The nursing shortage myth

For years we’ve read that the US faces a looming shortage of nurses. Shortfalls in the hundreds of thousands of nurses are routinely predicted. These predictions have been good for nursing schools, which have used the promise of ample employment opportunities to more than double the number of nursing students over the last 10 years, according to CNN.

Yet somehow 43 percent of newly-licensed RNs can’t find jobs within 18 months. Some hospitals and other employers openly discourage new RNs from applying for jobs. That doesn’t sound like a huge shortage, does it?

But the purveyors of the nursing shortage message have an answer for that. Actually two answers: one for the short term and another for the long term. The near term explanation is that nurses come back into the workforce when the economy is down. Nurses are female and tend to be married to blue collar men who lose their jobs or see their hours reduced when the economy sours, we’re told. Nurses bolster the family finances by going back to work –or they stay working when they were planning on quitting. There’s something to that argument even if it’s a bit simplistic.

The longer term argument is that many nurses are old and will retire soon, just when the wave of baby boomers hits retirement age themselves and needs more nursing care. Don’t worry, the story goes, there will be tons of jobs for nurses in the not-too-distant future. This logic comes through again in today’s CNN story:

Demand for health care services is expected to climb as more baby boomers retire and health care reform makes medical care accessible to more people. As older nurses start retiring, economists predict a massive nursing shortage [emphasis mine] will reemerge in the United States.

“We’ve been really worried about the future workforce because we’ve got almost 900,000 nurses over the age of 50 who will probably retire this decade, and we’ll have to replace them,” [economist and nurse Peter] Buerhaus said.

I don’t buy this logic. And I stand by what I wrote almost a year ago in Nursing shortage cheerleaders: There you go again:

My issue with the workforce projections is that they don’t take into account long-term technological change, but simply assume that nurses will be used as they are today. I’ve taken  heat for writing that robots will replace a lot of nurse functions over time. People seem to be offended by that notion and have accused me of not having sufficient appreciation for the skills nurses bring.

So let me try a different tack. Think about some of the job categories where demand is being tempered by the availability of substitutes. Here are a few I have in mind that have similar levels of education to nurses:

  • Flight engineers. Remember when commercial jets, like the Boeing 727 used to fly with two pilots and a flight engineer? Those planes were replaced by 737s and 757s that use two-member flight crews instead
  • Junior lawyers and paralegals. Legal discovery used to take up many billable hours for large cases. Now much of it is being automated
  • Actuaries. Insurance companies used to hire tons of them, but their work can be done much more efficiently with computers

I don’t know exactly how the nursing profession is going to evolve but I do notice that the advocates for training more nurses are typically those who run nursing schools rather than prospective employers of nurses, such as hospitals.

If you want to be a nurse, go for it. But if you’re choosing nursing because you think it’s a path to guaranteed employment, think again.

15 thoughts on “The nursing shortage myth

  1. Ginger

    It is expensive to put a new nurse to work. My child graduated from a 4 year BSN program, passed the RN exam and was hired by a hospital. She underwent 8 weeks of full-time paid training and a 3 month precept with an experienced nurse before she was ready to be scheduled like any other employee. I consider that to be a lot of training to get an employee ready to work. The hosptial did not even consider applicants who did not have a 4 year degree.

    Nursing school was expensive and harder than I had imagined it would be. Some semesters the books were more than $1,000. Good wages and relatively steady employment prospects have made the field attractive but in this market positions are much more competitive than is commonly thought.

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  4. Devon Herrick

    Ginger makes a good point. Many years ago when I was an accountant in a hospital, I was in a budget meeting with other accountants and a senior VP. He commented that a senior executive from another Dallas-area hospital called to complain that our hospital had raised wages for 2nd year nurses. This made the other hospital’s SVP mad because he thought our hospital was trying to poach his nurses after they went through a year of training (Heaven forbid that Dallas-area hospitals actually pay nurses market wages). The SVP at our hospital responded to us that he wasn’t trying to poach other hospitals’ nurses, just retain the ones we hired the year before.

    He explained… The first year or so after hiring a nurse straight out of nursing school (or a doctor’s office) was rather unproductive — such that the nurses’ first performance evaluations were often not very good, causing them to get no raise (or a low raise), prompting them to leave for higher pay. The hospital wanted to stop losing nurses who became angry after they worked a year and then were expected to earn about the same as someone newly hired out of nursing school.

    My experience as a hospital accountant was that we always had a hard time retaining enough nurses. But, part of the issue was that hospitals are labor intensive and we didn’t want to actually pay them enough to do the difficult jobs required of them.

    That said, I find David’s comment about replacing labor with robots to be very interesting. In the future we probably won’t be using nurses for the same tasks. Indeed, my hospital segmented nursing labor into unskilled and skilled tasks. The pharmacy techs that once roamed the halls pushing pharmacy carts full of pills have been replaced with automated (robotic) carts that can drive themselves.

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  8. yasmin

    . The nursing shortage IS a huge lie. My own theory is thatb/c there is a disproprtionate number of new yorker nurses versus other college grad professions being churned out, is that colleges r making booku bux off the lied to prospective nurses. No one tella what the name of the game is in nursing. Freezes (hiring), preceptors, horizontal/vertical violence among the hospital staff (mainly tho amongst nurses)” . Look at the expansion of universities? Especially the private ones? How much are they building on? How many of their degreed students r graduating/studying avidly and saying: imgoing for nursing! Im studyi.g for my RN! I want to be a nurse! Its a lie. Look at all the inactive licenses? How many r there? Hospitals r closing down. The abuse nurses face! Not just from families of patients/patients/doctors but among the nurses themselves? And lazy techs/other support staff? Nursing shortage is a myth. Nursing is not what people think it is and is advertised as. Its very sad. Look at all the gripin g on nursing blogs? Complaints? This needs to change. There is no demand for new nurses.

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  9. Lindsey

    There is not technically a “nursing shortage.” Plenty of nurses are willing and able to work, but there is a financial crisis in healthcare. Hospitals are not willing/dont have the budget to allow for adequate staffing. So while there are plenty of nureses available, hospitals are staffing with the minimal staffing necessary. This is causing nurses to have more patients than safely appropriate, being overloaded, running crazy trying to get everything done, and being grossly underpaid. It is much easier to work in an office, or do some other skill for the same amount of money (or more) and a lot less stress. The budget of hospitals needs to be address to allow for adequate staffing. Nurses taking 6+ patients for 12 hours is not safe for anyone involved. Patients are not receiving above standard care, simply because there is not time. This could lead to other costly problems for the patient/hospital. The sooner we realize the importance of nurses and help the nursing staffing situations, the better for everyone in the hospitals community

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  12. Sarah

    No there is not a shortage especially in Southern California. I have graduated from nursing school in 1992 and took time off to raise children and now I am attepting to return to the field. I have taken a reentry/refresher course. I never let my licenese lapse and yet the recruiters would rather higher new grads then to give someone with “old” experience a go. The argument is you are to expensive to train. They are using lots of travelers versus highering from local resources. My exerpience is very common. So until the econmy recovers we will not have a shortage. Will robots replace nurses? Not until we have “Star Trek Medicine”. Robots can not replace the human contact that is required. A good majority of a nurses time is spent comforting the patient physical, mental, and spritually. A robot simiple is not qualified to provide human comfort.

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