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Do we need nurses or not?

Posted Jan 27 2009 7:13pm
Thanks to Wellsphere for inviting me to be one of their featured health care bloggers! Check out the link, there's a lot of interesting stuff happening in the blogosphere, and this looks like a great collection of bloggers, from RNs to MDs, DOs, DMDs, DNPs, you name it.

To better "fit in" with the content on wellsphere I'm shifting the focus to more general issues involving the nursing profession and health care in general. I've gotten a lot of great feedback about my writing over the past couple of months, and my usual "slice of life" ramblings are still available on other blogs on an invite-only basis.

I've been getting a lot of emails lately from editors and content producers asking me to share their articles with my readers. Usually this sketches me out a little, sometimes I feel like I'm now a member of a target market that has a lot of attention focused on it. One of these articles, however, really spoke to me, like someone was reading my mind!

Jen Rotman, who says she's an editor of some kind, sent me a link to this article hosted on onlinenursingdegrees.com about recruitment and retention in nursing, the economic downturn, hiring freezes, all that stuff.

Have you had this experience also? As a new grad, I was surprised by how many facilities were in the middle of a "hiring freeze".

From the article:

Fresh and highly localized industry research is providing much more granular data on nursing staffing levels and needs across dimensions as targeted as a city. For example, the preliminary results from a December 2008 research survey in Houston, Texas (2) identified a targeted need for 5700 more nursing staff. Why? The addition of 3000 patient beds, of course, to the city’s healthcare facilities, compounding an already living and breathing nursing shortage. But it’s not as if 5700 nursing jobs are posted in Houston. MedHunters.com posts 97 open RN jobs right now in metro Houston and most of those are for Med/Surg RNs—oh, and candidates must be “able to write and speak effectively in English.”(3) That sinks the notion of plugging in a boatload of fresh Chinese nursing grads.(4)

…If new nursing grads was the real problem in the first place.


Well, I think it's reasonable to expect nurses to be able to speak and write effectively in english. The class I graduated with had two Chinese women in it. They had been speaking english for different amounts of times, but despite the fact that they said it was a struggle sometimes, they were both extremely articulate and didn't have any trouble communicating with -me-, at least.

In nursing forums across the web more than a few new nursing school grads have been expressing frustration since early Fall at what would seem to be a hiring shut-out. (5) Fewer hospitals, it would seem, are opening their units to inexperienced new RN graduates. These next-gen RNs are perplexed about the alleged nursing shortage, as well, particularly in an industry that drew them into schools with open and exuberant arms in the first place, an industry that claims it can’t get enough of new nursing grads. To quote one of these bamboozled grads, “What gives?”

Here’s one version of an answer: Apparently some hospitals and healthcare facilities have, instead of hiring new nursing grads, managed to inspire experienced nurses to stay on staff, work overtime, or they have otherwise leveraged/manipulated their human resources.(6)

That’s a lot of overtime. What about quality of care? What about the cost of paying experienced nurses for overtime? Let’s see, those 5700 needed RN jobs in Houston – subtract the 97 actually posted – let’s just say 5600 jobs, equals roughly 201,600 overtime hours per week (5600 nurses x 36 hours). Really, are experienced RNs working those apparently needed hours in patient care? Have you heard this excuse, too: would rather hire experienced nurses or retain staff versus spending the money to orient and train new grads. But don’t new grads also come with some much-needed high-tech savvy in a career circle heavy with older nurses with little tech know-how? And time spent orienting is an up-front investment. Can you say, “Mixed messages”?

In some circles, the word in healthcare is “hiring freeze.”

Quietly and without much ado more than a handful of hospitals and healthcare facilities across the country have gone on hiring freezes. The term “hiring freeze” is characteristic of economic direness. It says, “We are not as solvent as you think. We need to shut the gates here and now.” Even one of the most “recession-proof” nursing niches, travel nursing, has been recently affected. In mid-summer 2008 a few news headlines reported that travel nursing jobs were unaffected by the stock market storm. Now it’s clear that the number of jobs open to travelers has also dropped.


To be fair, the only facility that actually told me they were in a "hiring freeze" when I was searching for my first job was a state mental hospital. The community hospitals, however, were all extremely competitive, maybe because that's the environment where new grads can get the most intensive clinical training after graduation. Even without a hiring freeze, being told that there were 15 openings for new grads in one facility and over 150 people applying has to make you scratch your head sometimes.

More on travelers:

Right now 23 states belong to the Nurse Licensure Compact (NLC) program – if you hold a license in one then you are as good as licensed in all of them. It’s a sensible situation and allows travelers to have great mobility among the 23. But if you’re a nurse and eager to take a travel assignment in a state outside the NLC—for example, California, Florida, or New York (ironically, the bi-coastal states with the most travel needs)—then you need to apply directly to that particular state’s board of nursing for licensure. Each state’s licensure costs anywhere between $90 and $250 depending and takes at a bare minimum 2 weeks to secure. Forget about online applications or expedited anything—here is the real nitty-gritty of bureaucratic red-tape; “think” DMV. If there’s a paperwork snafu with a new license expect the delays involved in the back-and-forth of snail-mail to gum up the process, as well. In fact, you’d never know there was any urgency whatsoever to get qualified nurses on the job based on the machinations of the state nursing boards.


I got introduced to the issues surrounding the license compact while I was in school, and it sounds like a complex issue! One of the problems someone mentioned to me was that the AMA is waiting for state boards of nursing to re-open their practice acts so they can swoop in and lobby for reductions in the scope of NP's practice. The compact seems like a good idea to me, though. At the last NSNA convention one of the speakers was talking about how the license compact allows inter-state transmission of disciplinary records regarding individual licenses, and backed up the story with some compelling case studies that indicated that this is a good thing.

Personally, I don't reside in a compact state, but our state -did- recently re-open our practice act to define the role of clinical preceptorship in RN programs, and NPs still practice happily here, so maybe there's some wiggle room. I'm looking forward to getting involved in our state's chapter of the ANA, I did some ad hoc tasks for them back when I was a student. Maybe their conventions aren't as fun as the NSNA conventions (so I've been told), but that sort of thing's always appealed to me anyway.

Anyway, the article ends with a salient question. "Have we bailed out the wrong industry?". I'm no economist, but it does seems as though the priorities are skewed.

I used to think that the main reason there was a nursing shortage was the shortage of nursing faculty (nursingphd.org) in schools. This made sense while I was a student, because I noticed there were hundreds of qualified students competing for less than a hundred slots.

Now, I'm not so sure. Isn't the problem actually that the businesses that employ nurses tend to stretch their labor as thinly as they can get away with? I hypothesized a couple of weeks ago that if the number of nurses available to work suddenly doubled, patient ratios wouldn't improve at all, more facilities would be opened instead.

Tell me what you think.
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