1. Kennedy, Maureen Shawn MA, RN, FAAN


It seems the nursing shortage has arrived.


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Each year, I attend one of my favorite meetings-the annual conference of the National Student Nurses' Association (NSNA). This year, 3,000 enthusiastic attendees, mostly junior and senior nursing students, gathered in Nashville, Tennessee, and the atmosphere was charged and upbeat-more so than in years past.

Figure. Maureen Shaw... - Click to enlarge in new window Maureen Shawn Kennedy

Most of the senior students I met already had hospital jobs lined up; several had the luxury of being choosy about where they would begin their careers, with hospitals with nurse residency programs a key factor in their decision making. I asked Diane J. Mancino, executive director of the NSNA, if what I was hearing was widespread, and she confirmed, noting that the NSNA "has been tracking new graduate workforce data since 2008 and we are definitely seeing a higher employment rate for new graduates."


This is markedly different from prior years, when most senior students were still seeking positions in late April; some couldn't even secure an interview, as most hospitals sought "experienced RNs only." How things have changed! Hospitals are now seeing many nurses retire or, after amassing clinical experience, leave for opportunities outside the acute care setting (see AJN's February editorial).


Recent media headlines and reports from around the country cite an abundance of unfilled nursing positions and warn of worsening shortages in the near future. Karren Kowalski, president and chief executive officer of the Colorado Center for Nursing Excellence, an organization focused on developing the state's nursing and health care workforce, said that in Colorado there are "enormous shortages" of experienced nurses in critical care, EDs, operating rooms, and labor and delivery, as well as the neonatal ICU. She noted, "We graduate approximately 2,000 new nurses each year. Most are able to get jobs, although not necessarily in acute care. We project that we need approximately 3,200 'new' nurses per year."


Some hospitals have resorted to offering sign-on bonuses to fill positions, especially in specialty areas. Florida hospitals are offering five-figure sign-on bonuses as well as funding for relocation and tuition; one Pennsylvania nursing home is offering a $5,000 sign-on bonus for RNs and LPNs. Other organizations are developing partnerships with schools and creating programs to expose potential nurses to clinical settings, with hopes that many will stay on. In Colorado, the legislature enabled community colleges to offer bachelor of science in nursing degrees and LPN schools are expanding or reopening.


In a report released last July, the National Center for Health Workforce Analysis, using 2014 as a baseline, projected both shortages and surpluses of RNs by region. It noted that in 2030, seven states will be affected by shortages, with those in California, Texas, New Jersey, and South Carolina the most severe.


It's hard to know if these projections will become reality, but given the growth of the aging population and the increased need for long-term and community care, coupled with the retirement and rapid turnover of acute care RNs, it's likely that all health care settings will need nurses. The Bureau of Labor Statistics projects that more than 1 million RNs will be needed by 2024, and predicts RN job growth through 2026 at 15%-faster than any other occupation.


A survey of 233 chief nursing officers conducted last July by national staffing company AMN Healthcare found that 72% said their shortages were moderate to severe, and most expected shortages to worsen over the next five years. They also acknowledged that the shortage was having a negative effect on patient care, patient satisfaction, and staff morale.


The class of 2018, it seems, is entering a job seeker's market. Workplaces that need staff now-or smart workplaces that wish to get ahead in the future-are in competition to recruit new staff. Organizations that can invest in new nurses with programs that provide support and training will have a leg up in recruitment. But retaining these new recruits needs to be a group effort involving all nurses in an organization. We know from studies such as the RN Work Project that the first year of a nurse's first job is a critical one, with almost 18% of new nurses leaving their first employer after one year. We need to welcome our new colleagues, be patient and supportive, and remember that once we were new and inexperienced too.