By Megan M. Krischke, contributor
Jan. 15, 2010 - It wasn't long ago that the nursing shortage was making headlines, both staff and temporary nurses were in high demand and even new graduate nurses were being offered signing bonuses as an enticement to employment. The recession, however, has softened the shortage as many nurses have delayed retirement, returned to the workforce or increased the hours they are available to work. Health care facilities have also had to tighten their belts. These changes have contributed to fewer job opportunities and altered career paths for nurses seeking new employment in recent months.
Kathleen Dracup, RN, DNSc, dean of the UCSF School of Nursing, expects economic and legislative changes to open up new career opportunities for nurses.
But employers and jobseekers shouldn't be fooled, according to Kathleen Dracup, RN, DNSc. "This is just a small blip in what will soon be a tsunami of shortage."
As the job market moves forward into 2010, nursing leaders predict that a number of new career opportunities will be made available to nurses, due to changes in the economy, health care reform mandates and technology innovations.
Dracup, who serves as dean of the University of California San Francisco's School of Nursing, currently sees many new graduates having a difficult time finding their first position as employers are looking for experienced nurses. And, while in the early 2000s she served on a floor where 60 percent of the nurses were travelers, Dracup says that scenario has changed, but not for long. "Travel nursing will flourish again."
In spite of the depressed economy, the health sector has continued to grow and was one of the few industries that added jobs during 2009, according to the U.S. Bureau of Labor Statistics (BLS). In December 2009, the BLS predicted that we will see approximately 580,000 RN positions added to the work force between 2008 and 2018--more than any other occupation.
Dracup notes that this year's health reform legislation will dramatically increase the patient population and, thus, the need for nurses.
"Those currently not covered by health insurance are putting off preventive health screenings or coming to the ER for their care," she stated. "With the health reform bill, an estimated 30 million people who aren't now covered will be covered. People who have a pre-existing condition will be covered again and people will have options and incentives to purchase insurance."
While caring for patients with chronic illnesses is already an area of concern, Ellen-Marie Whelan, NP, Ph.D., associate director of health policy at the Center for American Progress, sees this influx of 30 million patients will press the issue on how our nation will address the health needs of the chronically ill. And because nurses are in a unique position to address these needs, their job opportunities may change to accommodate this growing patient population.
"In this new era of health care, we have to begin caring for the chronically ill outside of the hospital, where they should be treated in the first place. Seventy-five to 80 percent of the nation's health care costs go toward managing patients with chronic illnesses; we can reduce those costs--while improving patient outcomes--by moving care to outpatient settings. Nurses are especially well-equipped to care for the chronically ill because they are good at teaching patients how to manage their own care, and nurses can see the big picture when treating patients with multiple diseases. While much of the medical community has become highly specialized, nurses are able to communicate and coordinate care across specialties."
In addition to traditional bedside nursing and expanded opportunities in outpatient settings, RNs may find future roles as specialized translators. E. Mary Johnson, RN, BSN, NE-BC, career coach for nurses at Cleveland Clinic in Ohio, highlights the following specialties as key in the future of nursing:
- Clinical Informatics. As medical care and records are becoming increasingly technology based, nurses will need to play a central role in helping software developers and other information technology specialists understand how care is delivered, so that technology will serve the needs of health care providers and patients.
- Genetic Medicine. "We are greatly increasing our understanding of how genetics impact patient risk factors for disease, and then using that information to tailor the preventive care individuals receive," remarked Johnson. "Nurses are needed to explain to patients why it is important to understand more about themselves and to teach patients what steps are necessary for their long-term health."
- Health Care Navigator. "If you have a mass in your breast, next steps matter, and nurses will become an integral part of helping patients learn their treatment options and coordinating care among practitioners," said Johnson.
Other shifts in health care delivery have caused a growing demand for nurse practitioners (NPs) across the country.
"A gap is being created as many physicians are moving away from primary care and family practice for more lucrative specialties," Dracup remarked. "In many cases, it is NPs who will fill that gap in patient care.
"Additionally, legislation restricting the number of hours medical residents can work in a week has upped the demand for NPs, especially acute care NPs. Since this legislation passed we've gone from a relatively small to a very large number of NPs who work in hospitals, especially managing patients in intensive care units."
As far as the work environment is concerned, nurses may notice hospitals placing an increasing amount of value on experience.
"A lot of hospitals used to say a nurse is a nurse, but many are recognizing how complicated patient care has become and the important wisdom that nurses with a lot of experience bring to the job. Before, it was all about recruitment--signing bonuses and rewards for bringing in new nurses, but nothing directed at retention. We will likely see that change as we move into another shortage," Dracup explained.
Nurses' career opportunities may also be influenced by hospitals' increased emphasis on patient safety. As Medicare is no longer paying for expenses related to avoidable complications, hospitals have embraced patient safety on a whole new level. Some are asking nurses to play bigger roles in evaluating patients who have a higher risk of certain injuries or complications, or to serve as case managers.
"Ultimately, the only things that are going to matter in health care are patient satisfaction, patient safety and outcomes. Because nurses are with patients more than any other health care provider, we need more nurses to take leadership in addressing these issues," Johnson concluded.
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