Nursing: Where the Jobs Are

    • March 20, 2012

It is, by now, an accepted fact that nursing is one of fastest growing professions in the United States, a trend that has held steady during the worst recession in the nation’s recent history. In January 2012, the Bureau of Labor Statistics (BLS) reported that the health care sector, in general, added a robust 312,500 jobs in 2011, but the forecast for nurses varies—quite broadly—depending on region, type of health care facility, and desired working conditions, while several important questions remain unanswered for job seekers. Is there still a nursing shortage? Will there ever be enough nursing professors and student slots? And where should new nurses search?

Behind the Numbers

As optimistic as BLS statistics may be, “there’s no database that can easily tell us exactly what the numbers mean in terms of a comprehensive, national jobs picture for nurses,” explains Christine Kovner, PhD, RN, FAAN, a professor at the New York University School of Nursing and co-principal investigator of the RN Work Project, which is funded by the Robert Wood Johnson Foundation.

An expert not only on where nurses work, but the impact of working conditions on nurses’ careers, Kovner adds, “BLS data comes from surveys of employers, but there are areas where we do not have good data. We do not really know what’s going on in home health care hiring in the United States, for example, and it’s difficult to get good numbers on ambulatory care.”

The BLS reports a 26 percent increase in registered nursing positions nationwide between 2010 and 2020—an increase of more than 700,000 jobs—but an American Nurses Association (ANA) analysis of the statistics found that, “BLS data refer to companies reporting registered nurses employed to perform registered nurse duties. The statistics do not include registered nurses who are self-employed or business owners.”

Flaws in the data aside, the BLS report on nursing earnings and employment clearly indicate the sectors that employ the largest number of registered nurses (RNs). Hospitals are at the top of the list at 57.3 percent and physician offices are at 8.7 percent. Another 14 percent work in home health care, nursing care facilities, or outpatient care according to the most current statistics. The remaining jobs are divided among a variety of government and academic organizations and specialty health care groups.

Licensed practical nurses (LPNs) are most likely to find employment opportunities in nursing care facilities. In fact, LPNs are expected to account for 30 percent of the job growth in the nursing care facility industry that will occur between 2008 and 2018, according to the BLS report, Nursing Jobs in Nursing Homes.

Flexibility Key to Finding Work

While hospitals hire more RNs than any other employer, new graduates must consider that even that fact “varies widely by region,” says Joanne Spetz, PhD, a professor at the Philip R. Lee Institute for Health Policy Studies at the University of California in San Francisco. Spetz and her team found in a 2010 survey, “that California will have just over 5,000 positions for registered nurses each year in 2011 and 2012. But California institutions graduate just over 10,000 nursing graduates per year, so they are likely to have a very difficult time finding jobs,” she says.

California statistics reflect a nationwide trend. Nursing opportunities vary greatly by region. “San Francisco had the fewest registered nurse positions open,” Spetz says, while San Bernadino and Riverside County institutions reported difficulty recruiting nurses. Urban areas were near saturation, while health care organizations in rural areas struggled to find nurses to hire.

“We’re certainly not at 100 percent employment for new nursing graduates, as you might expect, given years of shortage reports,” says Carol Brewer, PhD, RN, FAAN, a professor at the University of Buffalo School of Nursing and co-principal investigator of the RN Work Project.

In New York state, “the Health Care Association of New York (HANYS) hospital survey showed that from 2008 to 2009, the turnover rate for registered nurses dropped from 10.1 percent to 7.1 percent and the vacancy rate dropped from 7.1 percent to 3.6 percent. Yet 54 percent of hospitals reported that they were still having a hard time finding experienced nurses. At the same time the number of nurses licensed in the state dropped, while the number of new graduates flattened in 2010. The recession has clearly had an impact,” Brewer says.

“The jobs are out there, but it’s complicated,” Brewer continues. “First, there’s much less of a shortage now. We’re seeing higher rates of graduation for nurses under 30 and older nurses staying in their jobs longer.”

“Labor markets are also very regional,” Brewer says, “Yet, our research for the RN Work Project found that most nurses tend to stay close to home. They seek jobs within 40 miles of where they went to high school. To really find the best opportunities, they might have to leave their hometown area.”

In addition, Brewer notes, nursing culture itself plays a role in making jobs more difficult to find. “New graduates tend to look first at hospital jobs because new nurses want to get at least a year under their belt there. But of course the best hospitals want nurses with experience, as indicated in the HANYS survey. That may mean a nurse may have to start out on night shifts, working weekends, in a nursing home, or other setting.”

“Even on the academic side, you must have some clinical experience so nurses graduating from school should keep that in mind. My advice to new graduates is to get experience in any way that you can. There are jobs out there, just keep looking,” she says.

Problems in the Pipeline

Women and men considering nursing careers may also be hampered by the limited number of slots in the nation’s nursing schools. The American Association of Colleges of Nursing (AACN) found that many who choose nursing careers are still unable to pursue baccalaureate degrees because of the ongoing shortage of space in nursing schools.

AACN data shows that more than 500 baccalaureate nursing programs turned away 51,082 qualified applicants in 2011 due to a shortage of clinical placement sites, faculty, and funding. These numbers are likely to climb as cash-strapped states continue cuts to state college programs focused on the sciences and health care professions.

Limiting the number of educational opportunities for nurses will also make it more difficult for health care organizations, employers, and educators to work together to increase the number of nurses with baccalaureate degrees by 2020, a key recommendation of the RWJF-funded Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health.

Shortage or Imbalance?

“I’m also arguing that we may not have much of a nursing shortage right now, in the short term,” Brewer says. “We don’t have the metrics right now to define where we have shortages and where we don’t.”

“That may be true,” says Peter Buerhaus, PhD, RN, professor of nursing at Vanderbilt University and chair of the National Health Care Workforce Commission. “But long term projections for job growth remain strong, particularly for registered nurses. Because of the short term effects of the great recession, hospitals have filled existing vacancies with older nurses staying in the profession longer. Those jobs normally would have been filled with new graduates. As a result, some new nursing graduates are experiencing a significant delay in finding employment, particularly in the area of nursing they may be most eager to practice. As the economy improves, many RNs who have reentered the nursing workforce during the economic downturn will exit from the workforce, which will open up positions for new graduates.

The Robert Wood Johnson Foundation’s RN Work Project is a 10-year longitudinal study of newly licensed registered nurses that began in 2006. It is designed to learn more about nurses’ career patterns.