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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148 Responses for “The Nursing Shortage Myth”

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  2. 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.”

  3. 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?

  4. 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.

  5. Melissa says:

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

  6. 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.

  7. Elnora says:

    Interesting Read

  8. 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.

  9. Larry V says:

    The RN to BSN program in California is a SCAM. There is NO evidence to support that an RN who obtains a BSN will be a better nurse. All the BSN program is is a bunch of extra show boat classes that have little to do with real life nursing. For example, Psychology 100 will not make you a better nurse. Nor will taking Chemistry. Or Speech. What is needed to protect lives in the hospitals is teaching nurses to get the hell off their cell phones, Facebook and pay attention to their patients. What is needed is for nurses to WASH their hands. Wash their hair. Practice basic infection control. Patients don’t care if their nurse knows the difference between a prokaryote and an Eukaryote. Patients don’t give a rip if the nurse knows Chemistry as it has NO real life application to patient care from a nurse. Nor does a patient remain safer if an RN has a piece of paper that says they are a BSN. IT’s a complete SCAM. What the state of California, in particular, the California Board of Nursing needs to realize is that they are out of touch with reality. If they want to make a real difference they should remove Chemistry, psychology, speech and all the BS diversity classes from the BSN (bull shit nursing) degree and include How to Wash Your Hands So You Don’t KIll the Patient with MRSA 101, Why it’s important to stay the hell off your cell phone and care for your patient 102, Why you shouldn’t be talking about your patient because it’s a HIPPA violation 103, Why you shouldn’t wear long nails because they poke through gloves and you can harbor S. aureus under your dirty artificial nails…104. And then add How to Care More About Your Patients than How Much You Get an Hour 105, then add a class called “HOW TO BE COMPASSIONATE” 106. Lastly, a class called, “Diversity is more than just talking about blacks, mexicans and gays, let’s talk about how to respect the elderly, handicapped and mentally ill patients since we don’t know what the hell to do with them when they’re in our hospitals and we end up giving them IM injections of antipsychotics instead of proper medical treatment, 107. Boom. There’s your BSN. Nobody cares if you have streak plated a Mannitol Salt Agar. Nobody gives a damn if an RN knows what KOH means. Nobody will ever ask an RN if they can quote statistical research to them. And clearly, no patient will ever ask an RN about their LYMPH system, because the second they do, the RN will refer the patient to speak to their MD. Quit wasting RN’s time with these BS classes and get REAL. Maybe if the people at the California Board of Nursing would exist their dusty offices and get back into the field they will recall that not one patient will ever give a sh^% about whether or not an RN has a BSN because all they care about is good care and that is not delivered by simply getting a BSN.

    • StacyRN says:

      Wow, I tend to disagree on the relevance of chemistry and psychology. As a PICU nurse, chemistry was vital to adequate understanding of fluid & electrolyte therapies, CVVH, etc. Psychology is present in therapeutic communication with patients and families. While I can appreciate your points about being attentive, using hygiene to prevent infection, and diversity, I think a broad educational base is important to a well-rounded nurse. Additionally, I think care managment and leadership skills (the valuable parts of BSN education) will only increase in demand. It’s not for everyone, but it’s definitely not a waste of time for many nurses who may have different nursing aspirations.

  10. Scott says:

    I went back to school, did a year of pre-reqs and got a scholarship to an LVN program 350 miles from home. So we moved and I graduated. Went back home to find out that hospitals only hire LVN’s as ward clerks or Techs. Only Option was LTC. 30-45 patients, not nearly enough CNA’s to provide quality of care. Forced into double shifts.(Do it or loose your job). $16.50/hr no differentials, no benefits. Working as a nurse with no insurance for my family. Luckily my son qualified for medicaid. I went back to school got an AS in general studies that covered the pre-reqs for my transition to RN. Another year in nursing school and I got my RN. Unable to find a job. Applied everywhere, was told that my LVN experience did not count. I called the hospital where I did clinicals and asked if they would hire me. They did so I made the 108 mile (one way) commute to the hospital to work PRN for $35/hr. I was feeling like I made it. Again, no benefits and worse off because my son no longer qualified for medicaid and still no insurance for all of us. I began applying everywhere with the intent to find a full time job with benefits and working whatever shifts I could get. I finally got an interview 300 miles from home in a correctional facility. On the phone the interviewer said that they really liked my resume and loved the fact that I was an LVN. Got a job offer that included relocation money and a sign on bonus. $19.38/hr ($540/month for insurance) CRAZY. There is no way that we could get by on that having to rent an apartment and basic living costs. We are not fancy people. My car is 12 years old. All kinds of people were saying you have to go where the jobs are. And Alaska is where you can make it. Spoke with the recruiter in Anchorage who stated the wage would be $26/hour and the state legislator has removed some basic benefits (no retirement). Over $800/month for insurance. I am now in a BSN transition. I am doing this with the intent of going on to a masters degree. Working part-time in the Nursing home and taking whatever PN days I can get from the hospital. WHERE ARE THE JOBS? We can move.

  11. Scott says:

    If anyone has any advice on where is a good place to move to get a nursing job with benefits. Please let me know. I am not interested in reports or statistics about how nurses are in demand. I think that they are skewed.

  12. Scott says:

    juneau2015@yahoo.com ———————Thanks

  13. Scott says:

    juneau2015@yahoo.com ———————Thanks I would prefer to work in corrections but I am not picky.

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