Tag: nursing shortage

Nursing shortage or nursing surplus?

February 11th, 2015 by

I’ve been a bit of a broken record about the so-called nursing shortage since at least 2009. (See here, here, here, here, here and here.) The conventional wisdom has been that we are facing a looming, massive shortage of nurses –in the hundreds of thousands in 10 or 15 years. I’ve always looked at those numbers with raised eyebrows, especially since they are often pushed by those with a vested interest in boosting the number of nursing students.

Of course there are variations by region, specialty, and level of expertise but in general the idea of a big nursing shortage just didn’t make sense to me.

So I was gratified to receive the following note from a researcher at Staffing Industry Analysts:

Hey David,

I ran across your article in 2013 about the nursing shortage rhetoric being hootzpah. Good article, and turns out you were right on the money. Not sure if you’ve seen, but the HRSA just updated its projections and now projects a nursing surplus of 340,000 nurses by 2025 (given current conditions continue).

Wrote an article on it here if you’re interested.

Sure enough, the government’s estimate of the balance between supply and demand has shifted radically. In 2002 HRSA predicted a shortage of 800,000 RNSs by 2020. The latest estimate shows a surplus of 340,000 by 2025. The biggest reason? A huge increase in nursing graduates.

I think the long-term outlook for nursing demand may be even more dire, because forecasters tend to neglect the long-term substitution of capital for labor. There will still be a lot of nursing jobs, but nurse productivity will increase as technology improves, and some tasks done by humans today will be done by robots in the future.

 

More nursing shortage myth building

February 4th, 2014 by

My piece on the nursing shortage myth received more than 100 comments when it was reposted on the Health Care Blog a year ago. My basic theme was as follows:

  • There’s a well-established narrative that there is a large and growing shortage of nurses
  • Evidence to the contrary –such as difficulty of new nursing graduates finding jobs– is dismissed by nursing shortage cheerleaders with two arguments: 1) experienced nurses come back into the workforce when there’s a recession, and 2) demand will explode over time as older nurses retire and baby boomers age
  • These arguments don’t hold much water and I am not particularly worried that the country will run short of nurses
  • Many of those predicting a looming nursing shortage have a vested interest in doing so because they are involved in the business of running nursing schools

It seems like I could re-write that blog post every year or so, because there always seems to be a new story acknowledging the current surplus of nurses but predicting a giant shortage in the future. I wrote a similar post a year earlier, for example.

Today I read another story about the so-called nursing shortage in HealthLeaders (New Nurses Report Tougher Job Market):

“The economic recession may be to blame for a downturn in demand for newly licensed registered nurses, suggests a survey from the Robert Wood Johnson Foundation. The lead author speculates, however, that demand will grow stronger as healthcare reform is implemented.”

The author –a professor of nursing– says the problem is the recession. Then she adds that older nurses are going to retire and the Affordable Care Act is going to boost opportunities. “The opportunities for nursing are going to be humongous,” she concludes.

As before, I have my doubts:

Workforce projections rarely take into account long-term technological change, but simply assume that nurses will be used as they are today. I’ve taken heat for writing that robots will replace a lot of nurse functions over time. People seem to be offended by that notion and have accused me of not having sufficient appreciation for the skills nurses bring.

So let me try a different tack. Think about some of the job categories where demand is being tempered by the availability of substitutes. Here are a few I have in mind that have similar levels of education to nurses:

  • Flight engineers. Remember when commercial jets, like the Boeing 727 used to fly with two pilots and a flight engineer? Those planes were replaced by 737s and 757s that use two member flight crews instead
  • Junior lawyers and paralegals. Legal discovery used to take up many billable hours for large cases. Now much of it is being automated
  • Actuaries. Insurance companies used to hire tons of them, but their work can be done much more efficiently with computers

I don’t hear visionary leaders of provider organizations banging the drum about a nursing shortage and clamoring for more grads. And if somehow I’m wrong and demand rises, the problem can be solved with a more welcoming immigration policy.

Like I wrote before, “If you want to be a nurse, go for it. But if you’re choosing nursing because you think it’s a path to guaranteed employment, think again.”

—-

By David E. Williams of the Health Business Group

More from the nursing shortage myth annals

December 2nd, 2013 by
Good news or bad news?
Good news or bad news?

FierceHealthcare has a weird little article about nursing shortages or lack thereof (As market worsens for hospital jobs, nurses look elsewhere). As I’ve written before, the nursing shortage is a myth. If you’re thinking of going to nursing school or sending your son or daughter there based on the inaccurate notion that good nursing jobs are plentiful, you should think twice.

The Fierce article mixes together two articles that tell almost opposite stories. The first, from the Indianapolis Star describes the dearth of hospital nursing jobs –which generally pay well. Nurses who can’t get jobs there are moving down the food chain to lower paying outpatient and home care positions.

New nurse grads are sending out 60 to 100 resumes and getting no responses, we are told.

That article mirrors my sense of the market. If there were a real nursing shortage you’d expect employers to be talking about it, yet I almost never hear a hospital clamoring for more nurses to be trained. Contrast that with the situation in high technology where employers are constantly beating the drum for more STEM (Science Technology Engineering Math) graduates.

The second article from the Long Beach Press Telegram is about a faculty shortage in the California State University system. Something like 90 percent of qualified applicants are being turned away, which we are told “is exacerbating the state’s nursing shortage.”

Actually, with a national nursing glut, the applicants may be receiving a blessing in disguise.

A commenter captures my feelings about the article well. He has a niece who graduated with her RN but is still waitressing six months later. Meanwhile, “if California has such a shortage of nurses, why don’t some of the new grads sending out the 60 to 100 applications go west?”

photo credit: HikingArtist.com via photopin cc
—-

By David E. Williams of the Health Business Group.

When evaluating physician and nurse shortages, consider the source

November 15th, 2013 by

‘Alarming’ Physician Shortages Lie Ahead, according to a HealthLeaders headline that’s bound to raise your blood pressure. Chances are you’ve seen even scarier articles about the looming nursing shortage, with predictions of a shortage of hundreds of thousands of nurses in the coming decades.

We do have serious doctor and nurse workforce issues in this country and we need to plan for the future, but before you get too worked up, it makes sense to consider the source of these pronouncements. The latest doctor shortage warning is brought to us by the Association of American Medical Colleges, a group whose objectives are to expand medical school enrollment and boost federal funding for residency programs. The original article appears in the current Health Affairs issue that’s devoted to “redesigning the health care workforce.” As I mentioned earlier this week (Talking sense about the physician workforce), the issue as a whole is a breath of fresh air in that it is largely free of the alarmist approach to the topic. My favorite articles Expanding Primary Care Capacity By Reducing Waste And Improving The Efficiency Of Care and Accelerating Physician Workforce Transformation Through Competitive Graduate Medical Education Funding demonstrate sound, innovative alternatives to simply jacking up the number of medical students. Maybe HealthLeaders should cover the full issue rather than just the extreme perspective.

As I’ve documented repeatedly, the nursing shortage is a myth. Nursing schools have boosted their enrollment and students have flocked to borrow money for tuition with the expectation of secure job prospects. And yet many new nurses can’t find jobs. Look closely and you’ll find that many of those that talk about a nursing shortage are the nursing schools that train nurses and not those who employ nurses –such as hospitals. In this case, proponents of the nursing shortage myth have harmed would-be nurses by misleading them about the job market.

So yes, let’s have a rational discourse about workforce needs and consider training more people when appropriate. But let’s not get too worked up by self-interested attempts to boost the medical and nursing school industries.

By David E. Williams of the Health Business Group.