The Nursing Shortage Myth

The Nursing Shortage Myth

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For years we’ve read that the US faces a looming shortage of nurses. Shortfalls in the hundreds of thousands of nurses are routinely predicted. These predictions have been good for nursing schools, which have used the promise of ample employment opportunities to more than double the number of nursing students over the last 10 years, according to CNN.

Yet somehow 43 percent of newly-licensed RNs can’t find jobs within 18 months. Some hospitals and other employers openly discourage new RNs from applying for jobs. That doesn’t sound like a huge shortage, then does it?

But the purveyors of the nursing shortage message have an answer for that. Actually two answers: one for the short term and another for the long term. The near term explanation is that nurses come back into the workforce when the economy is down. Nurses are female and tend to be married to blue collar men who lose their jobs or see their hours reduced when the economy sours, we’re told. Nurses bolster the family finances by going back to work –or they stay working when they were planning on quitting. There’s something to that argument even if it’s a bit simplistic.

The longer term argument is that many nurses are old and will retire soon, just when the wave of baby boomers hits retirement age themselves and needs more nursing care. Don’t worry, the story goes, there will be tons of jobs for nurses in the not-too-distant future. This logic comes through again in CNN’s story:

Demand for health care services is expected to climb as more baby boomers retire and health care reform makes medical care accessible to more people. As older nurses start retiring, economists predict a massive nursing shortage [emphasis mine] will reemerge in the United States.

“We’ve been really worried about the future workforce because we’ve got almost 900,000 nurses over the age of 50 who will probably retire this decade, and we’ll have to replace them,” [economist and nurse Peter] Buerhaus said.

I don’t buy this logic. And I stand by what I wrote almost a year ago in Nursing shortage cheerleaders: There you go again:

My issue with the workforce projections is that they don’t 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 know exactly how the nursing profession is going to evolve but I do notice that the advocates for training more nurses are typically those who run nursing schools rather than prospective employers of nurses, such as hospitals.

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.

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.

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171 Comments on "The Nursing Shortage Myth"


Guest
Carol W
Jan 15, 2013

I find your argument for the fake Nursing Shortage to be a pretty good one. The fact is, that most nurses look to work in hospitals and nursing homes for the steady hours, benefits, etc. The home care industry, which also employs many nurses has its problems due to the reimbursement issue from Insurance companies and Social programs, which only pay for short term visits, i.e. 2 to 3 weeks past discharge. Some states had been putting together programs to keep certain long term patients in their homes with the help of these agencies, but these are also dependent on funding. Areas of nursing that are lacking in specialists are also lacking in education programs. There are many specialties where there are Physician shortages, and these could be assisted by Nurse Practitioners, but there are no education programs for them to go to. So, in one case you are correct, the generic nurse is not going to find work very easily; but with a little research, they may find their niche and hopefully an education program to go to.

Guest
Sheila
Apr 18, 2013

Chances are you are not a nurse. Big pharmacy and big hospitals have been claiming nursing is a dying profession.Can you explain to me why nursing is still considered the second future profession? May I suggest you and Mr QIlliams allow a robot to take care of you on your dying days. Pharmacy companies own this country. You support Mr Williams you support big industry.

Guest
Sandi
Nov 8, 2013

I don’t believe that you are a nurse

Guest
J Thompson
Apr 19, 2013

My money says you are not a Nurse. There are 10 times the amount of nurses needed. It is Absurd.

Guest
m jadhav
Jun 3, 2013

Ill tell you this the patient load is way overloaded. So maybe there needs to be ten times the amount of nurses. OHHHH I forgot Obamacare took care of that little hope.

Guest
Sandi
Nov 8, 2013

You are correct

Guest
Luigi
Jan 14, 2014

I see why Obama was so desperate about creating Obamacare, yes it is true that there will be millions of people that will need medical care in the future, the problem is that a lot of these people can’t afford healthcare, or most jobs do not offer it.

Guest
J Thompson
Apr 19, 2013
Guest
Whatsen Williams
Jan 15, 2013

There sure is a shortage of good nurses. There sure is a shortage of nurses who spek out on the errors caused by CPOE systems. There sure are too many complex patients for the reant-a-nurses that inhabit the wards. There sure is a shortage of nurses who know their patients. I bought several Tolstoi novels to read while waiting for nurses to find the information I need to make appropriate decisions on my patients.

Guest
sueB
Sep 15, 2013

Your spelling is atrocious.

Guest
Peter1
Jan 15, 2013

“I’ve taken heat for writing that robots will replace a lot of nurse functions over time.”

Yea, and Popular Mechanics has been predicting every dacade or so we’ll all have our own personal flying machine.

“I don’t know exactly how the nursing profession is going to evolve…”

That’s for sure.

Guest
tcoyote
Jan 16, 2013

I’m with Peter on this one. Take a look at the age distribution of practicing nurses at any level. It has a huge “boomer bulge”. And those boomers have worked overtime without pay both at patients’ sides and feeding their insatiable electronic health records. When they quit, and it could be any day now, expect serious shortages of the unpleasant and underappreciated hospital and nursing home venues that will last for many years. This is an emerging disaster.

The really hard part of nursing will not be automated in our lifetimes. We could alleviate the coming shortage by re-examining all the Mickey Mouse “check the box” documentation requirements we’ve heaped on nurses, and by making the EMR’s truly functional and user friendly.

Guest
MlClem
Jan 16, 2013

Oh, thank you for that. “Insatiable electronic health records….” brilliant. They have become my patient. The crying babies in the isolettes only get in the way. Someone should let the hospital administrators/educators know that EMR won’t save any time for bedside caregivers if you add a new tome of ‘checky-box’ forms about every month.

Guest
AngryRN
Mar 15, 2013

Amen. The emrs are patients now. They are forms designed to make the institution blameless. It becomes mindless clicking.

Guest
Sheila
Apr 18, 2013

Electronic charting has done nothing but increase workload for nurses.Hospitals care far more about that electronic check mark than patient care
Also how many robots do you know that can clean stool, urine and get disabled patients out of bed. Waiting with bated breath for that. HAHA. Signed full-time baby Boomer critical care nurse.

Guest
Sandi
Nov 8, 2013

So i guess nurses (who you most likely aren’t) will just be taking care of code browns, and robots will do the rest.

Guest
jjr
Apr 18, 2013

I have been hearing that for 10 years..they ‘aint gone yet. These people intend to work until they die..

Guest
Jan 16, 2013

Nice post

Member
Jan 16, 2013

I know plenty of administrators looking for nurses and plenty of new nurses looking for jobs. The problem is the administrators want trained nurses and many young nurses leave the profession after a few years because of the variable hours, physically difficulty responsibilities and un-sexy work. In addition, there are challenges in employment positions due to the unionized model that many states employ. Lastly, but not least – ask any senior nurse (who, @whatsen williams, know their patients, are more than willing to fight physicians, and don’t have a shift mentality) about the quality of the younger generation of nurses and a long discussion will take place about the poor attitude and lack of ownership and responsibility in the latter group.

That being said – several truths here – (1) many nurses have gone back to work or are working till an older age due to the shitty state of the economy (2) as the demand on the system increases, there will be a greater need of non-MD practitioners (NP, PA, RN, etc) (3) as costs have to be managed better, much of the rote work will be assigned to the non-MD practitioners to more efficiently manage expensive resources.

Guest
J Thompson
Mar 23, 2013

I can tell there are alot of Non-nurses chiming in here. First of all, the industry is moving rapidly toward using nurses from the Pacific rim. Their bedside manor sucks, their skills are not that great, and you cannot even understand many of them…but they work CHEAP. THAT is the trend in the industry.
There is not, nor has there been for the last 7 years, a nursing shortage. There was a short shortage for about a year in 2006, but literally hundreds of private nursing schools sprang up, and the gap was quickly filled..but these schools didn’t want to close, so we get the “Shortage” myth, year after year. What there IS a shortage of is foreign nurses willing to work for nothing. My hospital just completed a recruiting trip from the Philipines, even though we have at least 2500 apps on file for RN’s.
The truth is far simpler than all the non-nurses here analyze it to be. Hospitals are looking to hire cheap nurses ONLY. Less than 8% of new-grad RN’s find work within 18 months..that’s a year and a half!

Guest
3 year RN license no job no RN experience
Apr 19, 2013

It is time TO TELL IT LIKE IT IS! Nurses let their own profession drive TRUCKS over them. Then when they speak up it is with a nursing union that winds up stabbing them in the back! WHY are nurses so spineless. So fearful of retaliation and retribution so they say and do nothing, to advocate for themselves?! It is ridiculous. In a newly released book that addresses “Toxic Nursing:…” a “controversial” recommendation was made to resolve the problems with nursing. The resolution offered was to higher more men!

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J Thompson
Apr 20, 2013

The CNA is possibly the worst union that ever was..

Guest
Brewskie
Dec 5, 2013

Are you an RN, or are you merely a troll?

Guest
volcanikred
Sep 18, 2013

The Philippines only spends 3% of its GNP on healthcare. Their kids die of pneumonia and they stick out the begging bowl for foreign aid instead of “nursing” their own. Let’s not forget the role of a certain large religious denomination in bringing in these nurses for decades and degrading working conditions for American nurses.

Member
Jan 16, 2013

Be wary of analysts bearing “myths.” Pretty much any time you see the word “myth” in the title of a post, you’re pretty much assured you are reading a political statement, not objective analysis.

Guest
d'CM
Jan 16, 2013

Nobody, except maybe some unscrupulous admission reps from nursing schools, continues to perpetuate the nursing shortage myth, so this article is pretty pointless. If we want to speculate about the future of nursing, that would be interesting. It seems nurses have always been their own worse enemy and that continues today. Unlike teachers with their unions or physicians with the AMA nurses they have no singular voice or leverage and are therefore subject to market forces. In fact, the most significant publication regarding, and titled, the future of nursing was written by the IOM. The entry bar to be an RN has to be set the same as PT, at the Masters level, not the current Associates to break the shortage/glut cycle, to advance the profession and improve the healthcare system.

Guest
Carol W
Jan 17, 2013

I believe the PT can begin practice at the Baccalaureate level also. But really, what would masters trained nurses do at the bedside. I worked with a girl who had her masters as a clinical specialist. She worked just as I did. Think of the frustration of someone highly trained to yet not being able to use that training in the way she/he was educated to do. Nursing does have to change, but no one has the answers, its a difficult issue to talk about. Many Nurses are very frustrated with the system but just see the job as a means to a paycheck. When Nurses can only do what the Physician orders, there can be no change.

Guest
J Thompson
Mar 23, 2013

Bullsh*t. This myth is told daily by nursing school recruiters. Let me guess…you would NOT be a nurse, yes?

Guest
Deborah A.
Dec 8, 2013

The reason for the shortage- at least in the South- is that the new nurses come out expecting to be respected for their brain and assisted with the heavy physical work in patient care. After a few years of not having their expectations realized, they decide to go to NP school, because “I can’t do this until I retire.” So the older nurses are left in the trenches to continue to render excellent patient care. At least this is what I have been seeing.

Guest
Jan 17, 2013

Thats great.. nice post David thanks.

Guest
jonie
Jan 18, 2013

The nursing shortage IS a myth. Look at the amount of inactive licenses? There ARE plenty of nurses yet the universities continue to perpetuate the “need” for nurses. The universities r making loads of money off of these poor kids. They get into debt right before they graduate to only become indentured servants to a hospital/loans. Then when they get out there thinking therell be “all these jobs”. They find there is no one there to take them on. Loads of debt and fake promiises of jjobs in healthcare? What a horrid lie. And even further yet they do not see the whole picture of why there r all these jobs in healthcare. Harassment – horizontal violence among the nurses/docsnurses – hospitals dont wish to train while paying for two nurses (preceptorships). And colleges keep pushing higher and higher degrees where you get the myth that youll make more cash if you are an NP or a so called doctorate in nursing. You still dont make much. For all the responsibility there is. There really are not all kinds of jobs out there. Its such a myth. And universities keep perpetuating it. Why are ther disproportionately more new grads in nursing than other professions? How sad. Where are all the jobs in this modern america. How awful.

Guest
J Thompson
Mar 23, 2013

PA, NP, RT, RN..they are all FULL. My hospital hasn’t hired anything higher than a (non-benefited) CNA in the last 20 months..

Guest
jonie
Jan 18, 2013

Btw look at how the private colleges seem to exploit this myth? They build and build and chaneg their college names from college to university to make it look as though they have more “clout/competitiveness”. Theyre using the nursing shortage myth. Other professionsr. Not really there anymore but “nursing” is there! And yet there is NOTHING available in nursing. Its bad too for the kid coming out of school w dreams of being a nurse being shattered b/c the reality is there are NO jobs in nursing. Hospitals are going belly up too. So why would they be hiring? Hospitals fold up. And the fact new nurses want to put their years worth of time in the hospital and get out? And of course hiring freezes which happen ever so frequently in hospitals. What a sad state the nursing profession is in these days.

Guest
Lynn
Jan 25, 2013

What is really the stinker in this whole thing.. is that most places won’t even hire an RN anymore.. they prefer BSN… a BSN for bedside nuring when their BSN schooling is based on managment skills.. I want to be a nurse to nurse.. not to manage.. but to get an entry level employment with a BSN stinks.. and if one gets hired as an LPN at some hospitals they do CNA work and not allowed to even pass meds.. Why did we all go to nursing school to become LPN’s, or RN’s when no one will hire us.. on another level they say that being a Medical Assistant is the way to go because most doctors offices hire MA’s .. that is phooey too.. Having an assoiciates in Medical Assisting and not finding a job after 3 years of looking I decided to go for my RN .. Here’s Hoping there is a position in my future..

Guest
J Thompson
Mar 23, 2013

RN’s are no better, and probably worse. My hospital hasn’t hired an RN in 20 months..that is almost 2 years! You shouldn’t have to “Hope” when so much time and money is invested..Bottom line, no matter how much you want to be in it, the health care field is, for the moment, closed; and not just RN’s. LPN’s are gone for the most part, as everyone is an RN/BSN. In my state, over half of the nursing licenses are inactive.
My advice is to do what no one on these boards has done. Talk to a WORKING nurse that works in a hospital(ER, Med Surge, ICU, etc) and ask if they have seen any new hires around for the last few YEARS, and what the job climate is. Blindly going to school on the hope it MAY lend you a better job is foolish, don’t you think? (8 years as a trauma nurse and flight nurse..and working) Bottom line, we can’t ALL be nurses. I got in at the right time. You did not. I would give it some VERY deep thought..

Guest
Stacy (real live BS, RN)
Oct 5, 2013

Wow. Lots of speculating on here. The nursing shortage is regional. If you are willing to travel, you will get a job as an RN. I would agree with those who have posted the need for an entry level to the profession. Although Masters and Advanced Practice Nurses generally don’t do bedside nursing. The BSN should be the minimum level of education for nurses in my opinion. To the LPN who thinks BSN programs teach management skills, you’re wrong. What you learn is critical thinking, cultural competency, communication skills, nursing process, etc. These are the skills hospitals don’t have time to provide on-th-job. I have been a nurse for 15 years. I am currently getting my masters, and also am an adjunct instructor for clinicals at a local university. LPN’s are not licensed to deal with the majority of patients (requiring assessments, education, etc) in the hospitals. They generally work in nursing homes now. Several LPN’s have gone back to school in our program and lack basic nursing attributes such as critical thinking, dosage calculation and basic anatomy and physiology. The reason so many nursing licenses are inactive is because too many nurses are overwhelmed by inadequate staffing levels, decreased patient contact, long hours and are tired of working nights/holiday/weekends. Part of the problem also lies in the communication and support of each other, lack of using evidence-based practices, and unwillingness to speak up when facilities are engaging in unsafe practices. Most people become nurses because they want to help people. When they get their training to finally be able to do so, it’s often a rude awakening that constraints often cause them moral distress in their jobs instead of satisfaction that you’re helping another human being.

Guest
Jane
Nov 17, 2013

Stacy, your last two sentences really resonated. Poignant, beautifully stated, and unfortunately seems to be largely unrecognized in the nursing profession. Mention “moral distress” (I have) to many nurses or non-nurses and often you will be met with a blank stare. Thank you for articulating this. Not sure if there is a way to fix it…with the medical culture these days, the more bloodless the nurse is, it seems, the better.

Guest
Volcanikred
Nov 22, 2013

You need the BSN for management not bedside nursing. I’ve met many BSN’s who were just awful on the floor. It seems many want to escape grueling direct patient care by becoming “MANAGEMENT.” They do not treat floor nurses as peers and are horrible bullies.

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Toni
Jan 27, 2013

What I have found, in my 27 years of nursing, is that hospitals will understaff nurses on units and then say those units have no vacancies. This causes delay in care by having to send patients to other hospitals for treatment. All an administration scam to “save” from paying nurses. So there has never been a shortage of nurses, This burns me because it limits nurses ability to have a secure job in acute care setting, make advancement in ranks and have selfworth in becoming a nurse.

Guest
Tara
Jan 31, 2013

There is no support for this opinion piece. The nursing shortage is not something that is “made up” by nursing schools. It has been recognized by the Institute of Medicine as something that represents a serious concern in the future (Zimm, Guglielmi, Davis, & Moses, 2012). As of right now, I am a nurse, a nurse educator, and an attorney. I have plenty of offers for staff nursing jobs, and the students with whom I have worked who have graduated recently have been able to find gainful employment. There is an issue with proper training of nurses, and employers are often remiss to invest in training. They’d rather spend the money on experienced nurses. Those organizations who have recognized the value in hiring new nurses, and providing adequate training are the ones who will reap the benefits in the future.

Zinn, J., Guglielmi, C., Davis, & Moses,

Guest
Tara
Jan 31, 2013

My post went before I finished the citation …

Zinn, J., Guglielmi, C., Davis, P., and Moses, C. (2012). Addressing the nursing shortage: the need for nurse residency programs, AORN Journal, 96(6), 652-657

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J Thompson
Mar 23, 2013

We must be living on different planets. In my world, there are 6 nurses for every available job, LPN/LVN’s are pretty much gone, there are HUNDREDS of apps for every opening(which is always filled from inside)

Let me guess..you work for a nursing school, yes?

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Volcanikred
Nov 22, 2013

Good catch.

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jjr
Apr 18, 2013

Lucky you. My nursing school (Astate, not a private school) placed less than 8% within a YEAR of graduation. This is about average, from what I understand

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jjr
Apr 18, 2013

I don’t know where you live, but out in my neck of the woods hospitals haven’t been hiring nurses for years. The nursing shortage is real, don’t I wish. Let me guess….you would NOT be a working nurse?

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Susan
Jul 27, 2013

You’re spot on! Hospitals choose not to hire, to keep the employment roster lean. Then scramble when the patient load is above a grid, often shifting the responsibility of finding needed staff to the nurses working the short shift. It’s very discouraging. Nursing is a labor and intellectually intensive position, whose performance at an “excellent” level involves very sophisticated interpersonal and knowledgeable acumen. Robots and automated systems may alleviate some of the chaos that organizational consultants have foisted on the floors, however you will never be able to substitute the benefit of a single nurse who can assess a patient’s status, identify the appropriate interventions, and act all in a seamless moment, while simultaneously advocating for the patient’s wishes. That’s what nurses do. That’s the value we bring and we need an advocate who is articulate and determined enough to persistently reinforce this to the public.

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Stacy (real live BS, RN)
Oct 5, 2013

Nice, even cited in APA format! :-)

Guest
Carol
Feb 1, 2013

@Tara, thanks for that interesting post. I spoke recently with someone about Nursing as it is. I began my nursing career back in the ’80’s when we actually did bedside nursing. I recently visited the same hospital and the only thing the nurses appeared to be doing was giving out medication. Could be a staffing thing, nursing assistants are cheaper to use for daily care, but the Nursing staff looked overwhelmed, harried, and intent on getting out their meds and finishing their notes. That was a med-surg floor. I personally had gone from M/S, to CCU/ICU, and then High Risk L&D. My experience as a nurse was much different from what I saw. I would not go back to patient care now for anything. My interests have changed and the workload now is just to high.

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J Thompson
Mar 23, 2013

I work Trauma/Flight. I wouldn’t work a M/S unit for all the tea in China. We call these “Bathroom” units, as your day is spent helping seniors go to the toilet

Guest
Sheila
Apr 18, 2013

Your attitude is what is wrong with nursing. As a intensive care nurse for 30 yrs. I can tell you I have the greatest respect for Med surgery nurses. I do not even understand any of your posts. If you are a nurse which I really doubt I suggest you walk into a large hospital today and view how hard nurses work on any type of unit. It is not about degrees as I have an advanced degree.

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J Thompson
Apr 18, 2013

First of all, I work Part Time in a level 1 Trauma center in a very large hospital.(most CFRN’s do) I am sorry you don’t like my career path.1 shift a week. I DO go up to other units..And No, my attitude is NOT what is wrong with Nursing. What is wrong with nursing is 1) Hospitals are refusing to hire new grads, but send recruiters over to the Pacific Rim, looking for cheap Nurses, sending infection rates soaring, and satisfaction plummeting and 2) The Nursing field is SATURATED. My state, California, has 8 times as many RN’s than are needed. As long as the private Nursing schools continue hyping the “Nursing Shortage” myth, it will continue. Throw in the new fad of “Doctor owned Hospitals” and I am slowly watching the field go from white collar to Blue collar, in front of my eyes..About my attitude..until YOU can cut a chest tube in a darkened, moving chopper…

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volcanikred
Sep 18, 2013

In the Pacific Rim, nurses train with a 50 patient caseload. The patients are like guinea pigs. Do you think they hold back while training, fearful of making a mistake the way American nurses do? Of course they have more “hands on” experience.

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Tara
Apr 18, 2013

As far as J Thompson goes – don’t waste your time. As we know, either of us can be trained to do “stuff” to people. (e.g., put in a chest tube in a moving helicopter, etc) … I can train to be a flight nurse – as I was a trauma nurse before I went to med-surg, but there is no way he could ever do my job (especially not the one I have teaching new nurses) – or yours. Our jobs require compassion and understanding for all people, not just a set of skills to be performed on them. I agree, the foul attitude and hyper-inflated unjustified ego is the issue there.

Guest
3 year RN license no job no RN experience
Apr 19, 2013

Well stated J Thompson!

Guest
Feb 2, 2013

according to bureau of labor statistics, there will be 700,000 more nursing jobs by year 2020 in the United States

Guest
J Thompson
Mar 23, 2013

And if you believe that…

Guest
Meg meg
May 13, 2013

Sure, 700,000 more jobs…on paper. Just like my hospital says ” you will have one nurse for every four patients” and I have 6-9 in the ER. Positions are “open” and many people apply, and their application goes into a black hole. So Yes, there will be more ‘nursing jobs’ but will hospitals be able to afford them? Probably not! Only be a nurse is you want to be a nurse!