Define Nursing Shortage

I have been asking colleagues and friends if they feel there is a nursing shortage.  I don’t feel one.  Most of them don’t either.  While we have overtime available at work sometimes, we also have plenty of slow nights where 3 or 4 RN’s in my ICU are being floated or given the night off.   In the hospitals I worked in as a traveler with 3 patients in the ICU- that seemed to be the decision of hospital management to run their staffing that tight. Its not safe but at one hospital specifically- hiring was frozen. So while all the nurses in the ICUs would have 3 patients- the hospital had no intention of hiring more.  They would bring in travelers now and again – but in the long term there wasn’t a plan for changing the culture. That is different then a nursing shortage.

Continuing with the discussion from Minnesota Public Radio, in the state of Minnesota RN Job vacancies dropped from 3500 in 2001 to 500 in 2009. There is a small amount of rebounding as the economy eases, but as I stated in my last post I don’t feel that hospitals have felt the full effects of the economic recession and nationwide unemployment.

While RN job vacancies dropped, the numbers of nursing graduates in the state of Minnesota more than doubled in that same time frame.  I know I’ve pointed to Minnesota a great deal in these last two posts, but the experiences of nursing graduates in that state is representative of  nursing graduate experiences nationwide.

On April 1st of 2011 the US Bureau of Labor Statistics reported that the healthcare sector continues to grow with 37,000 new jobs added (across hospitals, nursing homes, and outpatient care settings) and a 283,000 jobs within the last year.  For clarification purposes that is all jobs within healthcare; secretaries, x-ray techs, janitors, kitchen workers, nursing assistants, management, educators, advanced practice nurses, therapists, and RN’s.

My biggest concern of a possible nursing shortage is the opposite of what everyone talks about: Just because there is a continued need for nurses to take care of people getting sick; will there be organizations open and staffed to admit patients? How will the economic recession, job loss, and changes to Medicaid and Medicare in the future affect the financial bottom lines of hospitals?

I will never argue that growth in the health care sector is a bad thing.  Many of these positions come from expansion, building new hospitals, new outpatient centers, new clinics, and so on; and of course that does create jobs.  What I am really concerned about is whether or not this pace of building and expansion can be sustained.  Much of the money and reimbursement that almost every hospital gets is from medicare\medicaid and insurance companies.  I feel as though within the health care industry we have not felt the true impact of the economic recession and job loss as it pertains to paying a hospital bill.  As the job loss and unemployment rates skyrocketed most people lost their insurance and many people have stopped going to the doctor on a regular basis or don’t\can’t make an appointment with a doctor when something is concerning them about their health. Then we see them in the ICU when medical conditions become life threatening emergencies.

At the hospital I work at, we have had so many patients with bowel perforations, abdominal pain, and severe infections; tooth abscesses that go unchecked and lead to cellulitis in the neck and face or pericarditis; peripheral vascular disease and diabetes that is unmonitored and unchecked and ends up leading to gangrene in feet and toes.

Medical conditions develop and financial situations force them to have to wait until the point that they get so sick it takes weeks and months in the hospital, having many surgeries, and very expensive treatments to help them get better.  Eventually they leave and get discharged, though with a bill well over a million dollars. We treat people no matter their ability to pay- I don’t look at their chart for proof of insurance. It simply doesn’t matter. They are sick and need care.  Though it stands to reason that if they were unable to afford to go to the doctor to have things checked out; they aren’t going to be able to pay their hospital bill.  I consider myself fortunate to have health insurance and it would take me years to pay my share of a hospital bill that high.

I think that the economic impact on health care is lagging behind everything else and the possibility truly exists that hospitals will have to stop building and expanding and maybe start looking for areas to trim financial corners as more and more hospital bills go unpaid. Whether that is staffing ratios for nurses, more cuts to ancillary staff, not filling open job vacancies, not buying new equipment…. this is one aspect of the entire “nursing shortage” and “health care industry growth” that I feel is never ever talked about or addressed.  As a nation, there is talk about job loss and the economic impact in every other industry except health care.

The American Association of Colleges of Nursing has continued to assert that as baby boomers get older we will continue to need more and more nurses to take care of them.We need to explore the possibility of a nursing shortage from all angles.  At this point in time, we are providing enough nursing graduates for the needs we have.  It’s difficult for me to understand any agency trying to estimate the nursing needs that this country will have.  It seems no one predicted having such a precipitous drop in nursing job vacancies around the country; but it happened.  The biggest prediction is that the nursing shortage will get most severe because the average age of nurses in this country in 2012 will be 44.5 years old.  That is still 20 years shy of retirement age and who’s to say that in 15 years the economy will be in any condition that people can actually retire.  Nursing is a job that you can transition away from the bedside and manuel labor to work behind a desk and do that well into your 70’s.  I met an OR nurse the other day that was 86. I didn’t ask if it was her choice to work still or not…that fact being- she is still working.

We owe ourselves as professionals and the patients we care for an honest discussion about a potential nursing shortage.  Our current job situation and a possible potential shortage would affect everyone.  The best we can do is talk about it and keep talking about it….together.

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One Response to Define Nursing Shortage

  1. Teresa says:

    Thanks for you interesting words. This is a topic that I am exploring for a report in one of my BSN classes. I too I not seeing near as many job openings in Arizona as I did a year ago. I visited family in Dayton, Ohio last year and my cousin (also a nurse) told me that due to the plant closings Dayton nurses were finding it hard to find full time employment.

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