This is part three of a four-part series about the nursing shortage. Part one provided a historical perspective and examined conflicting predictions about the scope of the shortage. Part two looked specifically at a shortage of highly skilled, experienced nurses as new graduates enter the job market. Since industry trends tend to influence health policy decisions—as well as YOUR career choices—it’s important to understand the factors at play in today’s nursing labor market.
Despite industry forces calling for a more educated nursing workforce, most state licensure boards have declined to require a BSN for entry-level practice. Why? There’s a widespread fear that more onerous education requirements will only add to projected nursing shortages. Yet, as discussed in part two of this series, newly graduated nurses with an ADN are at a disadvantage in today’s job market and many are unable to land a job right out of school. It seems clear that we’re not just facing a need for more nurses in the face of labor shortages, but for a higher percentage of better educated and more skilled nurses who can quickly move into the workforce.
Studies show a strong link between the BSN and better patient outcomes. Because of this, many hospitals are encouraging (and even paying for) mid-career nurses to go back to school. Yet despite the market demand for more educated nurses, nursing schools are turning away thousands of qualified applicants—a whopping 68,931 of them in 2014 alone, according to a survey by the American Association of Colleges of Nursing (AACN).
Nursing schools simply don’t have the capacity to accept more students, because they lack sufficient classroom space and clinical teaching sites. As reported by the AACN, the healthcare industry is being hit with a double whammy, as it becomes apparent that we can’t avoid a shortage by educating more nurses—because there is also a shortage of nursing educators, as many either retire or move into higher paying jobs outside of teaching.
So what can we do? First of all, we have to fill open faculty positions in nursing schools, by attracting more nurses to a career in nursing education. Secondly, the rising generation of nurse educators will need to look toward non-traditional education models that can scale up the number of students they can accommodate, at all education levels. This includes state-of-the-art simulation centers that can supplement existing clinical training sites in hospitals.
Nursing schools that use a distance learning model, like American Sentinel University, are helping to expand nursing education. Because we’re not tied to a specific location, we can make higher education available to a wider pool of students—including working nurses who have constraints on their time or live in rural areas far from traditional classrooms. We can also hire the best faculty from all over the country and can easily add adjunct faculty as our enrollments increase. And because we leverage technology for more efficient and effective instruction, we’re not locked into a traditional semester schedule—so students can start classes during every month of the year, according to what’s convenient for them.
But nursing education must also produce RNs who are better prepared to step into nursing practice and feel comfortable at the bedside. A 2012 article in American Nurse Today titled “Tripping Over the Welcome Mat: Why New Nurses Don’t Stay” reports that:
In a recently conducted survey regarding newly graduated nurses’ readiness to practice in the hospital setting, only 10% of nurse executives believed that new graduate nurses (NGNs) were fully prepared to practice safely and effectively. NGNs agreed with nurse executives that they lack confidence and adequate skills for up to a year after graduation. The perceptions of nurse executives and NGNs seem to be borne out by NGN turnover rates of roughly 30% in the first year of practice and as much as 57% in the second year.
Preceptor-based orientation programs are one way to ease the transition from education to practice. Research shows that a six- to 12-week precepted orientation period can help new nurses gain skill, confidence, and familiarity with protocols and procedures. Nurse residency programs are even longer, ranging from six months to a year, and can significantly boost the retention of new nurses. Expanding the education pipeline to reduce nursing shortages will only be effective if we can make new nurses feel at home—and want to stay—in their chosen profession.
Looking ahead: In a free market, labor shortages generally resolve themselves over time. Why is this not the case with nursing? Part four will look at the various factors that affect the supply and demand of nurses in the workforce.