No Country For Young Nurses


The nursing profession takes a certain dedication to love. After all, most office jobs don’t involve standing for 12 hours at a time, scarfing a bite of lunch between “clients” or handling gallons of bodily fluids on a daily basis. But for years, nursing schools lured students with the promise that they would be snapped up by prestigious hospitals upon graduation, remunerated for their hard work with good pay and enviable job security.

And they were right – until now, that is.

It’s a paradox straight out of “Freakonomics:”  Even though California still faces a shortage of nurses, up to 40 percent of nursing school graduates will be unable to find jobs, according to the California Institute for Nursing and Health Care.

The recession set off a domino effect that has caused California hospitals to virtually stop hiring newly-minted nurses. The Institute estimates only half as many nurses will be hired this year as in 2008.

It’s all thanks to Botox, healthcare reform and other people’s husbands.

Back from retirement

Nine years ago, a severe nursing shortage was giving policy-makers night sweats. In 2001, national vacancies in nursing reached 13 percent, and over 120,000 nursing positions went unfilled, according to a report by the American Hospital Association. The numbers were especially dire in California, and in 2005 the state began funding and aggressively promoting nurse education.

“With this new initiative we are going to improve the quality of health care everywhere in our state. We are going to provide more classes, more teachers and more resources to expand the ranks of nurses in California,” Governor Schwarzenegger said in a press release at the time.

It worked. California nursing schools saw enrollment rise by 70 percent over four years as the profession became increasingly touted as “recession-proof.”

But the recession found a way.

A funny thing happened when the economy began to crumble. Peter Buerhaus, a nursing expert at Vanderbilt University, found that an astounding number of experienced nurses left their non-hospital jobs to work in hospitals.

Though only about 60 percent of nursing jobs are in hospitals, recent nursing graduates often rely on resource-rich hospitals to provide them with the extensive training they need to be considered ready to work with patients. In addition to having the best training opportunities, hospitals also happen to have the best pay, the best benefits and the best shifts.

“In two years, hospital employment grew by 243,000. That’s a world record. That’s astounding,” he said. “People were coming in from all over. I mean, we’ve got nurses coming down from Uranus, from Pluto, waiting to get clearance to come down.”

As one of the perks, many hospitals give nurses the option of changing a standard full-time schedule to three 12-hour shifts per week, which allows some nurses to pick up a second job on their free days.

It’s a life-preserving strategy for when their spouses (70 percent of nurses have one) lose their jobs, as millions of Americans have since the recession hit.

Retired and part-time nurses all over the country have been returning to work full time when their spouses’ jobs were threatened, or eliminated. Faced with the option of hiring an experienced nurse or a novice who needs training, the choice for hospitals is clear.

Or as a Marina Del Rey hospital representative said, “We are not hiring new grads at all. With the employment market the way it is right now, we don’t have to.”

And nurses who were going to retire decided to stay put.

“The turnover is almost nil,” said UCLA nursing school Dean Suzette Cardin. “They’re just not leaving. Everyone’s afraid to leave.”

These older, returning nurses have crowded out novice nurses who need training. And they’ve done so in greater numbers in California, where the economy has tanked harder and where there tends to be more workers nearing retirement age.

“There may have been a bigger reservoir of older nurses that weren’t working in California,” Buerhaus said, “and you had a very strong reaction of nurses getting back in the labor market.”

Fewer implants, greater uncertainty

One of the first casualties of the recession was disposable income and all the luxury items – watches, cars, and errr…silicone – that it buys: Allergen saw sales of Botox and breast implants plummet in 2009.

And as job loss led to health insurance loss, people were re-thinking not just nose jobs, but knee surgeries.

The decline has led to less demand for nurse assistance during some procedures. “Elective surgeries are down, so patient days are down,” said Deloras Jones of the California Institute for Nursing and Healthcare.

On top of that, hospitals are reluctant to beef up their staffs while the healthcare debate rages on. Hire too many nurses now, and in a few months they might be stuck paying more in salaries while getting reimbursed less by insurance companies.

“Hospitals are uncertain about what their near-term future is,” Buerhaus said. “It’s taxes one day, payment reductions the next. Given that uncertainty, it’s slowing their employment decisions.”

Pumping a dry well

Taken together, these factors have shattered the popular narrative of nursing jobs that are easy to come by. Cedars-Sinai hospital cut their job openings for new grads from 250 last year to 100 this year. UCLA’s hospital typically has two new graduate intake sessions – one in the spring and one in the fall. This year, the spring session has been canceled.

“A lot of nurses have applied to the UCLA new grad program in August,” said Kathy Carder of the California Nurses Association. “But in the meantime, they’re wondering how they’re going to feed their families.”

It took Cedric Lara seven months and 40 applications to find a job after he graduated with an associate’s degree in nursing from Whittier’s Rio Hondo college in May 2009.

“When I was in school, I was looking at jobs and seeing the well dry up,” Lara said. “Even hospitals where I looked during clinical rotation – Kaiser, Downey Regional, Presbyterian – by the time I graduated, they had hiring freezes.”

In Northern California, the prospects are even worse. Jessica Martin graduated with a master’s degree in nursing from the University of San Francisco in December, and she said just six of the 25 people in her cohort have gotten jobs so far. Those who have relied mainly on personal connections.

“It was pretty misleading,” she said. “The people that graduated before me were getting jobs easily, and people were recruiting them. But then I graduated, and there’s nothing.”

Martin is hoping for an operating-room job, but so far the only hospitals admitting new grads are those like Stanford, where there are 600 applicants for three to six open positions.

“I’m sending my resume out into the ether, and nothing is coming of it,” she said. “It’s fairly hopeless right now.”

For some, hope lies in less sought-after jobs outside of hospitals and doctors’ offices.

“Before, a new grad had 20 offers, but this is forcing them to seek other opportunities than what they thought,” said Kathy Lopez of the National Association of Hispanic Nurses. “Some students may have to start in a convalescent home, or maybe doing flu clinics.”

Some, like Martin, are looking out of state. Her student loans are coming due, and the alternative is moving back in with her parents.

“I’m 28 years old and I might be financially dependent again,” she said. “I’m trying not be be bitter and angry about it, it just takes time.”

Ironically, California is still projected to have a nursing shortage in 2020, especially since the older nurses are likely to swiftly re-retire after the economy rebounds.

Until that time comes, however, a pool of cash-strapped nursing school grads wait with increasing frustration. Healthcare experts hope they don’t give up before the recession does.

“We’ve been working hard to build our capacity, and we’re worried that if new grads can’t find jobs, we’ll lose the gains we’ve made,” Jones said. “Because if they leave California, they may not come back.”

Olga Khazan is a graduate student at the the University of Southern California’s Annenberg School of Communications and Journalism. She is a senior editor at Digital Tommy, the voice of Annenberg Digital News. More of her work can be found at OlgaKhazan.com.

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  1. Naim tersenyum. Baru dia hendak menutup buku biru itu, Memandang wajah suamiku yang sudah masam. Aku jumpa di dalam beg tanganku ketika aku hendak mengeluarkan telefon bimbit.“Tapi, Nak tak? Arghh! Tapi mengapa wanita itu seolah-olah sengaja tidak mahu memahaminya dan masih ingin dirinya dilepaskan.“Awak lupa ke. emak dan nenek Baha.“Saje je.” “Er.taklah bukan Saya tak kenal awak.Terima kasihlah cili padi. Ha.Mamat: saya nak naik tangga ni.(sambil tersenyum)Aku: HuhKisha: Takpe-takpe aku ceritakan nantiKisha pun menyampuk perbualan aku dengan mamat itu Kemudian Kisha mengajak aku duduk diserambi rumahnyaAku: Yang kau dari tadi tu tersenyum je macam kerang busuk tu apasalKisha:ha. Malam lailatul qadar merupakan malam di mana setiap doa yang dipinta, aku meminta kebenaran nenek untuk memasang radio dan memutarkan lagu-lagu raya yang popular pada zaman 80-an dahulu.Tiba-tiba matanya terpandang sebuah kad di dalam laci. Habuk masuk mata.?? Alisha memberi alasan??Mari abang tiupkan. tak perlulah panggil nama saya kuat sangat. Putera Aqish Asyrah mengaku salah dan aku minta maaf.

  2. John G: How would someone go about getting one of those jobs? Did your batchmates have previous experince as an RN and did they all have Bachelors degrees?

  3. LOL I was just telling my friend that as well. What am I supposed to do, get a license in all 50 states and just apply at every single hospital in the country? Unfortunately I am not made of money and could never actually do this but I am starting to wonder if this is what it is coming down to? I just wish I wasn’t lied to about how easy it would be to get a job once I had my RN license, especially a 2 year one!

  4. Plese enlighten me as to where these plenty of jobs in other parts of the country are because I have had no luck and it’s been a year. I have a TX license as well and still no luck. Where in TX?

  5. It is Jan 23, 2012 and I do not see this change that you are speaking of? It is still almost impossible to find a job as an RN without experience especially one with an AA degree to boot.

  6. Few of my batchmates found the jobs in India. They were hunting for a job in California for the past 1 year. They took up the India offers and moved there. Others have found similar offers in South America. According to them there is indeed a true shortage of nurses in Third World countries and you have your choice of speciality too. Life Style and Pay is as one can expec in Third World countries but its better than wasting the precious years in US.

  7. This reminds me of 2 nursing articles published about a decade apart (late 70’s & 80’s) entitled “Why we eat our young” & Why we still are eating our young.” I do plan to retire within 5-7 years & hope to find a well prepared young nurse to replace me. Unfortunately, there are multiple sides of this dilema:
    First- healthcare facilities have to invest in the new nurse and also demand that schools turn them out better prepared. In most hospitals the ADN and BSN grads start at the same pay and with the same level of preceptorship. Weaker nursing programs or stronger ones- all the same. So, there is more risk in any new graduate. Hospitals need to invest in evaluating the skills and be prepared to foster and sheperd our newest nurses. Otherwise, the good ones will eventually leave. And, we need to do it now- not when we have critical shortages.
    Second- To the new grad who loved OR, ICU, OB, ED as a student and only want to work there. Look for a postion with a good preceptorship in a med/surg area. A year or two of learning to implement what you learned in school and to develop sound critical thinking skills will be a bonus when you apply for that job you see as your goal. Be willing to pay your dues and work up to the specialty you might desire. Or if you love med/surg to become the “expert nurse” yu can be.
    Third- to those of us with more experience, we need to help the newer nurses and not critizice them when their thought processes are not always perfect. To those who are new, take every opportunity to listen, learn. Most importantly, FIND A GOOD MENTOR WHO IS A GREAT NURSE THAT IS WELL RESPECTED WHERE YOU WORK. This may not be in your unit. Also, involve yourself in a few task forces and committees- on your off time. Learn and research when you have quesitons. Committ yourself now to being a “life long learner”. This is very important to our profession as a whole and you as an individual.
    Fianlly- to those in hospital administration- quite listening only to your financials- balance the responsiblity of having a safely prepared nursing staff with the cost of the same. Investing in newer nurses now will cost you much less in the long run!!!

  8. No place for older workers either, and degrees don’t count. I graduated from a diploma program, have a BS and MN. I have 10 years med/surg background, including supervisory positions and 22 years psych experience including ER assessments/triage. I took 2 years off, then went job hunting. No dice. Moved to GA because they supposedly had such a huge shortage of nurses. No dice. It was suggested that I do a ‘refresher course’, passed it, hands down, 98 out of 100 questions, predominately medical/surgical. Took me 9 months to find a job at less than 1/2 my previous job. Grady Hospital offered me $17/hr in their ER if I’d sign a 2 year contract. Yeah, right.

  9. No Country for Young Nurses
    sadly over the years nusing education has not changed the time frame while it has increased exponetially what our young nurses have to learn. . .It is not possible to learn all one one needs to and to get the practical experience in current education programs. While there are still theories about who is trained for what level the market does not reconize them. . .a license is a license and education is not considered.
    additionally, Nursing is hard and new grads are often astounded. In addition to the fact that they are insecure, they are sure that so many nurses can not be working this hard and have these safety concerns in their first jobs. . .thus as soon as they feel a little secure about their skill they move on. The employer sees this as having spent a lot of money to help the individual to mature and that money is now lost. . .the hospitals are not so full of resources as to make up for this need.
    I strongly believe that we need standards of progressive licensure and NCLEX exams that reflect the level of education. Standards of levels of education should relfect scope of practice. Nurse internships should be developed as are medical internships, and paid accordingly.
    As to California and experienced nurses moving back into the hospitals. . .wasn’t that after ratios were set. . .ratios most would love to see?. . .a survey done a couple of years ago by the Massachusetts Nurses Association interestingly reported that Nurses who had left their careers would return to the bedside if they felt their practice was safe.

  10. Colonel Pat Wise found a job working as a TV Consultant on “China Beach” . There is work to be had as consultants if you want to inflate your resume with experience you did not get in Vietnam. A knowledge of earrings is highly desirable. Send your resume to HIMSS.org.

  11. Don’t give up hope. Nursing has been evolving since its inception and will continue to grow and develop further. There is a place for everyone from the beginner to the experienced. Nurses are in the unique position to provide total patient care – it is more cost effective for most hospitals to use exclusively nurses without nurse’s aides. The more exposure you get in all aspects of nursing, the more invaluable you will be. Even though I have more than 20 yrs experience as an ER nurse, the recession affects me negatively as well. I broke my leg on a travel assignment and just during the last few months while going through rehab, the travel nurse well dried up. I am now looking for a full time position to ride the rest of this recession out, but that source is also limited. I still believe that the profession overall will rebound and the jobs will be there. Especially for you new grads – heck, most of us are getting pretty old now.

  12. Brianna,
    I also live in Ohio and my school just recently lost it’s accreditation for the nursing program! Obviously I am very upset and trying my darndest to find another program that is highly recommended and legit! Where do you attend? Any tips? I just moved here from Texas a little over a year ago so I am a bit lost! Thanks so much!

  13. It is depressing. I was naive in thinking that I would start working as soon as I passed the boards. It’s been 23 days now. I’ve applied almost everywhere, made telephone calls, and I still have not received any call backs for interviews.

  14. ok. So I’m a nursing student living in Ohio. I hear it’s bad out there but I also see new grads from my school as well as others getting jobs right out of graduation. new grads are working as ICU nurses, on first shift! It just gives me hope that things will work out ok when I graduate in May of 2011 that things might be a teensy bit better

  15. I graduated top of my class and have applied all over the country, getting the same response (if any one bothers to get back to me). They aren’t hiring any new grads or they aren’t hiring new grads that don’t have licenses in that state. I can’t afford to get a license in every state. So until someone wants to take a risk, I wait.

  16. It must be so difficult for these new grads! However, there are plenty of jobs in other parts of the country. If people are able and willing to move, they might have better luck finding a position. Here in TX there are plenty of positions available.

  17. It is time to change the curricula in the pre-licensure and graduate nursing programs to prepare students to assume a leadership role in the new preventive health care model proposed by the federal government.

  18. Yes, and don’t ever grow old as a nurse. If you are not able to do it all, and you don’t have 30 degrees behind your name, you might as well hang up your nusring cap and call it quits.

  19. I worry about these new grads who are unable to find jobs in a year or two after graduation. Will they need retraining? How terrible… Us nurses lucky enough to have jobs are running ragged on them due to cutbacks in axillary staff, and the pt to nurse ratio is pushed to the limit.

  20. Even though nurses are experiencing a false nursing shortage due to another economic downturn, there is emerging a new health care direction that wasn’t in the mix before. A preventive health care model is being implemented at the federal level. Some version of health care reform will be passed by Congress and the Senate and signed into law by President Obama this year.
    Soon, Nurses will be employed in large numbers to work in community-based health agencies, such as public health, home health, hospice, long term care facilities, skilled nursing facilities, schools, and in neighborhood health centers. The minority of nurses will be employed in highly skilled hospitals. More master prepared nurses will be needed as NP, CNSs, Nurse midwives,as researchers reporting on nursing care outcomes in hospitals and community agencies, program directors, and CEOs in community health care agencies. Doctoral prepared nurses will be needed as faculty to conduct research on the effects of evidenced-based nursing practice and promote new directions in the nursing profession.
    Schools of nursing must begin to prepare nursing students to assume a greater role in the community and offer numerous clinical experiences working in a variety of community-based health care agencies. Technical nursing skills can be learned in the community-based health agencies as more patients are discharged with equipment and treatments to be administered in the home or in skilled nursing facilities. Critical thinking, clinical judgment, communication skills, and health teaching are better learned in the commuity-based health agencies and homes. It is time to change the curricula in the pre-licensure and graduate nursing programs to prepare students to assume a leadership role in the new preventive health care model proposed by the federal government.

  21. This article is great, as well as the comments. My good friend is a nurse and gave me a glimpse into the “inner workings” of hospital nursing, and as a result I have not gone into nursing, and probably never will. That said, I have high respect for the nursing field.
    Our country has to wake up to the fact that we are being lied to, and that the economy is not going to magically get better in a few years. We are about to see the inflation hit from all the “bailouts” and there won’t be any more jobs or work available for people in any profession or industry.
    It’s time to get creative, and figure out how we can create a way to make a living in a more local sense, and stop relying on “employers” or “government” to take care of us. Trade and barter with neighbors, make personal care products at home, learn how to grow food and grow a network of friends that you can trust…
    If you have loans due, DONT be intimidated by the banks or collections agents
    check out http://www.buddhibbs.com for info on how to deal with them without fear- you don’t have to let them ruin your life, and if you can’t pay it isn’t your fault, we have all been set up to be in debt that we can’t pay. So don’t feel guilty, just deal with the creditors directly (ignore all collections agents as a rule), don’t send any of them any money until you have agreements from them in writing that are fair for you. And don’t send them any money unless they agree to take OFF the bad marks on your credit report (yes, they usually CAN do this, even if they claim they can’t)

  22. Are you surprised? There is such a crisis…a nursing shortage…no one can pay for healthcare, but nurses can’t catch a break…even when you do know how to drop a J tube faster than the 80 year old who trained you…even when your IV’s flow like garden hoses….even when you are 18 but can’t say you should be paid like the heffers who probably smoke crack on their lunch breaks….so are you shocked that you can’t get hired now? Until this country recognizes it’s priorities…people will have to find their lost sons to wipe their asses come retirement and LVN’s will have to get paid where it’s competitive without recognition of fair treatment…even when they far outkick rn’s asses…whoa…go army!

  23. Why are people so certain that the economy will rebound enough for older nurses to retire? it’s projected (article in the New York Times today) that it will take years, and many jobs will never come back. Too many are going overseas, too many are dependent on other parts of the economy doing well (i.e. housing). I suppose eventually they have to, but I wouldn’t hold my breath.

  24. “No Country for Young Nurses”… this applies to us OLDER “new grads” too. I left the business world at the ripe age of 42 because I was tired of getting laid off. I was told the only “sure thing” was nursing, so I enrolled in a 14-month program and took out a $20K loan. Now, almost two years later, I’m still trying to find a job and yes, one nursing recruiter even told me maybe I should go back into marketing for a few years!

  25. Nutcase –
    Call your student loans and get a deferrment right now. As long as you are looking for a job, which you are, all you have to do (for Citibank loans) is sign a paper they send you stating that fact and you can have some leeway for several months.

  26. Finally someone has put two and two together and noticed that new grads are not getting jobs!!!
    Everybody thought I was crazy and wrong when I told them this was happening.

  27. Well written article and pretty much the same situation for nurses here in NC. I don’t know what nurses caught in their unforeseen bad timing expect anyone to do though. Certainly the government (especially CA) isn’t going to bail them out as they’re not a politically connected constituency, and having no initial job to even qualify for unemployment makes it tough. Apply out of state, take any health related job you can find and use every hour in the day to find work is about all you can do. It will turn around as my wife in the 30 years of her nursing career has found. Here is where people find out why being politically active is so important. Do you think if the proper financial regulations were in place and the Fed hadn’t been giving money away like water they’d be in this situation?

  28. I see you are interested in statistical research. I have put one of the most comprehensive link lists for hundreds of thousands of statistical sources and indicators on my blog: Statistics Reference List. And what I find most fascinating is how data can be visualised nowadays with the graphical computing power of modern PCs, as in many of the dozens of examples in these Data Visualisation References. If you miss anything that I might be able to find for you or you yourself want to share a resource, please leave a comment.

  29. Dave C is it your are not reading this artical with open eyes.
    -Flu shot clinics were talking the only job is a seasonal one limited to maybe 20 hours a week at 18 dollars an hour we can’t live off that long term almost not at all.
    I’m in washington the same problems exist here throughout the whole state.
    I’m down to relying in food banks soley for food and I’m actually unsure how much longer I can maintain enough income to survive I’m talkgn terminal death trapped between student loans from school and not enough work.
    I’ve seen everything in this article up close and very personal. I don’t even have family to turn too. I do however want to prevent my disabled mother who co signed one of those student loans from economic fateif somthing happens to me.
    Registerd Nutcase sleepless in Seattle WA

  30. Reading the statistic of 40% of new grads not being able to find jobs is a frightening and frustrating prospect for those people. I have been a R.N. for 13 years, with the last eight being in an emergency department in L.A. County. When I graduated from a 2-year ADN program, California had a glutton of nurses. I had to start in the psychiatric field(which I said I would never do)to get my foot in the door. Better opportunities opened after a few years, and I am a better nurse because of the difficult tasks assigned during those first few years. The economy ebbs and flows, a good nurse must learn to overcome adversity and be able to prevail with unforeseen problems. Sometimes this means taking a job you would not prefer, but entering with a positive attitude and a willingness to excel at the given task. Nursing is not always roses.

  31. The fact is that most of the RNs that came back into the workforce will retire again once the economy comes back within the next couple of years as most are over 55. Further, there are nursing jobs for new grads in many other parts of the country despite the recession and the notable shrinking of jobs in CA and other areas.
    A good barometer and leading indicator of near-term demand for healthcare workers is the HWS Labor Market Pulse Index (LMPI) published by San Francisco research firm, Health Workforce Solutions. Data for Q4 2009 can be found here: