There’s been plenty of gloom-and-doom conversation and hand-wringing lately about the looming nursing shortage. Understandable, considering the fact that nursing is the largest segment of the nation’s healthcare workforce, with nearly 4 million people professionally employed (Snavely).
In recent posts here, here and here, we at tekMountain delved into various causes for the shortage. But our tighter focus always is on the opportunity that any plague of pain points creates in a healthy tech ecosystem.
The first four reasons for the coming shortage that we’ve covered are that
- Baby Boomers are retiring en masse;
- The aging American population needs more access to healthcare services;
- The Affordable Care Act has provided that greater access; and
- As a cost-saving strategy, more nurse practitioners are in the field doing work formerly done only by doctors.
Here we’ll focus on a fifth reason: The number of people with nursing licenses who don’t work as in the field.
Here’s the deal: 25 to 30 percent of adults with nursing licenses don’t work as nurses. It’s a situation that exacerbates the bottleneck at the front end of the nursing career path: the very narrow supply line existing at nursing schools.
According to a recent report in The Atlantic, “U.S. nursing schools turned away 79,659 qualified applicants from baccalaureate and graduate nursing programs in 2012 due to insufficient number of faculty, clinical sites, classroom space, clinical preceptors, and budget constraints.” This is exacerbated because, as The Atlantic explains, “filling the vacancies left by retiring nurses isn’t a simple one-for-one proposition.”
The supply line is further impaired because of the deepening shortage of nursing faculty. Most nurse faculty are required to have a doctoral degree, so long-term investment in academic training and infrastructure that must take place for sufficient faculty to exist. Narrowing the pipeline at the front end depletes the supply of qualified nursing faculty. Faculty retirement is a major component of faculty attrition at the back end.
The supply chain is further hobbled later in its course because nursing is notorious for its inherently high rate of attrition. Good nurses with valid credentials and licensing leave the field in astounding numbers each year.
Why Nurses Leave
According to a 2016 study by Timothy Snavely, published in Nursing Economics, “An estimated 30%-50% of all new RNs either change jobs within nursing or leave the profession altogether within the first 3 years of clinical practice (MacKusick & Minick, 2010). Further, the average RN turnover rate in 2014 was 17.2% (up from 13.5% in 2011) with 24.2% of hospitals reporting a vacancy rate of 10% or greater (Nursing Solutions, Inc., 2015).”
Noting that nursing is a highly rewarding career, the study points to burnout, fatigue and stress as they major impetus for nurses leaving the profession. More localized causes for this include the following:
- Insufficient staffing. This exacerbates the stress, further reducing job satisfaction (AACN) and the efficiency of care. It has been shown that hospitals with better staffing have lower odds of readmission penalties than do hospitals with insufficient staffing.
- Workplace violence (ANA) reaching “epidemic levels” (rwjf.org). As reported in Becker’s Hospital Review in 2015, “between 2012 and 2014, workplace violence injury rates increased for all healthcare job classifications and nearly doubled for nurse assistants and nurses, according to data from the Occupational Health Safety Network
- Stressful conditions. According the report Nursing Supply & Demand through 2020, from Georgetown University’s Center on Education and the Workforce (CEW), “Stressful working environments, along with long hours and erratic schedules in some nursing positions, contribute to many nurses moving in and out of the field based on economic conditions and personal circumstances. Among prime-age (25-54) RNs with an active RN license, 44 percent of those who do not work in nursing indicate that workplace-related issues, such as burnout, scheduling, the physical demands of the job, inadequate staffing, and low pay relative to other opportunities contributed to their decision to leave nursing.”
- Unsatisfactory salaries. The CEW report goes on to say that 15 percent of RNs who do not work in nursing specifically identify low pay in nursing or better salaries elsewhere as one of the reasons for leaving nursing. The gender pay gap and regional variances in compensation worsen the situation.
- The economy. Nursing tends to be countercyclical to economic trends. The U.S. Bureau of Labor Statistics has even called the profession “recession proof.” Job gains in the field increase faster in recessionary periods than in non-recessionary periods. “In tight labor markets,” the CEW notes, “job security and relatively high wages act as an incentive to draw qualified nurses back to the profession. As the labor market starts recovering and more opportunities become available elsewhere, some nurses will leave the profession for jobs they find more preferable.”
During recessions, many nursing professionals return to the field, and older working professionals tend to delay retirement. The end of a recession tends to signal greater nursing shortage.
Source: U.S. Bureau of Labor Statistics
The Irony of Promise
New nurse graduates come out of school with enormous career promise compared to those in other disciplines. According to a major online survey conducted last August by the American Association of Colleges of Nursing, “The average job-offer rate at the time of graduation was 73 percent for new BSN graduates and 78 percent for entry-level MSN graduates. By comparison, the National Association of Colleges and Employers conducted a national survey of 23,282 new college graduates across disciplines and found that 46 percent of new graduates in 2016 had a job offer at the time of graduation.”
Soon after graduation, it gets even better: Four to six months after graduation, job offers swell to 94 percent for entry-level BSN graduates and 95 percent for MSN graduates. It’s a cruel irony that so many people interested in such a rewarding profession will be turned away within a few short years by deleterious work conditions.
Changing the attrition rate among nurses early in their career is among the deeper challenges facing us all. It affects us all because, as Snavely’s study found, nursing shortages contribute to increased healthcare costs and higher hospital-readmission rates. “High patient-to-nurse ratios are also associated with increased urinary tract and surgical site infections. … Inadequate staffing ratios contribute to ventilator-associated pneumonia, centralline-associated bloodstream infection, and Clostridium difficile infection; these five nosocomial infections directly cost the U.S. healthcare system (adjusted for CPI-U) between $28.4 and $33.8 billion annually” (Snavely 99-100).
Our next and final installment in this series points to a powerful tool that promises to help bridge the gap in the nursing deficit. This is an important focus for tekMountain, a leading entrepreneurial and innovation center located in the Port City of Wilmington, NC.
Carnevale, Anthony P., Nicole Smith, and Artem Gulish. (2015). “Nursing supply and demand through 2020.” Georgetown University Center on Education and the Workforce. McCourt School of Public Policy.
Snavely, T. M. (2016). A brief economic analysis of the looming nursing shortage in the united states. Nursing Economics, 34(2), 98-100. PubMed.