HEALTH CARE thoughts: Nursing Shortage Issues
by Tom aka Rusty Rustbelt
HEALTH CARE: Nursing Shortage Issues
As Labor Day approaches it is a good time to think about health care labor issues, some good news, some bad news.
A phenomena many of us have noticed over the years (hard to exactly quantify though) is that recessions pull nurses back into the labor market. Nurses (about 94% female) often have husbands or significant others who lose jobs or hours.
Also, some of the staffing pressure is off at the hospital level because elective procedures are down and that takes pressure off the nursing staffing.
Recessions are not the desired means of correcting the shortage though.
My files on the shortage go back at 20+ years, and amazingly little progress has been made during that time.
There are some new and expanded programs, but a big problem now is the lack of nursing faculty. Unlike many PhD qualified professors, nursing professors are in big demand for management positions, usually in hospitals and health systems. So we are cannibalizing our own nursing pipeline.
University nursing programs are labor intensive, resource intensive and not nearly as prestigious as producing more MBAs, lawyers and economists.
While universities will get into bidding wars over top flight business, science or law professors, the willingness to play in the nursing salary market seems muted (perhaps if nursing was 94% male???).
The shortage will persist; the average age of RNs is climbing, the boomer nurses are heading for the exit while the boomer patients are becoming seniors, clinical skill requirements are accelerating, tighter reimbursements leave providers with less flexible budgets, and at times up to half of all licensed nurses are not working in direct care nursing – – all which seems to be a perfect storm.
We can send a man to the moon, but we can’t figure out how to solve this problem in a country where lots of people need new careers (and yes, lots of people are not suited for nursing). Maybe when we have to shut a lot of hospitals?
Tom aka Rusty Rustbelt
Our local community college has a nursing school, and at present there is a one year wait to be admitted.
Small sample, but the three people I’ve met in the nursing curriculum are male. Leads me to believe some students try to figure out what careers will be hot in future and select their majors accordingly.
Now if colleges would only think that way too…
As every Republican officeholder knows, health care costs keep rising because people overuse the system. Reduce capacity, et voila! Much less “overuse.”
immigration is another possibility.
isn’t there a bit of a nursing glut in india?
perhaps we ought to invite some in if we are not producing enough of our own.
I’ve been married to an RN for some 46 years and over that entire period there was always a shortage of nurses. I’ve always wondered what were the structural problems that prevented an expansion of nurses training programs. During this period college four year BS and MS programs for nurses expanded. But this seems to have been offset by the death of many three year programs run by nonprofit hospitals as private for-profit hospitals squeezed the ability of non-profits to continue subsidizing nurses education.
Without ever closely investigating the situation this is the conclusion I have reached. Does anyone have any evidence that this analysis is incorrect?
Ty–We have been importing RN’s and other medical personnel for at least 20 years I know of. That we do so and do not build/invest in our own training facilities and staff is a result of corporatized medicine for profit. Doesn’t make sense to invest in nurses’ training facilities when you can get ’em practically on demand with the simple expedient of an H1B visa. Cheaper and you get a higher profit margin for less. NancyO.
Another area where health care is sorely lacking is care facilities. Right now about one in one hundred and sixty children are born with autism, many of these will require long term care, combine that with the amount of people who will have alzheimers or just need extended care as they age and it becomes clear that we lack the facilities for these people.
Nursing would seem to suffer from the combination of extreme commitment in terms of education and working conditions and low pay back in terms of wages versus the commitment required. If one wants to change the flow of nursing candidates into the workforce one needs to change this dynamic by either increasing wages, reducing the rigorousness orf the requirements to become one, or making working conditions more attractive.
This doesn’t mean that it will still be easy to get nurses, consider teachers who have been lured with substantial time off, pensions, and a living wage, it is still hard to attract highly competent people to teaching.
In a grander sense we need to instill our culture with a greater sense of vocation as opposed to work. Humans spend much of their time working and it is how many people define their lives, we too sharply define things we do on our free time as play even if they are actually a type of work, and things we do to make a living even if they are enjoyable to us. Having a sense of vocation can instill jobs like nursing with a greater feeling of satisfaction and honor making them easier avenues for people to pursue.
My regards to your Mrs.
Mrs. R. is a graduate of the old “diploma school” model, which died due to funding and management issues (hers was a joint university-hospital program).
Another issue is that women now have many more career choices (half of all new doctors and lawyers) while men have only stepped up in a modest way.
The Philipines intentionally trains excess nurses as an “export commodity” and we have taken advantage of that for years, but we can only fill the breach to a certain point.
As the average patient becomes more acute and nursing practice becomes more technical and more complex this has limited value.
The only way to significantly reduce overuse of the hospital system, where most nurses work, is end of life planning (AKA “Death Panels”), or rationing. Until republican officeholders have the gonads to tackle those issues, I am confident in my job security.
I’m married to a non-practicing but currently licensed nurse, who (a) doesn’t want to work in a hospital (there are lots of other places where nurses can work); (b) was blocked from obtaining a license in our new state by requirements for in-hospital-only retraining (despite a standing job offer from our local school district); (c) finds the pay scales offered to be below that for comparable education and experience in other areas; and (d) doesn’t care for the lack of respect shown by egotistical doctors. All of these factors have little or nothing to do with nursing training (unless there needs to be better training in shutting up and taking what’s offered). In my opinion, they do have a lot to do with nursing being a historically female profession, with an outdated, entrenched (in law and regulation) view of the role of nurses. Unfortunately, it can take a very long time for such misperceptions to change, particularly when the income of many parties in the current health-care structure depends on them not changing.
We illustrated an infographic about the the nursing shortage crisis.
For the past ten years the nursing shortage has been effectively oversold. My own hostpital has instituted an unofficial hiring freeze and nurses are getting shifts canecelled at a rate of about 1 of 5. It is difficult to argue that a shortage exists when practicing nurses are cancelled and new nurses can’t find decent jobs. To follow this more closely go to http://www.nursinglut.com or visit us on facebook at The Nursing Glut.