RNs-An Endangered Species?

My cousin recently graduated from high school and asked me for career advice. After much consideration, research, and an in-depth interview with the Chief Communications Officer at the American Association of Colleges of Nursing, I finally felt ready to give the answer she was seeking: nursing.

Job fulfillment and personal reinvention are welcome bonuses for my cousin, secondary to the chief precondition for the perfect job: competitive salary. Upon her graduating college and joining the workforce, the ideal profession must guarantee available job posts as well as reasonably rapid national growth, in spite of the job market. In other words, she’s inadvertently describing the nursing industry.

Lucrative Career
Not only is nursing in the top 10 jobs with the highest starting salary1, but the projection for growth and advancement is promising, with ample ever-evolving, ever-increasing specialties to choose from, ideal for customizing interests for long-term satisfaction and achieving ultimate income goals. If that’s not enough for my cousin, nursing students are predictably hired immediately upon graduation. In short, as the demand for registered nurses continues growing, both in the hospital setting and across universities, the number of job slots opens at a faster rate than being filled. Thanks to the national nursing shortage 2, my cousin will apparently be permanently guaranteed a nursing position, no matter the job market.

My cousin was almost convinced, but evidently she swoons at the first sight of blood and prefers suits to scrubs. (I figured Scrubs would’ve launched the medical uniform fashion trend by now.) And speaking of Scrubs, seemingly at this rate there’ll soon be more nurse-centric hit sitcoms than actual registered nurses. Indeed sitcom comedic effects are therapeutic, but until media technology is sophisticated enough to change bedpans, deliver babies, and administer medication in a timely manner, we remain dependent on reality (not “reality”) nurses to reverse our nation’s declining quantity and quality of care, and thereby preclude the emerging crisis in the healthcare industry.

In fact, the nursing shortage across America is generating a variety of preventable complications, including medication errors3, overcrowding in emergency rooms4, and mor alarmingly, unexpected patient deaths5. On the education front, the shortage of registered nurses equates to a deficit of hospital health educators and nursing programs, which in turn fail to meet the growing demand of well-qualified student applicants6. In other words, the registered nurse shortage limits the student admission load, particularly at a time when the demand is ever increasing.

Nursing Education Perspectives
Within the last 20 to 25 years, nursing diploma schools have been disestablished in numerous hospitals, consequently shifting education from hospital-based schools to academic centers that offer 2-and 4-year degree programs. Correspondingly, the number of educational slots required by healthcare employers is lagging as academic centers draw an inadequate number of nurse educators. This phenomenon may be directly linked to the healthcare industry’s increasingly stricter standards and stronger preference for nurse educators to hold an MSN degree or higher- a condition that potentially limits the pool of faculty applicants and increases the number of vacant teaching slots within the academic system.

For a more comprehensive account of nursing faculty shortage implications on our nation’s educational infrastructure, I consulted Robert Rosseter, Chief Communications Officer at the American Association of Colleges of Nursing (AACN), in Washington, D. C. “Similar to expectations across the health professions, nursing schools [including academic health centers] are to a great extent seeking faculty with doctoral level preparation. AACN’s latest faculty vacancy survey found that most of the open teaching positions (88.3%) at schools offering baccalaureate and graduate programs were for faculty roles requiring or preferring a doctoral degree.”

SEE ALSO: The Graying of Nurse Educators

However, Rosseter went on to explain that while having more well-educated nurses in the workforce improves patient care, it may likewise account for the high faculty vacancy rates and subsequent denial of qualified applicants. “AACN latest annual survey from 2012 found that for entry-level baccalaureate programs, 259,150 applications were received at nursing schools; of these, 162,978 met admissions qualifications and 104,864 were accepted. Primarily due to insufficient faculty and clinical training sites, 58,114 qualified applications to these programs were turned away.” To which my cousin quipped that if even well-qualified students are being rejected, then she definitely stands no chance.

Where are the Educators?
Granting Robert Rosseter’s meaningful firsthand perspective, I hoped to further examine the causes, trends and cold, hard truths behind the faculty shortage and its long-term impact on our nation’s hospitals. So I turned to my mom- a registered nurse, incidentally, close to retirement age. My mom directed my attention to the issue from which most problems stem: money. Upon researching this particular millstone around the collective neck of America’s nursing workforce, I discovered that indeed the pay-scale for even doctorally-prepared nurses with a capacity to teach is less competitive compared to pay-scales of “bedside” nurses, in this way further contributing to a substantial shortage by means of nurse educators.

But in terms of the standard pay-scale effect on the deficit, the salary is adequate enough to draw men into the profession, which was unheard of approximately forty years ago, with almost 9.6% of registered nurses in the US being male, compared to 2.7% in the 1970’s7. Parenthetically, despite being a minority with less cumulative presence in the nursing field, men nevertheless net a dollar for every 87 to 93 cents a female nurse earns in the same role8. For men and women alike, a 2009 salary survey determined that current salary levels for an entry level nurse with a two-year associates degree exceeds $60,000 per year, which includes the base salary, plus additional compensation for working on weekends, off-shifts, holidays, etc. Experienced nurses earn considerably more. Gucci scrubs anyone…?

Apparently not. An appetite for increased wages is permanently unsatisfied, rising more rapidly than a revenue sources available funding to pay for patient care. Complications attributed to the lack of funding impact the availability of laboratories, clinical facilities, nurse educators, and as previously stated, potential number of students pursuing a career in the healthcare industry. In addition to this trend, the shortage is compounded by the fact that currently employed registered nurses (like my mom) will be reaching retirement age within the next decade10. In other words, the number of students being prepared for nursing posts falls short as the projected retirement pattern of the older personnel increases, creating hospital nursing vacancies. In fact, due to the retirement trend, it is estimated that the nursing workforce may fall by 20% below the demanded level in 202011.

Of course this projection translates into short-staffing issues, which not only pose discomfort for the patients, but for on-duty nurses as well12. Particularly, the unfilled hospital posts create unfavorable working conditions due to inconvenient shifts, understaffing, and a disproportionate nurse-to-patient ratio13, as well as ensuing poor nurse retention14, all of which contribute to the issue long-term. In turn, new issues are raised as registered nurses inevitably seek employment opportunities beyond the scope of hospital stations- a trend that has developed significantly in the past several years. As such, non-hospital alternatives are sought in clinics, home health care agencies, and even attorney offices, thus increasingly redirecting nurses from the vital “bedside” roles. Such expansion of employment sites is steadily broadening the quantity and variety of desirable posts that draw in professional RNs, thus decreasing the hospital applicant pool.

Strategies to Bolster the Nursing Workforce
All the aforementioned factors contributing to the nursing shortage needn’t intimidate nor discourage potential candidates from pursuing a faculty-based or “bedside” post. Naturally there are solutions to direct nurses back to hospitals and ensure improved educational outcomes. It is just a matter of thinking outside the box in terms of academic innovations, educational partnerships as well as improved academic training strategies, external funding acquisition, and, as Robert Rosseter pointed out, advocacy. “AACN advocates for increased funding for graduate nursing education at the state and national level to help expand the pipeline of future faculty. Coalitions in almost every state are working to address the nurse faculty shortage as a top priority.”

My cousin’s growing concerns regarding higher education requirements and corresponding debt accumulation are not unfounded; however, according to AACN, these concerns are continuously addressed by the many state and nationwide actions currently underway, including loan forgiveness programs, salary supplements, faculty fellowships, and millions of dollars in funding for scholarship programs that expand faculty resources and enable students to earn advanced degrees. Additionally, hospitals are steadily putting more effort into subsidizing nursing faculty degree programs, maximizing the educational capacity of nursing schools, reimbursing nurses for advancing their educations, and are now seeking private support to strengthen the nursing workforce both on the hospital and educational front. If that’s not enough for my cousin, there are public awareness campaigns, minority expansion programs, and government legislations aimed at expanding and diversifying the pool of current and future nurses.

Clearly there’s no shortage of strategies to address the nursing shortage. And in addition to all the efforts to facilitate doctorally prepared nurses, there’s a surplus of job opportunities in the fields of research, healthcare administration, consulting, academics, advanced practice nursing and even entrepreneurship- all available and ready to hire recent graduates seeking fulfilling jobs with ever fulfilling benefits.


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Karina Gordin works for HealthWright in Wayland, Mass.

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