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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142 Responses for “The Nursing Shortage Myth”

  1. No New Grads says:

    I’m absolutely convinced there is no nursing shortage. Haven’t worked as a nurse since I graduated many years ago. If there truly were a lack of nurses, you wouldn’t have hospitals or other health care organizations demanding a min. of 1 year’s experience. Almost every single opening is demanding that and they make it known “New grads not welcome.” The H-1C visa program needs to be shut down and have new grad training as in the past. I just get so tired of reading about some nursing shortage when it’s really that they’re too cheap or lazy to train and want nurses that are already experienced. Stop perpetuating the fraud.

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  6. Melissa says:

    I wrote about this problem back in 2009, from http://content.healthaffairs.org/content/28/4/w657/reply#healthaff_el_17390

    ” I have experienced some new caveats to our current situation that I believe may be of interest. I graduated May 2008 with my BSN in Northern California and did everything by the book (hundreds of apps, spoke with managers, thank you notes, ACLS, BLS, professional resume, LTC, SNF, etc.) and was unable to locate employment. When an offer was made, my children and I relocated to a rural town four hours away. Sadly, after four months of orientation, I was told I “failed orientation” and they needed an experienced RN. My children and I moved again. Recently I applied to a Versant New Grad Residency. I made it through their first round of interviews but was told that I was no longer a “New Grad” due to my previous four months of experience!

    So, not only am I not experienced enough to work as a staff nurse, but I am no longer considered a New Grad! So, where do I fit in? I feel that if I cannot get into a New Grad program I will have the same unstructured learning demands and unrealistic expectations placed on me similar to my first failed hospital experience. It also appears that the longer it takes for me to find employment, the more reservations the employers have towards me.

    I have researched my situation. It appears my peers from nursing school are experiencing similar situations. http://www.allnurses.com, an all-nurses Web site, further elaborates that my situation is happening all over the U.S.A. to new nursing graduates.”

  7. Ms. Shelly says:

    It is near impossible for new grads to find enjoyment in our area. We are saturated with nursing schools with more in a 200 mile radius than some states have. Of the three hospital systems in that radius only one has a new grad residency program and they hire MAYBE 150 nurses a year for this program. However, there are approximately 2700 new graduates in that same year. One of the other systems will occasionally hire new nurses, but it is rare and there is no formal training… it’s sink or swim. The only area in nursing that is growing and has somewhat of a shortage is home health, both for PDN and skilled visit nurses. Problem there is that the pay is no where near hospital pay and often there are no benefits. Also, there is still a stigma that these nurses are second rate in comparison to acute care RNs. You spend thousands to get a degree to work 1-2 years in home care making the same money people without degrees are earning hoping that some hospital will eventually take a chance on you since you have experience. Then you wind up in am even worse situation because hospitals now don’t want to take a chance on you because you haven’t used acute skills since school so you are worse than a new grad in their eyes. I was one of the lucky ones, but have seen this over and over. When hospitals are able to pick and choose and continue to boost their minimum requirements, please tell me how that equivocates to a shortage?

  8. bittboo says:

    Ms Shelly, I think you and a few others are missing a key point- there is not a nursing shortage EVERYWHERE. You’re talking about YOUR area. Well, in MY area, nurses get hired very easily because there is indeed a shortage. Saturated with nursing schools? Of course there’s no shortage in your area! If more new grads were willing to take home care and nursing home positions, they would have their one year experience and could build upon that experience in one of the areas were there are shortages. Like many other fields, you may have to move to get the job you want as a nurse.

  9. Melissa says:

    Bittboo – sadly hospitals here do not “count” long term care experience. They want acute care experience.

  10. Grace says:

    According to the Bureau of Labor Statistics, nursing jobs are growing. In particular, one of the most common nursing job is that of a registered nurse. They’re expected to grow 19% over the next decade, which is faster than the average of about 11% for all occupations.

    I like to believe that the BLS has no connection with nursing schools. With that said, the outlook looks pretty good to me.

  11. Elnora says:

    Interesting Read

  12. Maria says:

    Even with 5 years experience in the US and another 10 outside of the US it is a handicap race to find a good job. There are jobs where companies “drain” your energy for low pay and expect a factory like output. It is really disheartening to realize that investing in a BSN degree can bring you more heartache than joy, especially when you are a truly compassionate nurse. I think there is a lot of hype so the schools can make the money and keep on producing more nurses. I have not seen the shortage and I am a nurse in Florida that has worked in Tennessee and I now am looking to relocate. Be sure to do your research before you move and see that you have plenty of options available.

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