Thursday, January 17, 2013

A nursing surplus?

From last June, noted employment commentator and Wharton professor Peter Capelli on nursing jobs (my emphasis):
Community colleges are jammed with people who’ve already got college degrees, people trying to get practical degrees. The nursing shortage is no longer. Even the employers have said there’s no shortage of nurses now, because so many people were chasing those certificates and those degrees and those learning experiences. 
Thanks to @CoulombicExplosion, I see some confirmation for that opinion this week via CNN:
About 43% of newly licensed RNs still do not have jobs within 18 months after graduation, according to a survey conducted by the American Society of Registered Nurses. "The process has become more and more discouraging, especially since hospitals want RNs with experience, yet nobody is willing to give us this experience," said Ronak Soliemannjad, 26, who has been searching for a nursing job since she graduated in June.
They interview Professor Peter Buerhaus, a registered nurse and a health economist, who has an interesting hypothesis:
Prior to the recession, about 73,000 nurses left the profession each year due to childbearing, retirement, burning out or death. But when the recession hit, spouses lost jobs, 401(k)s lost money, and facing financial uncertainty, fewer nurses chose to leave work, Buerhaus said. "Many of those nurses are still in the workforce, and they're not leaving because we don't see a convincing jobs recovery yet," Buerhaus said. "They're clogging the market and making it harder for these new RNs to get a job."
My thoughts on the CNN piece:
  • Profound sympathies to young nurses, who are getting into a tough field because of practical reasons. I suspect a lot of nurses will be moving to fairly remote places to do healthcare; that's not fun. 
  • Buerhaus' working hypothesis is that nursing employment is counter-cyclical; that nursing employment is high when unemployment is high and vice-versa. His NEJM paper from 2012 indicates he thinks that nursing employment will trend back down as the economy improves. I'll be frank, I'm skeptical, because I'm waiting for other shoes to maybe drop in 2013. 
    • That said, those same shoes (slowdowns in China, overall middling GDP growth in the US (predicted to be 1.5 or 2%), a crummy UK/Europe economy) were supposed to drop in 2012. 
  • Buerhaus' NEJM paper seems to say that it's possible to have 2 problems: a short-term pop in the supply of nurses and a long-term shortage as the US population ages and demands more healthcare. 
    • I wonder how that might apply to chemistry? 
  • If you go to the American Society of Registered Nurses, you'll see a "Save the Grads" program. It's a program to locate entry-level positions exclusively for young nurses. It'd be pretty darn great if other professional societies, say, the American Chemical Society, would be willing to do the same thing. 
Readers, thinking about nursing? (Get some good shoes.) 


  1. 1) It sounds unusual - most places like new grads because (if they don't place a high value on experience) they're cheap (which means more money for them).

    2) Our local health conglomerate (probably in part because of cost pressure from the large insurance company that manages my health care) laid off most of the nurses where my doctor is and replaced them with cheaper medical assistants. I wonder if the future shortage of nurses will actually occur or be mitigated by similar means. That would mean that long-term employment of nurses might be a problem.

    Saving grads won't save them for anything other than long-term unemployment if the market contracts (I can't imagine that Obamacare/health insurance oligopolies will help any). If their prospects are poor in the future (if current higher-paying jobs are sacrificed to fund jobs for grads, they can safely assume that when they are getting paid, their turn will come), they won't become nurses (unless they really like it, or have no better choice). This sounds familiar.

    Announcements of labor shortages sound like advertisements and come-ons for casinos - the house (employers) always win. Employers have strong incentives to get around shortages (just like us) and without labor organization, they have plenty of leverage to avoid them (or avoid paying for them if shortages occur). Just in case those methods don't work, they can always ask the government to help (with subsidies, visa slots, or training assistance) without being perceived as lazy as individuals would be asking for the same (though that is primarily for larger companies or industries).

    With all this, betting on (hyped) labor shortages to find a good career seems like a sucker bet. If you love it, the path is worth it. If not, the money to make the path worth it will probably be a mirage, and so the path will not be worth what it took to get there, if there is a "there".

  2. This is good news for the country I'm in. There is a nursing shortage and no will to pay them a lot of money. They get really low salaries, resulting in them wanting to move to the US. Now that that option is cut off, they'll be more trapped. However,the government is still a bit screwed since not enough students are going into nursing.

  3. My spouse has been an RN for just under 20 years now. What he's seen happen, locally in our small university town, is that nursing schools are expanding and/or opening up and producing more nurses, and that the market is shrinking for new, fresh graduates. In addition salaries are dropping across the board, locally. This is because we now have 2 nursing schools in this town, each producing up to 20-40 grads per year. The trend is for the new grads to gain experience anywhere they can (as EMTs, techs, etc.), for low salaries, then move to a large city where they can command higher salaries. I'm also seeing more and more "nursing internships" or unpaid positions to gain experience in a specific area of nursing. In the large cities we're seeing signing bonuses for those with experience in addition to opportunities to make extra money by picking up call shifts. As a result, the nurses with experience commute to the large cities and the working conditions for those who stay locally aren't exactly good for their mental health. Being a disposable commodity and all.

    It's been my own observation, from years of talking with my spouse about the job, that even in the best of hospitals, nurses get piled on with bureaucracy and bizarre management policies. Unlike the majority of docs (most of whom are more like independent contractors), the nurses are hospital staff and subject to the totality of hospital management, for better of worse. The flood in the market is not helping these things.

    And to really drive the point home, our small town has a large (for here) brand new hospital under construction. They're not currently hiring nurses. The job postings are for administrative staff, requiring an advanced degree (some state BSN/MSN, others PhD/MD or MBA) and experience.

    The one area of healthcare where I'm still seeing active recruiting is neuromonitoring and other surgical monitoring. They're looking for people with a BS in bioscience (or nursing degree or surgical tech certification) and will train and provide the first year's job placement, along with an okay salary.

    And the one area that I can't understand why there's a flood of grads is forensics. I get it that the TV shows are cool and all. But the actual job is far from what you see on TV. The starting positions basically pay less than a living wage to work in terrible conditions (I know of at least one lab lacking air the South) and they require a bare minimum of a BS in a STEM field (some require an MS or PhD). There are a number of nationally regarded experts in the field adjuncting in order to pay the bills.

    Also, locally, we're in dire need of veterinary techs (Associate's Degree) and veterinary diagnosticians (AS through DVM/PhD). To the point that I've seen university personnel recruiting at high schools and offering full scholarships. The pay's terrible and won't increase any time soon because the people hiring simply can't afford to pay more. But there are many jobs available. And another university is constantly stealing our good people from us.

  4. My limited experience as a patient in a major city over the past few years has been that when I go to a doctors appointment, I see a nurse (or some other tech) for most of the appointment and the doctor comes in for less then 10 minutes. The doctors office charges me a small co-pay and then bill the insurance for hundreds of dollars if even a minor exam procedure occurred in the exam room. Based on the jewelry, clothing, shoes, and phones of the doctors vs the nurses, I guess that the nurse gets the smallest portion of the insurance's payment despite spending the most time with me. I think it is a lousy deal for the nurses and patients. I wish I had the option of going to a veterinarian for my health care instead- it would be cheaper for procedures and tests, appointments actually run on time, I would actually get to talk to the doctor for 45 minutes, and I wouldn't have to deal with as much paperwork/ insurance hassles.

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