"Whatever jobs we have, we keep expanding. And our competitors are doing the same," said
Nursing jobs in
It's tempting to argue that nurse hiring difficulties, in
Hospitals, nursing homes, home care agencies and doctor's offices, like a lot of employers across the country, have a specific resume in mind. Employers often want new hires to have experience in a specialty such as operating room nursing. They may not be able to raise wages to easily attract that experience. Meanwhile many new nurses, armed with a degree that's supposedly a ticket to the middle class, struggle to land their first job.
Colleges aren't equipped to deal with this disconnect. Some employers, such as Houston Methodist, are addressing the problem by beefing up their internships and in-house training.
A long-term solution for the nursing workforce also would have to resolve critical pay issues, including whether
Most nurses are RNs, the single largest occupation in the sector that's set to become the nation's largest. They're the millions of men and women who give patients their medicine, monitor their vital signs and symptoms, and help them understand how to manage their conditions at home. Licensed practical and vocational nurses, who are credentialed at a lower level than RNs, provide more basic care, such as helping patients dress.
Over the past decade people have flooded into nursing programs at two- and four-year colleges, seeking good jobs in a growth industry that's all but recession-proof. The federal government projected that by 2025 the nation would have more nurses than it needs, but the study didn't consider the potential need for nurses in new roles as the health care system changes.
Today, as the number of graduates continues to rise, employers are increasing their requirements. A decisive shift occurred in 2010, when the nonprofit
A generation ago, all RNs had to worry about was getting their nursing license, which they could do without going to college by completing a nursing diploma or certificate program at a hospital. Now nurses with an associate degree, who still make up 40 percent of newly licensed nurses in
Many employers across the country raised their degree requirements during the Great Recession, according to Burning Glass Technologies, a company that analyzes online job postings. It's not clear whether this was because there were so many desperate job seekers that companies could afford to be picky, or because higher skills really were needed -- or both.
The decision to hire nurses with higher degrees was backed by research that found that patients did better at hospitals with more highly educated nurses. But there was an opportunistic element to it in some places, too.
Employers also want to hire nurses with work experience that nursing schools can't deliver. "People are looking for folks who are, quote, 'prepared' to start right away," said Dr.
So are employers in all kinds of industries. In
Health care employers say new nurses can't step into just any job. They can't yet hang an IV bag quickly or draw blood with steady hands. They need at least six months of on-the-job training and lots of mentoring -- expensive investments for any employer. Hospitals do hire and train new nurses, but they can only afford to safely orient so many at a time.
There's also no way new nurses can fill specialized, high-pressure roles in the emergency department, the operating room or the intensive care unit. Those are some of the toughest RN positions to fill nationwide. At Houston Methodist, some positions that require more experience can take over 86 days to fill.
Nursing schools can't prepare students to step into these jobs because it's illegal for unlicensed nurses to practice on real live patients. So during their limited clinical rotation hours, maybe 8 to 10 hours a week, students get to practice only basic tasks under close supervision.
The gap between nursing education and job openings isn't anyone's fault, said
Competitive Pay and Retention
Elite hospital systems can offer raises, bonuses and other incentives to attract the perfect candidate. Last year Houston Methodist offered a
When all else fails, the hospital will take on temp workers such as traveling nurses, who charge high hourly rates.
To one economist, raising compensation is an obvious response to a hiring problem. "I've never heard of jobs going begging. Remember, this is a labor market. Unless you underpay, you can fill jobs," explained
But some employers just can't do that. Low wages consistently create hiring problems for government jobs, from state troopers to prison guards.
Smaller health care providers can't raise wages, particularly those that rely on public funding such as
Nationwide, average RN pay is
Bloomer specializes in children who need hospital-level care at home. That might mean a child who can't breathe without a ventilator, or a child with severe cerebral palsy. "Every provider that's doing this is predominantly
Some open nurse positions in home care don't get filled at all, she said.
Location affects nurse hiring too, as in any other industry. Rural hospitals along the
Employers also have a retention problem. Being a nurse is demanding, and new nurses, like new teachers, are particularly likely to leave their jobs: About 20 percent of new nurses quit within a year, according to a 2014 study.
Some nurses say that their professional culture doesn't help matters. There's a saying that nurses "eat their young," meaning that more experienced nurses often bully newcomers. This kind of hazing isn't unique to nursing; it's also common in the skilled trades, for instance. But it helps push rookies out of a profession that needs them.
Bridging the Gap
To bridge the gap between nurse supply and demand, policymakers can do a few things, such as offering student loan assistance to nurses willing to relocate to a rural area. States can appropriate
Many employers are investing more in on-the-job training. Houston Methodist, like a growing number of hospital systems, puts new nurses through a paid six-month "nurse residency." It hires about 350 new bachelor's degree graduates into the residency each year.
The hospital has also created better pathways into specialties. At other hospitals, it would be rare for a recently licensed nurse such as
The hospital has found that its supportive residency program helps new nurses stick around, said
Participants spend two days a week working at a hospital and Saturdays working through online training scenarios or practicing on simulation dummies at
"It's very interesting that when they go for interviews and say they're doing a transition to practice program, they get hired," said Nwachi Chigbundu, who teaches the Lehman program. When she started her first nursing job, 25 years ago, she remembers going through a six-week orientation. "It's not really enough, because nursing is really complex."
This Story is Part Two of Help Wanted: Why Willing Workers Aren't Filling Open Jobs.
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