The worst economic recession in the post–World War II era has shed jobs across almost all industrial sectors, pushing the national unemployment rate close to 10%. Yet for one group in the slowing but still robust healthcare sector — hospital-based registered nurses (RNs) — the current economic downturn has led to a record employment spike, according to a study published online June 12 in
Health Affairs.
However, this spike is only temporary, warns lead author Peter I. Buerhaus, PhD, RN, the Valere Potter Professor of Nursing at Vanderbilt University School of Nursing, Nashville, Tennessee. "We've eased the nursing shortage, but we haven't permanently ended it," Dr. Buerhaus told Medscape Nursing.
The history of such shortages, Dr. Buerhaus and the study coauthors write, is inversely related to the general health of the economy: RNs are in short supply during boom periods and are available to fill vacancies when the economy is spiraling down.
In 2001, 3 years after hospitals began reporting difficulty filling vacancies, RN shortages peaked. With vacancy rates reaching a national average of 13%, an estimated 126,000 full-time-equivalent (FTE) RN positions went unfilled, forcing "many hospitals to close nursing units and restrict operations."
The 2001 recession altered this trend. Faced with a bad economy and the prospect of reduced family income, nurses already in the workforce increased their hours, and those who had left it returned, in part to take advantage of the substantially higher RN wages that hospitals began offering in 2002. The exigencies of the recession, coupled with the lure of higher wages, worked like a magnet: During the next 2 years, hospital RN employment surged by 184,000 FTE RNs. "At the time, that was a world record — right off the charts," Dr. Buerhaus said.
But if hospital officials thought their nurse vacancy problems were solved, they were wrong. Once the economy recovered, the shortage problem reasserted itself. In fact, the annual growth in FTE RN employment between the economic boom years of 2004 and 2006 was −0.9%. It has taken this most recent recession, which some argue started as early as the final months of 2007, to reverse the nursing shortage problem yet again.
In 2007 and 2008, according to the study, hospital-based RN employment increased by an estimated 243,000 FTEs. As in the 2001 recession, bad economic times have pushed nurses back into the labor market, and for many of the same reasons as before. But the lure of higher wages is not among them; for the most part, said Dr. Buerhaus, hospitals did not increase RN wages in 2007 and 2008. That fact, he says, makes the dramatic surge in RN employment during this recession all that more surprising. "From our past studies, we knew the effect the recession would have. But we were completely stunned by the size of the increase. Looking back, there's simply no 2-year period of growth in the hospital employment sector that rivals this one."
For nurses fresh out of school, the influx of new hires has not always worked to their benefit. "Their ability to find the job of their dreams in the hospital down the street from where they live has probably changed," Cheryl Peterson, MSN, RN, director of Nursing Practice and Policy at the American Nursing Association, told Medscape Nursing. "We've also found that employers can be a little more selective these days, holding out for someone with more experience rather than hiring a recent graduate or someone with limited experience."
Despite the trend toward older, more experienced hires, however, younger nurses are by no means absent from the workforce. In 2008, for example, the number of FTE RNs aged 23 to 25 years — 130,000 — was the highest it has been in more than 2 decades, according to the study. In addition, in 2008 there was a large jump in the number of younger FTE nurses with children younger than 6 years, compared with in 2007 — a phenomenon the authors say is related to families' efforts to boost their incomes during hard economic times. Overall, in 2008, employment of RNs younger than 35 years increased by a dramatic 74,000, with most ending up in hospital-based jobs.
Getting a Handle on Looming Shortages
Given the oddly cyclical nature of nurse employment, however, few if any in the nursing community are sanguine about the recent employment surge. "We can't be lulled into thinking that the problem of a shortage is over," said Ms. Peterson.
Similar to past shortages, Dr. Buerhaus said, future ones will be driven by the interaction of supply and demand. On the demand side, he and his coauthors lean heavily on projections outlined by the federal Health Resources and Services Administration (HRSA). Noting that "changing demographics constitute a key determinant of projected demand for FTE RNs," HRSA points to the "much greater per capita healthcare needs" of an aging baby boom generation, the leading edge of which will approach age 65 years starting around 2010.
Dr. Buerhaus and coauthors also consider something likely to drive demand that HRSA does not — the prospect that healthcare reform will expand coverage to more citizens, thereby placing even greater pressure on the nursing workforce.
On the supply side of the equation, the authors say, the waves of baby boomer RNs retiring during the next decade will be significant. So too will be the prospective size of the successive cohorts that will replace them. Will these cohorts be large enough to keep the workforce from shrinking, and yet too small "to meet the projected demand"? If so, the authors say, a much older RN workforce than ever before may be left to do the heavy lifting.
Action Plan for Policymakers
The authors conclude by proposing a series of action steps for policymakers. They want to strengthen the current workforce and, in particular, to "improve the ergonomic environment of the clinical workplace" for older nurses. They want to improve communication skills, especially for RNs educated in other countries — a group that has not only helped to fuel the current surge but also is likely to play a significant role in future supply scenarios. Perhaps most notably, they want to see steps taken to expand the numbers of 2 "underrepresented" groups in nursing — men and Hispanics.
Representatives of each group are sympathetic, although they cite challenges.
"We're up against the historical image of men as doctors and women as nurses," Demetrius J. Porsche, DNS, RN, dean of the Louisiana State University Health Center School of Nursing and president of the American Assembly for Men in Nursing, told Medscape Nursing. Among the barriers to full participation that Dr. Porsche sees are unsupportive families, school counselors who "don't understand that nursing is an autonomous profession, not just a handmaiden to doctors," and too few public images of men in the profession. Each year, Dr. Porsche explained, the American Assembly for Men in Nursing presents a series of awards aimed at enhancing the status of men in nursing, including one for the best workplace and another for the best nursing school/college.
"The push for men in nursing is a diversity issue," he said. "The profession should be open and welcoming not only to all races and ethnicities but to both genders."
Anyone recruiting Hispanics to nursing also faces barriers, said Norma Martinez-Rogers, PhD, RN, FAAN, associate clinical professor in the Department of Family Nursing at the University of Texas Health Science Center, San Antonio, and president of the National Association of Hispanic Nurses.
The biggest barrier, Dr. Martinez-Rogers told Medscape Nursing, is money. Despite some funding, she said, "many Hispanic students end up having to pay back big loans." Then there's the work issue, she added. Used to holding down part-time jobs to make ends meet before entering nursing school, too many Hispanic students try, at their peril, to duplicate that work schedule once enrolled. "Nursing school is all about the application of the content that you're learning, which is very time consuming," Dr. Martinez-Rogers said. "Students can hold down part-time jobs, but they risk having to repeat a course."
Hoping for more funding and support for what she characterizes as "not a brand-new problem," Dr. Martinez-Rogers has been talking to the Congressional Hispanic Caucus about renewed efforts to bring more Hispanics into nursing. One step would be to work with universities — her own included — that have the potential, because of their location, to enroll significant numbers of Hispanic nursing students. Once enrolled, she said, such students need to be mentored while in school and encouraged after they graduate. Her own university has what she described as a "student-driven" mentorship program; for its part, the National Association of Hispanic Nurses is working to develop its own national mentorship program.
Dr. Buerhaus thinks that expanding the capacity of educational programs — for Hispanics, men, and anyone else interested in becoming a nurse — is key. So, too, he said, is turning out the "right" nurses: "Beyond all the rhetoric, we need the future nurse to be really, really sharp in the areas of both quality and safety."
The ANA's Cheryl Peterson agrees, but added that nursing education "can't change on a dime" and that employers must also do their part by giving the freshly minted nurse the necessary "space to learn."
Source : http://www.medscape.com/viewarticle/704668?sssdmh=dm1.488649&src=nldne
