Equipping the Future Demand for Nurses Rises — Along with a Push for More Education

If you want to be a nurse, the jobs are plentiful. If you want to be a certain kind of nurse, well … that’s more complicated.

At issue is the so-called nursing shortage, which made headlines 15 years ago but has receded somewhat since then, yet is expected to percolate again as Baby Boomer nurses finally move into retirement.

“I think, because of the age of our workforce right now, a shortage is going to happen,” said Joyce Thielen, associate dean of the Elms College School of Nursing, adding that many were ready to retire several years ago, but postponed that step when the economy went south in 2008.

“But as the market improves, as the economy improves, more people will start to retire. That’s the current thinking, anyway,” she noted. “There are specialties where that is particularly true. One example is the OR; many of the nurses in the operating rooms in area hospitals have been here for many years, and they’re predicting a shortage of them coming up.”

Nancy Craig-Williams, assistant dean of Nursing at Greenfield Community College, also sees plenty of opportunity, noting that all her school’s recent graduates who have passed the National Council Licensure Examination have received job offers in fairly short order.

However, “the opportunities may be changing from what people stereotypically think of as nursing,” she told HCN. “Some students come in and expect to see the ER all the time, or they come into the nursing program and say, ‘I want to work in the hospital; can you guarantee me that?’ Well, no — we educate you to become a nurse and use the knowledge and skills you learn in school at a facility that needs those skills. Sometimes their ideas change once they’re in school.”

Some graduates, she said, don’t find themselves working immediately in their preferred environment, or working as many hours as they’d like, while about 20{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of GCC’s nursing graduates move on from the two-year program and enroll in bachelor’s-degree programs elsewhere, reflecting a trend toward higher education for nurses in general.

“For them, this is a stepping stone as opposed to an end point,” Craig-Williams noted. “I think it has become more apparent to our associate-degree students that a bachelor’s degree will get them into positions, like acute care, that they want to go on to. Some of our graduates do go right to acute care, though, because they’ve been working at the facility or an opportunity presents itself.”

The Institute of Medicine (IOM), among other groups, has been calling for a better-educated nursing workforce, Thielen said, especially at a time when a shortage of primary-care physicians is becoming more acute and nurses are being called upon to do more. “Overall, we’re seeing a trend where associate-degree programs are highly encouraging their graduates to get their bachelor’s degree right away, and those with bachelor’s degrees are thinking about graduate schools,” she said, noting that fields like physical therapy, occupational therapy, and pharmacy are starting to require doctoral degrees for certain jobs, and nursing may not be far behind, especially at a time when the accountable-care model of care requires healthcare providers from various disciplines to work more collaboratively. “In order to be equal around the disciplinary table, nurses need to be better educated; it’s all about better patient outcomes.”

Still, she said, these trends shouldn’t scare prospective nurses from a field that’s sure to pose plenty of career opportunity over the next decade and beyond, at every education level. “It’s still a real phenomenon. It’s looking up. The last few years have been brigher, and opportunities continue to improve.”

Healthcare economist Peter McMenamin told American Nurse Today recently that a combination of factors, from the aging of the nursing workforce to implementation of the Affordable Care Act, is driving rising demand for new nurses.

“Nursing is a good job,” he said. “Work satisfaction is high. If you look at the employment in U.S. hospitals for the last decade, month after month, there’s only a single month where employment went down. Hospitals have been continuing to hire during the recession.”

He cited U.S. Labor Department projections that 712,000 new jobs for registered nurses would be created between 2010 and 2020. “Everyone is expecting there are going to be more jobs. We’re hoping that there will be enough nurses to fill all of those jobs.”

The problem is that nursing schools are actually turning away applicants en masse, with capacity issues stemming partly from a long-standing lack of nursing professors.

From 2012 to 2013, for example, enrollment in bachelor’s-degree nursing programs increased by 2.6{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}, the slowest increase in five years. Meanwhile, nursing programs turned away 53,819 applicants in 2013.

That needs to change, according to a U.S. Bureau of Labor and Statistics (BLS) report that projects a 22{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} increase in available registered-nurse openings by 2025 and a 25{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} increase in licensed-practical-nurse and vocational-nurse jobs. Meanwhile, according to a study published in Medical Care, the nurse-practitioner workforce is expected to surge by 94{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} between 2008 and 2025.

“One of the trends is, we’re seeing hospitals offering residencies — they’re waiting for the right graduates to become licensed, and they’re offering residency programs that allows for a very intense orientation and helps with their entry into the practice,” Thielen explained. “And, again, we’re seeing a lot of graduates going to graduate programs earlier than ever. We’ve seen a lot of that because of IOM’s recommendation that nurses become a better-educated workforce. And the need for nurse practitioners is increasing because we have a decreasing number of primary-care providers. These are all trends.”

Craig-Williams agreed. “There’s a huge call for nurse practitioners right now. We do have students graduate from our program and transition to nurse-practitioner programs. In some cases, if they have other education or background, there are a lot of opportunities.”

Thielen also noted that a graduate’s chance of getting the job they want might depend on how willing they are to relocate.

“Our graduates are getting jobs, and they’re getting them right away if they go beyond New England,” she said. “We’ve had students go to North Carolina and other states — there are many more opportunities if you’re able to move out of the area. People staying in the area are taking a little more time; they may start out with part-time positions that grow into full-time positions or evolve into something else.”

According to the BLS, Texas, Florida, Washington, and Virginia ranked highest in job postings for nurses in the first quarter of 2014, while other states that showed significant growth over the last year include Georgia, Minnesota, and New Mexico.

“I believe most of our national organizations, including the departments of Education and Labor, are saying we’re still looking at a nursing shortage,” Craig-Williams said. “Maybe it’s not as pronounced here in the Northeast, but it certainly is apparent in other areas of the country.”

Demographics — specifically, what’s commonly referred to as the aging of America — creates demand for nurses in two ways: by creating a wave of retiring older nurses, and by keeping people alive longer and needing more nursing care.

In fact, according to the American Medical Assoc. (AMA), adults 65 years and older represent the fastest-growing segment in American society, and this group is expected to surpass 40 million, or 13{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of the nation’s population, in the next decade. America’s adult mortality rate, for men and women combined, ranks only 49th in the world.

At the same time, the AMA notes, chronic diseases account for 75{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of American healthcare dollars spent, while more than half of Americans have some sort of chronic disease, like diabetes, heart disease, or cancer. Meanwhile, obesity has reached epidemic levels, with more than 72 million Americans, including 12.5 million American children, classified as obese.

The result is an American healthcare system approaching a state of dire need for many types of healthcare providers, nurses foremost among them — in all sorts of care settings, not just hospitals.

“Many of our students are getting positions in step-down, subacute units, long-term care, rehabilitation services. Some are working in the community, doing visiting-nurse or home-care placements. There are a few working in acute care,” Craig-Williams said, adding that a number of GCC graduates work at the Brattleboro Retreat, a behavioral-health facility just over the Vermont line, due to an ongoing relationship between the center and the nursing program. “Every year we do a rotation there.”

Overall, she told HCN, nursing provides an abundance of opportunity for young people considering careers.

“We’re a small school, and we don’t graduate a large population of students, but our graduates are excellent candidates,” she said, adding that many are adult learners with bachelor’s or master’s degrees in other fields who considered nursing as a career later in life.

Whatever the case, she added, it’s becoming an increasingly good idea for many nurses to attain as much education as possible. “The research is pretty clear — a bachelor’s in nursing is going to increase your possibility of working where you want.”

Wherever that may be, it’s important to remember that the greatest career benefit of nursing may be the ability to do something meaningful each day to help other people, Vicki Good, president of the American Assoc. of Critical Care Nurses, recently told nursezone.com.

“It may sound cliché, but we need to keep our eye on the ball, which is our patients and their families,” she said. “It’s so easy to become overwhelmed and distracted by the inevitability of change that we forget on whose behalf we do what we do.”