reasons, they will not be able to do so indefinitely. Meanwhile, fewer than 10 percent of registered nurses are under age 30, which means there will not be enough younger nurses to fill the shoes of their more senior colleagues when they do retire.
At the same time, the general population is aging along with the nursing workforce, which will place even greater demands on the health care system. And as people lose their jobs—and their health insurance—during the economic downturn, they will likely put off preventive care which means they will arrive at the nation’s emergency rooms, hospitals and health centers in graver condition and greater need of care.
So while the recession may temporarily ease nursing shortages in some areas, “the reality is that this is going to happen,” Bakewell-Sachs warned.
For nurses, there’s a silver lining in the clouds of the looming crisis: the long-term job outlook for nurses remains sunny. Nursing, in fact, is the nation’s fastest-growing profession, according to the U.S. Department of Labor—and, as Bakewell-Sachs reminds her students, “remains an incredible career opportunity.”
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