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Welcoming immigrants and robots to fill the nursing shortage

David E Williams

In a report this week, Nursing crisis looms as baby boomers age, CNN Money repeats a well-known story:   there are unlikely to be enough nurses to take care of people as they age. Nursing schools can’t keep up with the demand and trouble awaits. We’ll face a shortage of 260,000 RNs by 2025, we’re told.

I don’t really believe it’s such a big deal.

There are two good solutions to the problem, and they aren’t mutually exclusive:

  1. Increase the recruitment of nurses from abroad
  2. Substitute technology for labor

The first option is already in effect to some extent. But anti-immigrant attitudes and rules limit the number of non-US nurses here. There are also an ethical considerations; when nurses from middle income countries like South Africa and Thailand come to the US, it creates a shortage of nurses in those countries. Some of those shortages are filled by bringing nurses from poor countries to middle income countries. That leaves the poor countries bereft at a time of tough challenges such as HIV and TB.

The second solution essentially means replacing at least some nurses (or some of their functions) with technology, including robots. A lot of things nurses do will be doable by machine, if not this year then certainly by 2025. These robots will take many forms, but one could certainly be as a “personal medical assistant” that handles most mundane functions. It could check vitals, provide encouragement, remind patients to take their medications, and go beyond those tasks to other areas, such as playing games, cleaning the house, making food, and even engaging in pleasant conversation.

This technology trend shouldn’t encounter too much resistance from nurses, who after all should still have plenty of opportunities for employment.

The nursing workforce issues are real, but they provide opportunities for innovation, not cause for panic.

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 blogs regularly at the Health Business Blog, where this post first appeared.

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36 replies »

  1. “Your ideas are hilarious, really. I’m laughing. What a joke. Happy blogging..”
    “Mr. Williams is so illinformed a clueless about what is really going on in nursing and nursing employment that it is truly laughable.”
    I know something more laughable and hilarious… people criticizing someone w/o giving their own ideas. That’s what’s laughable.
    Look at the two “RNs” before you. They showed how ignorant they are and how wrong they are with all those cheap labor accusations.
    Oh wait, maybe that’s why you two don’t bother to give you own ideas and couldn’t even point out exactly what is laughable about the Mr. William’s blog.
    ‘Gary Lampman’ and ‘Health IT’ gave valid, helpful points.
    And the RN that identified herself as having an MS – you don’t even understand Mr. William’s blogpost. You’ve taken almost everything out-of-context.
    It’s like something got lost in translation somewhere in your brain.

  2. Mr. Williams is so illinformed a clueless about what is really going on in nursing and nursing employment that it is truly laughable.

  3. I’m all for Health IT . However, healthcare will always need nurses (real, live, breathing, living, nurses). I believe that healthcare will overall be benefited by Healthcare Technology but rather than believing that “robots” will take over healthcare and eventually the earth… we all need to (I can’t believe i’m saying this) get along and work together. 🙂 Let the robots and humans work together as one… cheesy, yes, I know.

  4. Why not a self serve lane . First window collects your billing and insurance information from a embedded chip. Then, you pull up to the machine,Scanning your hand with a Bar Code Reader and another input device reads your implanted Medical Chip that has all your medical Data on it. It will give a list of symptoms that you will input. Sensors do a full body scan that reads vitals.The Doctor takes a glance at you at the second window,inputs script data and a copy of the script is issued like receipt paper.
    Machines are not flawless and neither are nurses who are understaffed and overloaded in most Hospitals.However, Education has a small measure of Credibility when one fails to apply it to its full potential. It may seem difficult to believe but the Quality of Care today is best served by patient advocates and family members who look out for the patients needs.
    Nurses are too engaged in making rounds and placing information in charts etc. Even working on the intranet for their next certification to be very effectual in attending the needs of a patient.
    The squeaky wheel(family) gets the attention,while a sick and drugged patient is not strong enough to call attention on their own needs. The way Health Caring is going today.A robot may have a programmed personality that would indeed be refreshing!

  5. Mr. Williams, Why stop at nurses ? Let’s develop robots to replace overpaid pharmacists. After all, how hard can it be to count and pour. And while we are at it let’s replace P.T. and O.T. as well. what about routine legal services ? Your article is inaccurate. Nursing isn’t just tasks..it involves decision making and critical thinking. Taking accurate Vital Signs and evaluating Vital Signs involves some knowledge. For example, if a patient’s BP is running a little low, but has previously been high with a different cuff, you should ask yourself why? Is the new cuff too big ? Do I have the cuff at heart level ? Am I using AHA guidelines ? Is there a new clinical problem ? Does the patient have possible hypovolemia that requires intervention. Would a robot be able to assimilate and understand the variables. Do you understand the variables, Mr. Williams ?
    Mr Williams, If you want to suggest that a non-RN (i.e. Medical Assistant) off the street with only a few months of training can be replaced by a robot, go ahead. But please don’t use the term nurse so loosely. Registered Nurses have at least three years of college ( many have 4-6 years college) and are well educated.

  6. “The Health Care Industry, with the assistance of the US Federal Government, has manipulated the nursing labor market, through a multitude of overt and covert means, for many years for the purpose of maintaining poor working conditions, low wages, and poor job security with the object of reducing nursing labor costs.
    Given the aforementioned hostile and conspiratorial attitude by the health care industry and the US Federal government against American nurses, American nurses should leave nursing and advice American citizens to avoid nursing.
    The following is the URL of a Wikipedia article which, in my opinion, accurately describes the causes of the nursing shortage:
    http://en.wikipedia.org/wiki/Nursing_shortage
    With all due respect, wikipedia is a nice over-all general resource but it should not be cited as a credible resource. That wikipedia article you linked, is even being given a low rating by wikipedia itself and soon someone will even dispute the credibility of it’s content.

  7. The Health Care Industry, with the assistance of the US Federal Government, has manipulated the nursing labor market, through a multitude of overt and covert means, for many years for the purpose of maintaining poor working conditions, low wages, and poor job security with the object of reducing nursing labor costs.
    Given the aforementioned hostile and conspiratorial attitude by the health care industry and the US Federal government against American nurses, American nurses should leave nursing and advice American citizens to avoid nursing.
    The following is the URL of a Wikipedia article which, in my opinion, accurately describes the causes of the nursing shortage:
    http://en.wikipedia.org/wiki/Nursing_shortage

  8. “I just love it when people who do not work directly in the health care delivery system seem to believe they know exactly what the correct recipes are for improvements.”
    I also love it when so-called people that work directly in HC believes that what they think is exactly correct or even feasible. I also love it when they think no one can figure it out other than HC workers only.
    Really now, does it really take a rocket scientist to know exactly the problem is and what are the possible solutions. No one needs to be in direct HC to know.
    Anyone with commonsense knows it.
    “What a sad day it is in our country when we fail our citizens by looking to import employees from abroad, rather than taking the more appropriate step of investigating changes that would establish better recruitment and retention problems within that job choice.”
    I have breaking news for you. It has already been investigated a long time ago. And they already concluded that even if there are no bottlenecks nursing schools and even if there is no lack of nursing educators there will still be not enough nurses. Try and read the CNN article and other related articles (and understand it) about it before you even open your mouth. What you are talking about has been done a long time ago and a conclusion reached a long time ago as well.
    “Perhaps, Mr. Williams, you are a bit anti-American and rather than focus on fixing the problems of the career to recruit and retain more Americans in the nursing career, you would rather just take the easy route of looking at other countries for nurses willing to provide cheaper labor, and worse, look to robots!!”
    Perhaps, Mr or Mrs CriticalCare RN, you are a bit of a Xenophobe and rather focusing on fixing the problems to recruit and retain more Nurses, you would rather have a nursing shortage and blood in your hands rather than recruit foreign nurses.
    And oh, foreign nurses aren’t cheap labor. It’s actually against the law to not give foreign nurses the same prevailing wages American Nurses do.
    If it’s really cheap labor why not you sue the hospital you work in or any hospital with foreign nurses for hiring cheap labor and let’s see how it goes. If you are a member of a union, let your union do it. They can’t do it do they? Why? Simply because it isn’t true.
    Maybe the anti-American is you. How? You can’t stop new nurses from being retained and it’s been a very well known fact to everyone that old nurses eat their young. Your fellow nurses doesn’t want to teach on the same salary as most educators in the US receives and wants more money for it. And for what selfish reason? That bedside nurses has a higher wage (rightfully so)than someone just teaching? Another breaking news for you: almost all students eventually gets a higher wage than their old professors. If all professors and teachers had that kind of mentality, there will be no teachers and university professors. So, now who is again on an environment on instilling the desire to earn and achieve their way up the socioeconomic class scale?

  9. “You do not take care of sick people do you.
    The mindset Mr Williams promotes is the same one that put our economy in the tank.”
    ACTUALLY I DO. Just because I agree with some of what he says already leads you to conclude that I don’t take care of sick people? For all you know I may be a doctor or even a nurse like you. You think all doctors and nurses think alike and should think like you??
    So, now are you going to make some lame excuse for yourself and the other guy I responded to?
    Tell you what. Your response to my response pretty much vindicates what I was saying. Actually, you did not really to respond to my post.
    You are just bringing in Mr Williams and using him as a scapegoat.
    Are you not even going to contradict what I posted? You couldn’t right? Because it’s all true and I exposed you not even knowing the real issues. You do not know that there is really an oversupply of nurses from many countries. South Africa and Thailand isn’t even where most foreign nurses are recruited.
    Can you at least elaborate exactly how Mr. William’s mindset has lead to the tanking of the economy??

  10. Jack,
    You do not take care of sick people do you.
    The mindset Mr Williams promotes is the same one that put our economy in the tank.

  11. “Sucking scarce nursing personpower out of the third world to satisfy our insatiable demand for nurses is an irresponsible and unsustainable solution to our problem.
    They are needed in the countries where they grew up. If as much as a third or more of medical care in our country is unnecessary or of marginal benefit, and as little as a third of our present nursing time is actually spent with patients, we need to make much more efficient use of the nurses we have before worsening the supply of critically needed nurses in their countries of origin.”
    There are actually some countries (like Brazil and Philippines) where there is an over-supply of nurses and with their population they can supply the insatiable demand you are talking of.
    So, now that you know are you going to change your mind? Or are you going to make-up another excuse?
    Are you then going to now make-up a lame excuse saying there’s really no nursing shortage but a shortage of nurses willing to work even after ?
    Are you going to make an excuse for nurses that quits only a few years into the workforce becasue they couldn’t handle it and/or after getting married and having kids?

  12. I have an even better idea – I can’t believe an innovator like you didn’t think of…….
    Import foreign robots!! Healthcare problem solved. So simple really.

  13. I just love it when people who do not work directly in the health care delivery system seem to believe they know exactly what the correct recipes are for improvements.
    What a sad day it is in our country when we fail our citizens by looking to import employees from abroad, rather than taking the more appropriate step of investigating changes that would establish better recruitment and retention problems within that job choice.
    I would like to see the number of Americans who leave the nursing career, after they have already been trained, because of the working environment.
    Recruiting these jobs to foreign trained nurses is already happening in large numbers, and has been for a lot of years.
    1. Those foreign trained nurses incurred how much personal debt to secur their education, compared to American trained nurses?
    2. Those foreign trained nurses grew up with what standard of living surrounding them – instilling the desire to earn and achieve their way up the socioeconomic class scale (ie., the American dream of earning and achieving a higher income), compared to American nurses?
    Perhaps, Mr. Williams, you are a bit anti-American and rather than focus on fixing the problems of the career to recruit and retain more Americans in the nursing career, you would rather just take the easy route of looking at other countries for nurses willing to provide cheaper labor, and worse, look to robots!!

  14. Technology is constantly being improved to do the jobs it can do, but then we’ll need more IT to keep that stuff running. So jobs will still be needed, just different kinds.

  15. I would like the author to comment on how this proposed nursing shortage in 2025 would differ from the nursing shortage that was supposed to peak in 2010. As a future 2010 BSN grad facing difficult job prospects, I can assure you that the best solution to a nursing “shortage” is a better workplace environment. Importing cheap foreign labor is not the answer.

  16. “The writer seems to have no idea what RNs actually do.”
    Yup. Welcome to “health care reform.”

  17. The robots have already arrived along with countless other technological ehnacements to care delivery across the continuum from the home to the community to the hospital. As nurses we will need not only to embrace the technology, but take part in its development and appropriate adoption so that it’s used as a effective extension of nursing and medical resources.
    As for solving the shortage with recruitment of foreign nurses, we have to consider the impact that this “brain drain” has on the public health of their home countries. The aging baby boomer issue is a global one, and must be addressed globally, remembering that the existing nursing pool is a shared resource. An alternative would be to increase our own community based health education outlets for nursing and allied health. Glean prospective health care workers from within our communities by expanding schools of nursing and allied health to provide the pool of healthcare workers to take care of us boomers in our fast approaching senior years.

  18. I am always really dubious of these types of “manpower” studies that get put out by the BLS and other private agencies especially about such distant end points.
    Frankly, the two most interesting trends in nursing from what I have seen the lack of NP to take full-time teaching positions because of some of the pay issues and the increasing efforts to unionize nursing workforces. You could also throw in some of the changes in nursing informatics that are coming about in the hospital-space because of the ARRA funds and increasing installation of clinical IT applications.

  19. If a nurse from abroad can make me feel better and do a quality job, I’m all for it. Medical care is too important to leave on the backburner–it’s a PRIORITY.

  20. One of the problems is that there are a shortage of teachers for nursing students. There’s a lottery each year for potential nursing students in this area–people are flocking to it, but there just aren’t many open spots. After all, why would an experienced nurse want to take a major pay cut to teach?
    As for robots, I’m not sure I’d want a robot giving me a blood transfusion 🙂

  21. I have to agree with Tim. The functions that Mr. Williams believes could be provided by a robot are ALREADY routinely handled by Aides who are paid just a bit over minimum wage. If you want to invent a robot that will truly be helpful, give us one that will complete all the paperwork, charting, documentation, etc. that takes nurses away from the patient.
    As for the nursing shortage, as a nurse recruiter I am hearing from newly graduated RNs who CAN’T FIND A JOB!! Why, you ask, if the nursing shortage is so acute would a new nurse be unemployed? Experience. It seems that inexperienced nurses require a very expensive commitment on the part of the employer. They must be trained, mentored, monitored and educated. Contrary to popular belief, nurses do not come out of nursing school ready to take on a patient load! Double this requirement for foreign nurses, what with cultural accomodation and all. With healthcare budgets being slashed, the important task of training and mentoring newly minted RNs has fallen by the wayside. Graduation from nursing school is just the first step in creating a competent and functional nurse!
    Heidi Hawkins RN,BSN,MS

  22. Dear Author and tcoyote-
    There are thousands of Asian nurses working in middle east who are physically and mentally abused. They will be more than happy to be given a chance to work in US. They will get their dignity back and hopefully this will take care of potential nurse shortage.

  23. Every year, ever so often, the industry is forecasting shortages of health care professionals, be it nurses or physicians. The proposed solution is always importation of persons from less developed countries.
    And yet every year our colleges and universities are turning away massive numbers of talented, perfectly qualified young Americans seeking training and education in these fields.
    Is there a reason why we are refusing to educate our own doctors and nurses? Are we short on bricks and mortar to build the necessary classrooms? Are we completely incapable to come up with decent pay for instructors? Are all those brilliant networks of state colleges, supported by taxpayers’ money too busy turning out totally unnecessary armies of MBAs?
    Or is it the prospect of paying imported persons a fraction of what a locally educated person would be able to command?
    Importation of people is not exactly an innovative concept. Robots, yes, that is pretty cutting edge, but I bet those would be made in China as well.

  24. So this is the list of nursing duties the robots will do:
    “…check vitals, provide encouragement, remind patients to take their medications…”
    The first is usually delegated to aides already. The second no machine will ever be able to do. The third is the job of an alarm clock.
    The writer seems to have no idea what RN’s actually do.

  25. Sucking scarce nursing personpower out of the third world to satisfy our insatiable demand for nurses is an irresponsible and unsustainable solution to our problem.
    They are needed in the countries where they grew up. If as much as a third or more of medical care in our country is unnecessary or of marginal benefit, and as little as a third of our present nursing time is actually spent with patients, we need to make much more efficient use of the nurses we have before worsening the supply of critically needed nurses in their countries of origin.
    PS What are these bizarre painkiller spam postings that keep cropping up at random in these comment threads? What can we do to get rid of them?

  26. Healthcare IT is very important, and I agree that we will need to take advantage of these new technologies to make our healthcare workers more efficient. The problem is the initial cost of developing and putting them into practice.
    As far as immigration rules, I think it is a disgustingly underreported topic. In OECD countries, there is actually not too much differentiation, and in order for America to stay great, it is my opinion that we must reform our immigration laws to encourage hard-working and/or educated individuals to come to America.
    Every industry is interrelated — in this blog post you bring up the relationship between tech and immigration to healthcare, but there are many many more industries that are related to healthcare. It is my personal belief that, sure, the healthcare and insurance industries are a little screwed up, but the industries that are connected to the healthcare industry are just as equally as screwed up. If we fix those industries, we also move towards fixing healthcare.

  27. In 2025 you will need neither doctor nor nurse. Just enter your symptoms into the government health screening portal found in every home by then. You will be denied coverage and told to suck it up. Go to your home marijuana patch and your still and sooth yourself. Come election day vote for whomever let you keep alcohol and marijuana and healthcare in place of work and freedom and wealth. By then you will be able to vote from home as many times as you want. All results will be certified in Beijing. From little acorns mighty Chinese oaks grow. Happy Chinese New Year.

  28. 3. Family member and friends will have to step in and supply the non-skilled needs. Nursing assistance can be taught in high school as part of the regular curriculum.

  29. WOW! Really? You look like you may be just the right age to need skilled nursing care in the year 2025. Hope your robot takes good care of you. LMAO….

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