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How many times have you read about the staggering shortage of nurses? It’s routine to see numbers in the hundreds of thousands tossed around – representing the seemingly insatiable demand for nurses from an aging population. I’ve always been suspicious of these estimates. First, it’s not how the economy works. We’re not really going to have 260,000 unfilled nursing positions in 2025. Either supply will rise, demand will fall or there will be a substitution of other kinds of labor or capital. Second, these numbers often come from interested parties, usually advocates for higher nurse pay and benefit or people who are running nursing schools and would like them to expand.

So I was struck by an article today that mentioned a glut of nurses, even in places like California that mandate minimum nurse staffing ratios. The situation is blamed on the recession, which depresses demand as hospitals and other nurse employers seek to control budgets, and also increases supply as nurses delay retirement, seek more hours, or return to work when a spouse is laid off. I’m sure there’a lot of truth to this, but if there is really such a big shortage it shouldn’t turn into a glut so quickly.

I don’t think employers of nurses are quaking in their boots due to the prospect of a gaping shortage of nurses. Although they might not say so openly (since everyone loves nurses) the forward thinking hospitals are planning for the day when nurses comprise a substantially smaller portion of their costs than they do now. They’ll do it with better decision support systems, workflow tools and robots that will take over many routine and high-skill nursing functions. Hospitals may seem capital intensive now, but I really believe there will be even more substitution of capital for labor in the future.

So if you’re betting on a giant nursing shortage in the year 2025 my guess is you’re going to lose.

David E. Williams is co-founder of MedPharma Partners LLC, strategy consultant in technology enabled health care services, pharma,  biotech, and medical devices. Formerly with BCG and LEK. He writes regularly at Health Business Blog, where this post first appeared.

THCB is looking for nurses to blog on this and other topics. Send your posts to john [at] thehealthcareblog.com

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18 Responses for “Nursing Shortage: Is it a Case of Crying Wolf?”

  1. Peter1 says:

    “They’ll do it with better decision support systems, workflow tools and robots that will take over many routine and high-skill nursing functions.”

    My wife’s a NICU nurse, care to elaborate how a robot is going to “take over many routine and high-skilled nursing functions” in her unti.

  2. RJohnRNfromMiami says:

    Mr Wiiliams,
    Smart folk and educated, well-read folks happen to read this blog also. So may I suggest you read extensively on the topic, gather empirical evidence, and avoid conjectures. While I respect your right to journalistic freedom, you have the responsibility to publish facts not “guesses..” I highly recommend you purchase this text below and read it cover-to-cover and re-blog.
    “The Future of the Nursing Workforce in the United States: Data, Trends, and Implications. By Peter Buerhaus, Douglas Staiger, & David Auerbach, 2009, Jones & Bartlett Publishers.
    Thanks, John

  3. RJohnRNfromMiami says:

    Mr Wiiliams,
    Smart and educated, well-read folks happen to read this blog also. So may I suggest you read extensively on the topic, gather empirical evidence, and avoid conjectures. While I respect your right to journalistic freedom, you have the responsibility to publish facts not “guesses..” I highly recommend you purchase this text below and read it cover-to-cover and re-blog.
    “The Future of the Nursing Workforce in the United States: Data, Trends, and Implications. By Peter Buerhaus, Douglas Staiger, & David Auerbach, 2009, Jones & Bartlett Publishers.
    Thanks, John

  4. RJohnRNfromMiami says:

    Also, the work of Dr Linda Aiken, Christine Kovner, and countless articles published in “Health Affairs” are very informative and will be very helpful as you write your “factual” re-blog on this topic.
    Thanks.

  5. AM Judson says:

    I am a new RN, BSN, and I graduated without a job. 8 months later, I’m still spinning my wheels putting my CV online and begging for a chance to be part of the nursing field (I have a near-perfect GPA). The hospitals hear “new grad” and I get hang ups, rude comments, and slammed doors. If there were a nursing shortage, there would be new grad programs. As it is now, anyone in nursing school is NOT guaranteed a career or even a job.

  6. Jonathan H says:

    RJohn, please enlighten us, since many of us have an interest in the topic but aren’t going to read an entire book on it. On what basis is the argument for a shortage made? If the claim is that there is a shortage of jobs compared to what society should have from a public policy or historical per population levels, then I don’t see how you’ve refuted his point. If the argument for a shortage is based on data showing that many open nursing positions are going unfilled, at a rate higher than open positions generally, then I’d say your response was appropriate.

    David Williams’ point, as I read it, was not that there would be no health benefit from having more nurses, but that there is no major disconnect between nursing supply and demand in an economic sense, and that over time he would expect the demand for nursing to decrease on a per capita basis.

  7. Shyrock says:

    Although “glut” may be a strong term, this is happening all over the country. See this brief from Virginia here:

    http://www.dhp.virginia.gov/hwdc/docs/NursePrograms/2010FactSheet.pdf

    It seems a decade of shortage projections may have had the intended effect–higher production of nursing grads. New models of care and increased competition may mean BSN and masters trained nurses become more valuable, while ASNs and diploma-trained nurses find fewer and less rewarding opportunities. (As in most professions, the need for constant education is increasing.)

    • Irene says:

      I find that hospitals will hire an ASN with experience before they hire a BSN with none. Also, the industry said they would do away with the LPN, and I see plenty of LPN jobs out there. The only reason I won’t go for a BSN, is because the curriculum is mostly management/social work, which doesn’t warrant all that classroom work and expense.

  8. John says:

    It seems there is always some sort of discussion surrounding a shortage of nurses in the healthcare industry. What perhaps is an interesting take off on this article is discussing the expanding roles nurses may occupy with the passage of the ACA and the need to keep practices running. It might just reframe the nursing shortage discussion we hear way too often.

    http://bit.ly/Aypg0G

  9. Irene says:

    There may be a shortage of nurses willing to work for $15.00/hr, which I think is the health industry’s goal. Also, if we would finally solve the horizontal bullying crisis, 1 in 5 nurses wouldn’t leave the profession.

  10. Majicdanser says:

    While I can see your point that automation and technology will improve greatly in the future – with a genuine point of reducing human error and improving patient health outcomes – there is one critical element that they cannot provide. This is intelligent decision making, critical thinking regarding proper treatment modalities, and of course, the healing human touch. A machine administering medication may not only cause fear in the patient, but interaction precautions and post-administration reactions require the education and experience of a human being.

    Right now, I agree that we should NOT be focusing on the “nursing shortage.” The glut of nurses exists in the bottleneck created by the renewed interest in healthcare careers by those disenchanted with status-quo business practices and desk jobs that give little satisfaction. We are promised valiant careers as EL-MSN programs come to fruition. For the reasons you list, nurses aren’t creating space for new graduates to be trained.

    Hence, what we have is a “glut” of graduated nurses (many, like myself, with RN, BSN and RN, MSN degrees) without the prospect of ANY job openings. There are 1000′s of new nurses competing for new grad programs that only admit 5-10 nurses!

    I am a person that entered nursing genuinely for the love of the profession and to help escort it into an era where medicine is so complex and treatments so involved, that highly educated nurses are needed in order to fulfill the expectations of the public – and rightly so – to receive excellent care in our hospitals and to have as close to 0 human errors as possible.

    Robots, computers, and technology won’t replace the need for nurses in the future. That much is so very true in so many ways. But we need to focus on training the new graduates that are needing 1-2 years residency experience in the acute care setting in order to be effective. Right now, we are wasting an amazing amount of human capital.

    • Sandra_Raup says:

      Just to clarify – are you suggesting we need highly educated or highly experienced? Are you talking about skills in reliably and competently performing a complicated task, such as those that involve complex machinery or that require difficult manipulation (lines, airways, etc.)? Or are you talking about the need for more cognitive skills – such as observational or computational skills? I think it’s hard to determine what training, education and experience is needed without thinking about what’s really needed and how best to get there. I’m not sure more (classroom) education and residency experience are both needed; if they are, what’s the goals of each?

  11. Bsn student says:

    Predicting robots performing cares on patients is ridiculous. I hope nobody makes their career decisions based on idiotic predictions like the ones in this article.

  12. EMacDonald says:

    “the glut of nurses exists in the bottleneck created by the renewed interest in healthcare careers by those disenchanted with status-quo business practices and desk jobs that give little satisfaction.”

    That’s one I haven’t heard before. Usually when the nurse lobby stirs itself for a renewed round of scare tactics the bottleneck contains all those who desperately want to get their BSNs (aka the only nurse who counts) with “too few seats” due to “too few faculty” even though they are simultaneously demanding that faculty have a minimum DNP degree by 2015.

    What a mess. Anyway, Dr Buerhaus recently let fly with the statement that the 2002-2009 RN cohort is the largest seen since they began collecting data. They are finding faculty someplace! He stated that if interest continues among young people as it is now, the supply of nurses will remain at parity with population growth until 2030.

    He mysteriously began to couch his statements right away though, as the nurse lobby stirred itself for a trip to the woodshed for their usually reliable talking-point pal, Peter Buerhaus. Poor guy, yikes!

    That’s why we saw the NEJM letter, and a strangely coerced sounding “qualifier” released by the aacn. called “there is too a nursing shortage!! It’s biblical in it’s awesome horribleness!” Not sure if it was a Fact Sheet, a Press Release or an Alert, though.

  13. Anne Judsosn says:

    The bottleneck exists. It is the “new grads” that are not only not finding jobs, but are receiving anger, degradation, and humiliation in the community for even looking. I am genuinely qualified to become a nurse and spend my days at the coffeeshop putting in at least 8 new applications per day, each accompanied by a “no” letter.

  14. Micah says:

    Countries which economies is driven by their labor force such as India and the Philippines for example will always be able to fill this shortage. And also, machines will never replace the tender care of a living person.

  15. EMacDonald says:

    We don’t need to import foreign nurses because there is no nursing shortage. US trained nurses are taking jobs in fast-food restaurants and as topless maids because they cannot find jobs as nurses. We are hearing reports of facilities laying nurses off in anticipation of ACA implementation, not the catastrophic shortage it was supposed to cause. Their selfishness disgusts me.

  16. Cuando veo su feed RSS que arroja un montón de basura, es el mal funcionamiento de mi parte?

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