What We Talk About When We Talk About Nursing Shortages

Not so long ago, the air was filled with dire warnings of an impending nursing shortage. By 2020, according to one widely-cited analysis, demand might exceed supply by as many as 800,000 nurses.

That analysis was made in good faith, and it was based on not-crazy extrapolations from thirty years’ worth of economic data.

But in many local labor markets in 2012, there’s no sign of a shortage. In fact, in some regions there’s evidence of a glut. A few months ago, the California Institute for Nursing & Health Care announced that 43 percent of people who received nursing degrees in California and 2010 and 2011 were not working as nurses.

I’m going to try to make some dimly-informed comments about the nursing labor market in the next few posts. But first, a few words about what it means to say that there is (or isn’t) a nursing shortage.

In this context, “nursing shortage” is used in an unsentimental labor-economics sense. A nursing shortage exists when employers are actively trying to hire additional nurses but are rubbing against supply constraints, as evidenced by:

rapidly rising wages
mandatory overtime
heavy use of temporary “agency” nurses to fill gaps on units
a greater-than-usual willingness to hire nurses with little experience or limited training
new investments in nurse-replacing technology
desperate 3 am phone calls from hospital administrators to college presidents, begging them to launch new nursing programs

To say that there is no nursing shortage today is not to say that all hospital units are adequately staffed for patient safety and decent quality of care. There is plenty of reason to believe that patients would be better off if hospitals invested in stronger nurse-patient ratios.

As Linda Aiken put it on NPR, “There’s no actual nursing shortage. There’s a shortage of nursing care in hospitals and other health care facilities.”

Actual nursing shortages — prolonged episodes in which employers went through the contortions I listed above — occurred in the late 1980s, and again in the late 1990s and early oughts.

From the point of view of the nursing profession, phases like those have their virtues — rising wages and heavier employer investment in training new nurses.

But shortages also carry serious costs: Nurses are more likely to burn out when they’re pressed into overtime. Patient safety almost certainly suffers when there’s rapid turnover on units and when a higher proportion of nurses are fresh out of school. And those are also periods when employers are more likely to cast their wandering eyes around for alternatives to registered nurses, turning certain tasks over to assistive personnel or to robots.
David Glenn is a student at the University of Maryland School of Nursing and author of the blog, Notes on Nursing, where this post originally appeared.

5 replies »

  1. Thanks for the piece. Nursey/truck driver here. Wish I had known earlier, but the ed was still great, a good guidepost for my kids.

    Someone should be accountable, but I do not purport to know how to implement.

    All the best.

  2. Thanks for making the distinction between a nursing shortage and shortage of nursing care. I suspect, that as long as nurses continue to fill in the gaps, the hospitals will continue to keep staffing levels low. After all nursing has not found a way to conceptualize and quantify the value or benefit that they bring to especially the hospitalized patient. Until that happens, sadly, nursing will continue to be viewed only as a cost that hospitals have to bear as part of doing business.

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  4. Hi David – Thank you ever so much for writing this very important piece.

    I’ve been a registered nurse for over 30 years. In 2009, I took a job with a pharma company to get a break from the bedside. In January 2011, I was laid off after our company was taken over. I’ve now been an unemployed nurse (used to be an oxymoron!!) for over 20 months!

    I’ve applied for over 75 positions, not even just nursing or hospital-based, and haven’t been hired yet! My unemployment ran out 6 weeks ago and I’m wondering what my fate will be.

    I just wrote a comment on another related post on this site, “Why New Nurses Can’t Find Jobs (No, Really)” where I stated that as nurses, we need to:
    1) Remember the power that we have. We’re a huge and central part of the healthcare system and, should we choose to, we can leverage a good deal of pressure,
    2) We are all gifted individuals who should use the gifts that we have to create alternatives for ourselves,
    3) We need to support each other in our endeavors, whether that’s creating nurse-advocacy groups or breaking from the system to create our own nursepreneur companies.

    I’ve never seen anything like this, it’s always been easy for me to walk in the door and get hired the next day. It’s frightening and very disconcerting in its implications for healthcare (or the lack of it!).

    Thanks again for bringing this important issue to light.

    Take care,

    Jerome Stone, RN, MA
    Author – Minding the Bedside: Nursing from the Heart of the Awakened Mind

    P.S. – If you can, please visit my Indiegogo campaign (http://www.indiegogo.com/mindingthebedside); share it, tweet it, comment on it, and if you’ve the wherewithal, please contribute. Even a small amount will help me. Thank you ever so much.