Contradictions: Part 1

Contradictions abound and run rampant in discussions related to future projections, job outlook, employability, and needs for registered nurses in this country.  This has been a topic that has been on my mind and grossly prevalent in my own life and practice for years.  I stopped working as a travel nurse in 2008 and decided to settle down and take a staff position I did so because the available travel nurse positions were rapidly dwindling.  Open staff positions were non-existent in the state and city where I began my nursing career and returning home was not an option. I was living and working in Seattle as a travel nurse and considered myself fortunate that hiring and job availabilities for experienced ICU nurses at that time were good.  Since then I have found it to be the perfect city for me to live in, write from, and continue to grow professionally.

Nursing has been constantly listed and discussed as one of the most recession-proof professions.  No profession is recession proof, that is a falsehood. For about the last 5 years, people looking for new career paths have been driven to and encouraged to pursue nursing.   Even as hiring has slowed to a near halt and layoffs have become prevalent, the continued assertion has been that we will continue to need nurses as our population continues to age.  I am curious why this assertion continues to exist.

On February 27th, US News & World Report listed nursing as the #1 best job in 2012.  What is the reality of this #1 listing based on? Software developer is listed as the #2 job in 2012.  These jobs are so different.  Health care jobs are generally 7 days a week, 24 hours a day, holidays, and weekends.  The lifestyle and pay of a software developer is MUCH different. The company they work for, the salary they make, and the benefits they receive are all vastly different then that of a registered nurse.  Nursing is not a job you do or a profession you pursue because the lifestyle is amazing.  You do it because the opportunity to make a difference exists everyday.  Software developer work is a linchpin to the Seattle economy: Microsoft, Google, Nintendo, and Amazon all have headquarters here.  It seems absurd, and software developers would agree, to list these professions in the same category and in the order in which they were in this article.

All of the points that the author listed about what makes nursing a great profession are true.  However, what immediately came to mind reading this was that the author probably did not interview one single Registered Nurse, nursing student, or nurse educator for this article- otherwise while singing its praises as one of the best jobs they would have also covered the reality that the profession is facing in these tough economic times.  Schools are not hiring nurses; secretaries are doing the job done once by registered nurses.  Community clinics may have one registered nurse in the office, but most of the work is done by assistants.  Rehab centers are not staffed by registered nurses; they are staffed by nursing and medical assistants that do the hard minute to minute work and care.  Registered nurses work to maintain paperwork required for insurance, medicare reimbursement, and other regulatory agencies.  This author tried to hit the nail on the head but instead she was way off base.

From my viewpoint as a registered nurse delivering care in Seattle, WA, I would be comfortable in asserting that over the last few years while vast parts of the United States has experienced the gripping, choking hold, lack of opportunities, and lack of available jobs for new graduate nurses, we haven’t….. until recently.  Seattle has been a draw for new graduate nurses from all over the country looking for nursing opportunities.  Many hospital organizations in the area continued over the last three years to have new graduate training programs, while hospitals in other parts of the country were not hiring at all.  Many states talked openly about the steep decline in available nursing vacancies they have been experiencing over the last 4-5 years; this region came to this realization quickly within the last year.

Last week, The Seattle Times wrote about and addressed this very issue.  This is a great article, one I really recommend you read, regardless of where in the country you live. It’s very comprehensive and well thought out. It is also one of the most honest articles on the topic I have read in a long time and it holds the promise of hope.

The article addressed many important points, the five most important I read were:

#1.  Openly discussing how long it took Alex, the nurse featured in this story, to get a job and the challenges she faced until she finally landed part-time work.  Fifteen months is an unimaginable length of time to me, I’m really happy for her that she didn’t give up in her job search.

#2. Openly listing the layoffs that have been occurring at hospitals in Seattle and the region.  Swedish Medical Center, the health care organization that Alex works for, closed it’s Visiting Nurse Service and Hospice program this month citing financial losses as its primary reason leaving more than 220 employees looking for work. Swedish has been back in the news this week for talking of more staff layoffs secondary to financial losses topping $250,000 a day. A nurse recruiter for MultiCare Health System, based in Tacoma, talked about how hard the profession of nursing and its education has been sold and now how sad every organization is not to be hiring.  MultiCare had massive layoffs in 2011. Nurses and ancillary staff were affected and the reason given was an increased financial strain caused by an increase in charity care.

#3.  Shedding light on the fact that unemployment rates have skyrocketed  (600% since 2008) among Registered Nurses in the Puget Sound region.  This is a small but significant representation of what is going on throughout the United States.  A 600% increase in jobless claims among a set group of professionals when jobless claims in the general population dropped does not, in my mind, make it the #1 job in 2012.  We need to talk truth.  It’s a hard program to get into, a hard program to finish, a heart-wrenching career, and when you finish your education you may not get a job.

#4.  Demonstrating that there has been a great shift in open nursing vacancies.  Across the country there are nearly twice as many nursing job seekers as there are vacancies.  When nursing job vacancies are listed as a general heading it is important to remember that there are not 1700 (from The Seattle Times article) open positions in hospitals and nursing homes that new grads can apply to in Washington.  This open vacancy number applies to and includes every possible vacancy that can be titled as “nursing:” nurse practitioners, teachers, professors, administrators, and bedside nurses.  1700 is a very low number.

#5.  A turn around in staffing and a future anticipated shortage.  This article cites a study at the University of Washington that includes federal insurance programs changes, aging populations, and an aging workforce as factors that will influence the need for more nurses and put us back into a shortage by 2017. I have to hope so, but that is still 5 years away and our country, politically and economically, is in the middle of great turmoil.  Next year could be very different and Medicare could be gone.

I appreciate the study for the information it brings. I appreciate the assertions made by every nursing organization, school, and employer about the future of nursing as it fits into the future landscape of health care.  I don’t want to remain cynical, just realistic.  My doubt for a turn-around stems from the fact that no one has ever talked about the impacts of the economic recession on the nursing profession today, nevermind the future.

No one seems to be talking about the fact that once hospitals learn that they can accomplish the same care with less, that less becomes the new normal.

No one seems to be taking about the fact that hospitals and health care organizations across the country are beginning to stop offering insurance benefits to their employees.  That as the economy and job outlook continues to improve (fingers crossed) most people are not getting jobs that offer health insurance and the uninsured and underinsured population stays the same.

No one is talking about the fact that just because we will need health care as the population ages, it might not be there.

Hospitals aren’t talking about how to keep the population healthy and in the best condition to keep them out of the hospital, they are claiming and citing the fact that people aren’t pursuing health care as the reason that they are losing money.

No one is talking about the fact that access to health care shouldn’t be a luxury or insurance based.  We should treat you in the hospital because your life would end without it.

No one talks about making excellent nursing care the reason that your hospital stands out.  They talk about their amazing, innovative doctors and new technology.

No one talks about using nursing excellence and expertise as a route to cost containment they talk about nursing care as an expense.

They might not be talking about any of this but I am and I will. Nursing, its continued professional development, and practice excellence are my passion.  I don’t want a talk about how difficult it is to get a job as a new nurse to deter anyone.  I want to see and work alongside nurses who have gotten to that professional point because it is what they really want and they have worked really hard to get there.  I want there to be a continued refreshment and rejuvenation in this beautiful profession because without it innovation, ingenuity, and change would cease.  Fostering, educating, and empowering nursing’s future professionals is the only way to accomplish this.  Talking about this topic shouldn’t scare anyone away.  It should empower us to keep moving forward and seeking change.

Stay tuned for part 2…..


2 comments on “Contradictions: Part 1”
  1. TC says:

    Clap, Clap! I can feel your honesty thru my laptop screen. I am hearing your cheers and hope to continue making a difference as a fellow nurse. Thank you for your insightful summary of our nation’s current plight. Healthcare issues will never cease so the provision of health care shouldn’t either. I love your blogs!

    1. Thank you for reading… It means so much! Thank you as well for your dedication to our profession!

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