How Education and Retention Affect Ongoing Nursing Shortage

The nursing profession continues to grow and will continue to experience a shortage well into the next decade. Yes, it’s true there are new nurse grads who cannot find jobs. However, there are many factors that can be the reason this. Not the least of which is competition and how well those applicants measure up on paper and in interviews and employer testing. Other issues include nurses wanting to work and live in large popular cities where there is an abundance of nurses vs. working in small communities and even rural areas where the demand exists.

In addition to the geographic issues, if hospitals and other health care employers are going to pay top dollar salaries, they’re going to expect top candidates. The main priority for employers is most often BSN-prepared nurses. Students from the few remaining diploma nursing programs and those from Associate Nursing programs who cannot find a job would be well advised to continue with their education right away and obtain a BSN. If their sites are on a more advance nursing practice, they would be well-advised to stay in school and go for it now.

The Baby Boomer Effect

According to the American Nurses Association, the average age of nurses has increased steadily and is reported to be 50 as of 2014. In fact, more than 53% of nurses are over the age of 50, as compared to the 1980’s when 54% of nurses were under 40 years of age. One of the reasons for this is that many Baby Boomer nurses who were eyeing retirement a decade ago have had to forgo those plans because of significant financial losses in the Recession of 2008. Almost ten years later, they still need to work because they simply cannot afford to retire. At some point, it is expected that there will be a tsunami of older nurses leaving the profession and a critical need will ensue. That hasn’t yet materialized, but it’s always on the mind of employers.

According to the Bureau of Labor Statistics Occupational Outlook Handbook, there will be an increasing need for RNs at least through 2024. Here are a few interesting stats from the BLS:

  • As of 2014, there were 2,751,000 nurses on active duty.
  • By 2024, an additional 439,300 RNs are expected to be needed; an increase of 16%.
  • Advance Practice RNs (APRNs) such as Nurse Practitioners, Nurse Midwifes and Nurse Anesthetists, totaled 170,400 as of 2014. This number is expected to grow by 31% (53,400) by 2024. This growth also reflects a growing need for NPs to fill a need due to a growing shortage of Primary Care Physicians.

Meeting this need is another story. According to the American Association of Colleges of Nursing (AACN), there was only a 3.6% increase in enrollment in BSN programs in 2016. This number doesn’t come close to meeting the increasing need for nurses, APRNs and nurse educators. In addition, the shortage of nurse educators continues to affect enrollment. AACN reports that U.S. nursing schools turned away 64,067 qualified applicants from baccalaureate and graduate nursing programs in 2016. This is due to a variety of factors including insufficient number of faculty, clinical sites, classroom space, and clinical preceptors, as well as budget constraints.

The Job Itself

Nursing is a stressful and very demanding occupation. It entails huge responsibilities and it’s truly not for everyone. Those new grads who have had some experience in, and good exposure to the health care profession, are going to move up the ladder of preferred applicants. The more relevant the experience, the better.

Nursing pays well, although most will argue it’s not enough, but those who are just looking for a career with great salaries and job security will often be disappointed and disillusioned by the expectations of the actual job. The median salary for RNs in 2016 was $68,450 which equates to $32.91 per hour. The median salary for APRNs in 2016 was reported to be $107,460 or $51.67 per hour. APRNs require a minimum of an MSN. (The median is a statistical point at which half of the nurses earn more than this and half less.)

Nursing is a challenging career both emotionally as well as physically. Health care is 24/7 for 365 days a year. Sick people don’t postpone their care while nurses take vacations, spend holidays with their families, and are off every 2nd or 3rd weekend. Nurses are in demand, and expected to fill the growing needs of the community.

This can be very stressful when home life and social life demands conflict with a work schedule, in particular when spouses, families and friends don’t understand. Shifts are typically 12 hours in a hospital, but can run over when the unexpected happens. Nursing is not your typical 9-5 Monday through Friday job.

New grads will always get the worst shifts, work the most holidays and feel put upon. It’s the nature of the beast. With some seniority, these things will change. But the fact remains that shifts need to be staffed adequately and patient’s given the best possible quality care.

Nurses need to be physically strong, and always mindful of body mechanics and other risk factors in the job. They need to be passionate about nursing and have compassion for their patients. Team players are sought after. Nurses need to be able to sympathize as well as emphasize with their patients, and know the difference. Patients are not at their best when they are ill or suffering. Nurses also must advocate for their patients and be willing to go the extra mile to make sure the patient gets the best quality care; even if the patient is downright nasty.

New nurse grads who have a BSN bring a preparation to the job that has been proven many times over to provide a lower mortality rate for patients. Outcomes are crucial to hospital reimbursement and financial survival as well as attracting top medical staff and patients. While some will argue the BSN program doesn’t prepare nurses adequately for clinical care tasks such as inserting Foley catheters and starting IVs, the BSN nurses have been versed more in critical thinking skills, leadership and decision making on the fly which are critical to patient-centered care and outcomes.

Nursing Turnover

Another factor that weighs on employer’s minds is retention of staff. For example, the RN Work Project has reported 17.5% (1 in 5 nurses) of new nurses will leave their first job in the first year and 33.5% (1 in 3 nurses) will leave in 2 years. These are staggering numbers and the RN Work Project continues to study them. Some reasons they have discovered include leaving to pursue advanced education including becoming physicians to burnout or a need to leave the profession all together because it’s not what they expected.

It’s estimated that it can cost between $10K and $88K to replace just one nurse depending on the amount of on-boarding costs, training and supervision provided. An average 600-bed acute care hospital can spend an annual average $5.9 to $6.4million just on replacing nurses. With these exorbitant costs in mind, despite the needs for more staff, employers are being forced to be very selective in the staff they hire. New grad nurses who are naive about the nursing profession and the healthcare industry in general can be an added risk factor for employers.

Hiring a warm body is not cost effective and with the uncertainties facing the health care industry including rising costs and health insurance hanging in the wind, employers don’t have the luxury of not trying to find the finest applicants. They must search for nurses who are well educated and prepared and will be dedicated and want to stay. Retention becomes a necessity that frankly hasn’t been at the forefront but is rapidly rising in importance. Benefits, work conditions, education reimbursement, flexibility and other factors are once again becoming important in making employment attractive to quality nurses.

The responsibility for successful outcomes relies heavily on the quality nursing care in the hospital as well as how well the nurses prepare the patients to manage their conditions and prevent complications with effective patient education in preparation for discharge. Short staffing and time constraints wreak havoc on the success of this. Advocating for follow up care with post-acute options such as skilled home health care can be advantageous especially when the continuum of care is understood and a working relationship is present.

New grads who can factor all this information into their interviewing skills and shine for the employer, will improve their chances of being hired and having success throughout their career. Nursing is the joining of art and science, but it is also ruled by a vicious cycle of economics. In turn, the economics are tied to higher reimbursement rates for successful patient outcomes. Successful outcomes are evidenced by low readmission rates. Employers have many needs in selecting the best candidates. Understanding this helps applicants present a better resume and prepare for an effective interview.

The need for nurses is always going to grow. The population is steadily aging and their need for health care increases along with their age. Nurses continue to assume more responsibilities for patient care and education as well as quality outcomes. This is an exciting time to be a nurse. Become the best nurse you can and continue to thirst for and share knowledge.