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Retirees and New Graduate Nurses: The Wild Cards Impacting the Nursing Shortage

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By Debra Wood, RN, contributor

CNO at Texas Health Dallas
Cole Edmonson, MS, RN, FACHE, NEA-BC, said the nursing shortage is still very real but has been somewhat masked due to the economy.

While America’s recession raged, many nurses held off retiring, picked up more hours or returned to the workforce, putting the looming nursing shortage on a temporary hold.  But as the economy improves, the population continues to age and more citizens join the ranks of the insured, the country will again face a serious shortage of professional caregivers.

“The nursing shortage remains very real across the nation,” said Cole Edmonson, MS, RN, FACHE, NEA-BC, chief nursing officer at Texas Health Presbyterian Hospital Dallas. “The same fears exist among nurses and nurse leaders regarding the loss of the mature, experienced nurses due to retirement, as the economy has only delayed it and not prevented it.”

Andrea Higham
Andrea Higham anticipates the nursing shortage during the next five years will be worse than first anticipated.

Andrea Higham, director of corporate equity at Johnson & Johnson and director of its Campaign for Nursing’s Future, said, “There is still a shortage and going out three, four, five years, it is going to be more significant than we anticipated.”

The U.S. Bureau of Labor Statistics’ Occupational Outlook Handbook, 2010-11 Edition, estimates that by 2018 the country will need nurses to fill 581,500 new positions and will have to replace the hundreds of thousands of positions that will open as experienced nurses leave the profession.

Patricia G. Morton
Patricia G. Morton, Ph.D., RN, CRNP, FAAN, said that the country will need more nurses to fill vacancies and new positions to care for its aging population.

“The nursing shortage is in no way solved, but there may have been a temporary easing,” said Patricia G. Morton, Ph.D., RN, CRNP, FAAN, associate dean for student and academic affairs at the University of Maryland School of Nursing in Baltimore, citing a current 8.1 percent vacancy rate.

“When the recession ceases, people will return to part-time work, drop out of the workforce or retire, but now they are afraid to retire,” Morton added. Also, she said, hospitals have been reluctant to fill positions, with the decline in occupancy rates as people lost their jobs and with it their health insurance.

“When the economy took a dive in 2008, that affected people’s income, and they sought health care less frequently,” said Susan Penque, Ph.D., RN, senior vice president of patient care services at South Nassau Communities Hospital in Oceanside, N.Y. “That helped the shortage diminish in the last two years.”

Kerri Scanlon, RN, MSN, ANP, chief nursing officer at Long Island Jewish Medical Center in New Hyde Park, N.Y., said her facility has not experienced a shortage, in large part due to neighboring hospitals closing.

Retirements at time of increased need

Although economists say the recession is over and consumer confidence is improving, nurses are hanging onto their jobs.

“We really have not seen a demonstrated effect yet on the employment of nurses in relation to the beginning recovery of the economy,” Edmonson said.

But those retirements will come. And when they do, Marvel Williamson, Ph.D., RN, CNE, ANEF, dean of the Kramer School of Nursing at Oklahoma City University, said she thinks the shortage will be worse than it was pre-recession, especially as additional people gain health insurance due to passage of the Affordable Care Act.

Susan Penque, Ph.D, RN
Susan Penque, Ph.D, RN, reported a shortage of experienced critical care nurses and said the profession must get creative to prepare graduates for these areas.

“Nurses are being used in so many ways,” Williamson added. “A little more than half of the RNs work in hospitals, but the rest are doing other things.”

Penque reported an increasing need for home care and public health nurses, which requires experience.

The health reform act also will increase the demand for advanced practice nurses, which could pull nurses from the bedside to pursue delivery of primary care, climbing the career ladder, Scanlon said.

Nurses older than 50 years of age comprised 44.7 percent of the more than 3 million U.S. registered nurse population in 2008, according to the Health Resources and Services Administration’s 2008 National Sample Survey of Registered Nurses, published in September 2010. Nurses age 60 years or older make up 15.5 percent of the population. 

Randy Caine
Randy Caine, EdD, APRN, ACNS-BC, ANP-BC, GNP, said interest in nursing is robust, but faculty shortages cause less experienced nurses to teach a growing number of incoming students.

“Since nursing is physically hard work, [such as doing] a 12-hour shift on your feet, it’s difficult at age 65,” Morton said. “So we will continue to have problems with retirement and vacancies. In addition, there’s a projection of new positions being created, because as we keep people alive longer, you need nurses to care for people.”

Nurse faculty members also are retiring, creating a bottleneck for educating qualified candidates interested in nursing careers.

“The nurse faculty shortage is just as critical,” said Randy Caine, EdD, APRN, ACNS-BC, ANP-BC, GNP, dean of Hawaii Pacific University’s College of Nursing and Health Sciences in Honolulu. “It’s not enough to produce more RNs, we need to prepare more nurses in advanced practice, and doctorally-prepared nurses who can educate the next generation of nurses.”

Kerri Scanlon
Kerri Scanlon, RN, MSN, ANP, said that nurses play an integral part in health care delivery and more will be needed in the future.

Williamson said universities and the profession must “rethink how we can change education to increase enrollment.” 

Scanlon carried that thought further, saying hospitals need to look at care delivery to ensure nurses are practicing efficiently and use support staff and technology to the fullest to allow nurses to spend time at the bedside.

Current challenges

With experienced nurses temporarily staying in the workforce, new graduates in some parts of the country are having more difficulty finding positions. Morton said all University of Maryland nursing graduates received jobs, although not everyone got their first choice.

Likewise, Williamson reported that—for the ninth year in a row—all nursing graduates from Oklahoma City University secured jobs within one month.

Edmonson said that many new graduates are seeking first time employment in sub-acute or long-term health care settings or delaying first-time employment, awaiting intern/resident positions in hospitals to come available. But once those jobs open up, fewer experienced nurses will be available to bring the novice nurses along.

“We really need the older nurses working with the younger nurses to impart that wisdom about the skills involved with nursing and to help them navigate their careers,” Higham said. Johnson & Johnson has developing student mentorship programs with the National League for Nursing and another with the National Student Nurses Association to foster those relationships.

“The health care system will lose critical clinical and institutional knowledge that creates a safety net for patients and novice nurses in the complexity of today’s health care,” Edmonson said. “We will, as a profession, need to create new roles for maturing nurses and new ways to transfer their knowledge successfully to the next generation of nurses. The knowledge, expertise, intuition and navigation skills of the expert nurse are vital to creating and maintaining not only patient safety, but also the stability of the patient care systems in health care.”

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