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The elephant in the room: employment for new graduate RNs.

It is a rare thing to have someone speak, other than you, the exact words that are on your mind at a time when you truly want those words to be spoken aloud and for the record. While attending the most recent American Association of Colleges of Nursing (AACN) Baccalaureate Education Conference in St. Louis last month this happened to me.

A keynote speaker spoke about The Future of Nursing Report released by the Institute of Medicine (IOM) in October 2010. The main focus of the presentation was the need for nursing educators to help meet the IOM's call to raise the number of baccalaureate prepared registered nurses (RN) from the current 60 percent to "80 percent of the nation's RN workforce by 2020" (IOM, 2010, p. 173). The reason for this call was to ensure that the RN workforce possesses the educational capacity to provide "an expanded set of competencies, especially in the domains of community and public health, leadership, systems improvement, and change, research, and health policy" expected to be a part of the expanded role of RN's in the changing health care landscape faced in the U.S. as health care reform and increasing demands progress (IOM, 2010, p. 173).

So, where was the elephant? The answer was another question. Where is the demand for new RNs? One attendee stood to ask how competency is maintained if there is a prolonged time between graduation from nursing school and employment. Another attendee from California stood to assert that the RN shortage was a myth as her program graduated ninety RNs in 2011 and of those only two had found jobs within the year. Her words were "I think we are missing the 900 pound elephant in the room. If there is a shortage, where are the jobs for these new graduates?" My thoughts exactly. It is difficult to see graduates struggle to find work as an RN in the current economic climate cognizant of the educational debt most incur while unable to see any clear indication of increasing opportunities in the RN workforce in Nevada.

So, is the "current" nursing shortage a myth?

As hard as those words might be to hear, they do seem to be correct. Dr. Peter Buerhaus, Director of the Center for Interdisciplinary Health Workforce Studies, Institute for Medicine and Public Health, Vanderbilt University, states "In the near-term (next couple of years) we can expect that, until there is a strong jobs recovery, most hospitals and other employers will continue to find that they can employ all the RNs they want at prevailing wages" (as cited by Tri-Council for Nursing, 2011, para. 21).

There is hope in the near-term for new graduates seeking positions if a few things occur as projected. A big IF.... First, if we see continued and more rapid economic recovery the near-term need for RNs is expected to rise sharply. The average age of the working RN population is rising. The current average age of RNs in the workforce is over 47 years (IOM, 2010). Currently, over 900,000 of the estimated 2.6 million working RNs are over the age of 50 (Buerhaus, 2011). It has been estimated that two-thirds of the recent growth in RN employment was supplied by RNs over the age of 50 who reentered the workforce as a result of family income difficulties resulting from the current economic recession (Buerhaus, Staiger, & Auerbach, 2009). "Because hospital employment of RNs over the age of 50 increased by more than 100,000 in 2007 and 2008, the exit could be swift and deep as many of these RNs seek to resume (or begin) their retirement once their spouses' rejoin the labor market (Buerhaus, 2011).

Additionally, if the past trend of nurses over the age of 50 years moving away from health care delivery to either retirement or roles away from direct patient care continues, more direct care jobs will become available. One recurring reason cited by RNs for moving away from direct patient care has been dissatisfaction within the nursing workplace (Black, Spetz, & Harrington, 2008). The current "difficulties are further complicated by other changes in hospital care, such as new medical technologies and a declining average length of stay, that have led to increases in the amount of care required by patients while they are in the hospital" and an increasing physical demand on RNs in direct patient care that adds to job dissatisfaction (Stanton, 2004).

Finally, if new graduate RNs re-think the "must haves" of their job searches; they should reevaluate their expectations in light of current workforce realities (Clavreul, 2011). Many of the graduates are frustrated because they are unable to land their "dream job" located in the "dream location" as opposed to any nursing job where the nursing demand and needy populations reside. The opportunities that once existed in specialty care for new graduates are not so plentiful now, but there are new opportunities in other aspects of health care delivery such as home health and long term care centers. "Employment in nursing care facilities is expected to grow because of increases in the number of older persons, many of whom require long-term care. Many elderly patients want to be treated at home or in residential care facilities, which will drive demand for RNs in those settings" (U.S. Bureau of Labor Statistics, 2009, p. 4). Further, home health care "is expected to increase in response to the growing number of older persons with functional disabilities, consumer preference for care in the home, and technological advances that make it possible to bring increasingly complex treatments into the home. The type of care demanded will require nurses who are able to perform complex procedures" (U.S. Bureau of Labor Statistics, p. 5).

There is an elephant out there. But, so are nursing jobs. There is something to be said for reality checks and a willingness to work as a needed direct care provider in the geographic area where the demand exists. The result will be a nursing workforce in the future with valuable experience and who prove that they do, indeed, possess those valuable competencies research suggests will be so necessary in tomorrow's health care environment.

References available on request.

Carrie O'Reilly, PhD, MSN, RN

Assistant Professor and Undergraduate Programs Coordinator, Touro University Nevada
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Author:O'Reilly, Carrie
Publication:Nevada RNformation
Date:Feb 1, 2012
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