Re the article & fact sheet below there is apparently a chronic national shortage of nurses in some areas that has lasted for some years now and threatens to extend well into the future. Hospitals are using large bonuses and other incentives to attract nurses.
Assuming supply and demand are still the major levers in this economy why has this chronic shortage persisted? Nurses (with some experience) seem to relatively well paid, and yet the shortage continues. Are the pay rates too low? Is the job too demanding? Why hasn’t pay increased or working conditions improved if these are really the limitations? Why aren’t unemployed people seeking nursing training in drives?
Why are the usual rules of supply and demand not operating efficiently to correct the impediments noted in generating more employable nurses?
I don’t have all the answers, but one factor is the nursing schools. They don’t seem to have expanded their capacity and I hear regularly about the stiff competition and long waiting lists to get into them in my area.
Health care economics doesn’t always follow the supply and demand model very well. The money to pay nurses comes from health care consumers. In one sense the need for health care is essentially infinite, but the true demand (consumers willing and able to pay for it) is limited and the market is not straightforward, with costs being paid by government, insurers and individuals.
This is a good question. I have thought about asking it myself for a while.Nursing shortages are chronic and it is not easy to say why this is. Most people spout out that the pay is low even when it really isn’t. I think that they are confusing RN’s with nurses aids or something. Even though the pay is not that low generally speaking, it may still be too low to attract enough people into nursing training as opposed to other careers that only require a general bachelor’s education. Becoming an RN or nurse practioner requires some pretty rigorous and specific training. However, the laws of supply and demand should correct by pushing wages even higher but they have not seemed to yet.
I have thought about changing careers and becoming a Nurse Practitioner. Some of the open houses I went to said that the lack of space in nursing training programs is the bottleneck like Ca3799. You generally have to get a Ph.D. in nursing (a Doctor nurse) to teach at one of the better nursing schools and there simply aren’t enough people that want to teach nursing academically.
The other aspect is that it’s still largely true that nursing is a women’s profession, and seen as such. So you automatically cut the potential supply, not quite in half, but close. And on the other side of the coin, you have high-paying fields that have historically been male (medicine being one example) that are now not just open to women, but in same cases actually recruiting women to correct historic imbalances. So the same sort of smart, competent women who in a previous generation might have become nurses are now becoming something else instead.
An aggravating factor is the perception that nursing is a demanding, stressful job with low job satisfaction – a perception that is to some extent borne out by polls taken among nurses. A pretty high percent (sorry, can’t remember the exact figure) said they were actually planning on leaving nursing soon because of burnout.
In one of the few Seinfeld routines I’ve seen, he said the problem with unemployment isn’t that there aren’t enough jobs, it’s that there are too many people who are too fastidious for their own good. “I may be out of work, my kids may be starving, but I ain’t picking that up!!!”
This article and other one like it that I just read, indicate that the problem has nothing to do with finding people wanting to go into nursing. Applicant pools have increased 25% or more in recent years and very qualified applicants are being turned away from Nursing programs.
The problem is a bottleneck in all areas of nursing training.
Nursing programs are very expensive to run and many institutions shy away from starting a new one or expanding an existing one.
There isn’t enough teaching staff. Nursing professors usually need a Ph.D. Getting a Ph.D. is difficult because few slots are available. The average age of nursing professors is in the 50’s.
There aren’t enough teaching hospital slots to train nurses on clinical practice.
These factors all constrain the number of nurses that can be produced even though both the potential supply and demand are high.
I understand Harriet the Spry’s point about medical economics not necessarily following normal supply and demand models, but you’d think there would be a point salary and perks wise where it would seem like a good idea to teach nursing academically, or market demand-wise to make nursing schools larger if that’s really the bottleneck.
I was out of work for over a year, and I got a call from the state unemployment office that I could have trained to be a nurse, paid for completely by the state. But I ain’t picking that up!
No starving kids, though. And a couple more years of unemployment, I might have jumped on it.
Just a tiny bit of a hijack, but the thing I’ve wondered lately about nursing is why they haven’t changed its name. The word “nurse” is a very female sort of word (especially in its other meanings) and I get the impression that “male nurse” is not a PC term. Since a lot of men are getting into the profession now, why not change the name to something a bit more gender neutral? They changed “secretary” to “administrative aide” or “administrative professional” for this very reason, so why not “nurse”?
It would seem that items 2 and 3 derive (mainly) from # 1 (IE more programs would mean more slots and more staff). Why, in the face of very high levels of demand (hospitals etc) and high levels of supply (potential students) are they “reluctant” to start new programs or expand existing ones? The money (in the form of potential tuition’s) is apparently practically beating down the door. It just doesn’t make sense to me.
I think the problem is that it is difficult to justify more and larger nursing programs at the undergraduate level. They are much more expensive to run than most other undergraduate programs. An institution would have to charge nursing students much more than other students to make it worthwhile. I think that most are reluctant to do that especially given the stereotypes associated with nursing.
Assuming you could be more and larger undergraduate programs, you still have to contend with a lack of clinical training slots. The hospitals simply haven’t created them.
Basically you have a well ackowledged problem that has a bottleneck with no real incentive for the people doing the training to fix. Colleges are businesses too and it is hard to unilaterally make a change that has only indirect benefits to themselves.
I was at Swedish Hospital in Seattle in July. Downstairs by the HR department they had 6 pages of job openings for RNs. Swedish is not a dive as hospitals go, but with that many openings you’d think that they’d be willing to take justa bout anyone with RN after their name.
Another angle is that the RN program can be kinda expensive, and is a 2 or 3-year commitment depending on the prereq courses. Some of those prerequisites are Anatomy & Physiology, Chemistry, Microbiology, Statistics…not really simple classes. My bet is that folks with the ability to handle those classes are already involved in a 4-year bachelor’s program and have a different career in mind. Others of us who got that BA in Art History or English currently have jobs that might pay a little better than entry level RN so we don’t consider this occupation as an option…plus the fact that it’s a tough job stereotyped as “thankless.” Nuts to that!
I just don’t think the job has been made attractive enough to bring tons of viable candidates into the pool. Cost of education is a minor issue: most hospitals I’ve encountered have a hiring bonus that effectively covers the tuition.
I am under the impression that while individual nursing jobs are high-paying, that medical institutions try to economise by short-staffing, thereby creating bad working conditions for those who are there for their high-paying jobs.
My girlfriend is a nurse and she just recently got accepted to a masters of nursing program. She was on a two-year wait list despite excellent grades, experience and recommendations. She was told that colleges, even ones with very a very enlightened board, are not as flexible as a corporation. Apparently, there are a ton of laws and procedures a college has to go through to open a new school. It’s not like adding a department (which I heard is also difficult) or a new class to the curriculum. There is a whole lot of investment and logistics to work out. Also, as others have cited, there is a lot of training that is needed and qualified professionals to administer the training. In addition, there is also accredidation to worry about. My friend in the office said his school just recently added a business school, and it took 3 years (maybe more) to receive accredidation. Would the new nursing school be able to operate without accredidation? Even it could operate, could the new nurses coming out of the program be able to work professionally?
So, I surmise that law and demand still apply to healthcare in a general sense, even in light of the true comment that healthcare demand is practically infinite. With all the laws and procedures in place, it just takes a little longer to see these effects happen in market.
There are also artificial barriers set up that differ from state to state.
When Deb moved down to Ohio from Michigan, she got in trouble a couple of times in her first few months for performing procedures she had performed for five years in Michigan that were prohibited to nurses in Ohio. Similarly, she found that she was constantly called upon to perform what she considered LPN tasks (based on Michigan protocols) that had to be performed by RNs in Ohio. Over the last 20 years, she has seen one place after another simply stop hiring LPNs on the grounds that there are too many tasks they are prohibited from performing. (But instead of simply hiring more RNs, the companies have changed their hiring ratios from 1 RN:2 LPNs:2 aids to 1 RN:4 aids and told the RNs to run their asses off.) Deb knows several RNs who decided that medical management or real estate were better ways to get similar pay for far less stress. Most of the local hospitals and nursing homes have a rotating door as nurses wander from one employer to the next hoping to find an outfit that will actually support the workers. Good nurses who want to stay in nursing are seeking out niche markets (home health care or clinics, for example), leaving a shrinking pool of competent nurses for hospitals. The wages at large hospitals can be quite competitive, but they are not sufficient to the responsibility or hassle.
Part of the lack of hiring is directly related to payment. Deb has long noted that departents that carry mostly Medicaid patients always have fewer nurses than departments that carry mostly private pay. The nursing salaries are similar, but there are fewer nurses staffed, leading to faster burnout in Medicaid departments.
My husband is a RN, and it is very emotionally draining work. He worked for many years in a state-run mental hospital that was chronically short-staffed, resulting in very dangerous working conditions. One of the HSTs (aides) was kicked in the stomach by a patient, causing her to miscarry. The state is trying to close the hospital, and has already closed the Mental Retardation unit. So a very large, agressive 18 year old MR patient is put on the ward with the adult psychotics, schizophrenics, etc. The kid is very aggressive both to staff and other patients, and after Mr. SCL’s requests to sedate him were denied (after repeated attacks on both patients and staff, including slapping Mr. SCL in the face) the kid kicked Mr. SCL in the balls. Mr. SCL quit working there the next day. He is now working as a case manager for a home health care company.
Hospitals are not in business to lose money, so they operate with the bare minimum of staff in most cases. Many now require 12 hour shifts, which in my opinion is dangerous. Nurses are on their feet all the time, and tired people make mistakes. Many doctors are much less than considerate and polite of nurses. Sick people aren’t at their best (understandably) and sometimes are very difficult to deal with. When a doctor decides the patient can’t have any more pain meds, guess who gets to tell the patient, and gets reamed out for it?
I respect my husband immensely for his decision to go into this field. I have never been so happy in my life as I was when he quit the mental hospital - I was afraid every night he was going to be seriously injured.
I think you show this pretty conclusively. Still, the other part of the supply equation – namely, people who are already nurses – is affected by the phenomenon I mentioned above, namely high burnout and people leaving the field because they have options elsewhere. Because of the bottlenecks you cite, these people can’t be replaced so quickly.
Trained humans are not a commodity in the sense that a bushel of winter wheat or a barrel of crude oil are. You can’t just increase production capacity and make more or stockpile them when there is no demand.