Nursing: Trouble in Paradise?

Despite the consistently wonderful press about the trust that Americans place in the nursing profession, not to mention the heady days of new nurses being assured a plethora of jobs upon graduation, the nursing zeitgeist seems just a little diminished and subdued these days. At least for now, many new grads are hard pressed to find work and there is little to cheer about when it comes to nurses' economic standing.

It doesn't seem like it was too long ago when we were all cheering for new nurses to virtually sprint to nursing school, graduate as quickly as possible, and get themselves out into the field in order to assuage a nursing shortage of critical proportions. There were promises of jobs, competitive salaries, and apparently a generation of older nurses who were ready to retire.

Now, it appears that large percentages of new grads can't find work, and older nurses are staying in the workforce after losing significant portions of their retirement accounts and worrying about the future. With a new surplus of nurses, we're now faced with a highly-trained workforce who are twiddling their thumbs or fruitlessly searching for work when they should be providing care to those who need it (and 40 million uninsured Americans certainly need it, as do many of the insured as well).

Meanwhile, there are rumblings that nurses' overall job satisfaction is not what it used to be, even as nurses remain the most trusted profession in the United States in 12 out of the last 13 Gallup polls (Firefighters were voted the #1 trusted profession in the aftermath of the September 11th terrorist attacks in New York City). 

And the mixed messages just keep coming. We're told that the need for nurses will continue to climb as the Baby Boomer generation continues to retire and age. We are simultaneously being told that hospitals are choosing to ask part-time nurses or travel nurses to fill more shifts in lieu of training new nurses for those positions. This tactic may come back to haunt us when a wave of nurse retirees makes its plans known and we are caught short, having chased many new nursing grads into other fields due to the lack of promised employment.

Several factors may contribute to future challenges if we continue down our current path:

• College tuition hikes will make higher education less affordable and attractive for many prospective nurses
• Interest rate increases on student loans will add to would-be nurses' education-based debt load
• If the economy shifts, older nurses will begin to retire in larger numbers and there will be fewer new nurses ready to replace them
• We continue to forecast doom and gloom vis-a-vis the supposed current surplus of nurses and the shortage that now seems further off at some point in the future

If I was an individual who currently was thinking about going into nursing, I would be significantly confused and dismayed by the conflicting reports that I was hearing. On the one hand, a need for nurses as the Boomers age seems like a foregone conclusion, yet other reports state that the need for such nurses is still a long way off---2030, perhaps? And as new grads report increasing difficulty finding jobs after graduation, I might simply decide to pursue a career in occupational, physical or speech therapy, where the job prospects currently seem much more promising.

Mentoring new nurses, offering internships (paid and unpaid), and otherwise attracting the best and the brightest into our profession seems like a good "marketing strategy" for the profession as a whole. However, recruiting the best and the brightest becomes increasingly difficult as the prospects for employment continue to seem shaky at best.

I am personally concerned about the state of nursing, economically speaking, and I'm also concerned that seasoned nurses staying in the profession for largely economic reasons when they are on the edge of burnout is a recipe for poor outcomes and increasingly unhealthy nurses.

I'm no economist, so I have no answers. But I do know that these mixed messages will only serve to erode our talent base of new prospective nurses as they shift to more stable professions, and when the shortage looms its ugly head again, the American health care system---and the public---will be left holding the bag.