The RN job squeeze

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For more than 30 years, Rose M. Dimino, RN, wanted to be a nurse. But life kept her too busy.

Finally, in August 2008 she earned her associate degree in nursing from Becker College in Worcester, Mass. She took her boards in November, was licensed in early December, and — until she hit the job market amid what some are calling the Great Recession — was ready to embark upon her dream.

“It’s been my goal since I was 16,” says Dimino, 47. “It’s such a letdown when you pass your boards and you have a license and you can’t find a job.”

Nurses hunting for jobs are caught in some unprecedented trends, says Peter Buerhaus, RN, PhD, FAAN, a professor of nursing at Vanderbilt University’s School of Nursing. Since the economy has declined, nurse employment has actually surged, he says. But that’s because experienced nurses are extending their reach, taking on new jobs or more hours to fill recession-related income gaps in their households, he says. Research by Buerhaus and colleagues estimates hospital RN employment increased by 243,000 full-time-equivalent positions in 2007-08.

The researchers found that 50,000 nurses from nonhospital settings shifted during that period to the hospital sector, which typically offers better compensation and sometimes a schedule that allows nurses to hold two jobs. A California study, meanwhile, found average hospital vacancy rates down to 4.9% for the first quarter of 2009, compared with 7% for that period in 2008.

“The problem for new graduates is timing,” Buerhaus says. “They made the right decision to go into nursing, but they got caught in one of these economic contractions. And this one was so severe.”

Dimino and classmates struggled to find work. She prepared more than 100 applications to hospitals, agencies, and elsewhere. Many of the Boston hospitals were interested only in RNs with BSN degrees, and mainly in nurses with experience. “I even applied for nursing assistant jobs because I wanted to get my foot in the door,” Dimino says.

Experts say in this tight market, level of education matters. “What we’re seeing is that when employers have the opportunity to make a choice, when they’re not up against the wall to hire any [available] registered nurse, they will make a choice to hire the best educated nurse,” says Polly Bednash, RN, PhD, FAAN, executive director and CEO of the American Association of Colleges of Nursing.

Now is an excellent time to get a bachelor’s degree, say Cynthia Hopkins, RN, MA, CHCR, nurse recruiter for Salinas Valley Memorial Healthcare System in California. “There’s a huge emphasis on education at any hospital that’s working toward Magnet accreditation,” says Hopkins, vice president of the Northern California Association of Health Care Recruiters.

It’s also important for new graduates to be flexible in what opportunities they will consider. “This crisis is opening up everybody’s minds to think, ‘What about community health nursing, long-term care, and other opportunities?’” says healthcare systems consultant Jan Boller, RN, PhD.

Susan Hassmiller, RN, PhD, FAAN, senior adviser for nursing at the Robert Wood Johnson Foundation, expects demand to grow in community-based nursing. “That is where more and more nursing will be,” she says. “This healthcare system can’t sustain hospital care for everybody.”

New graduates should be willing to think outside the box, advises Donna Nickitas, RN, PhD, CNAA, BC, editor of Nursing Economic$, a journal for healthcare leaders. She suggests exploring national service under the Kennedy Serve America Act, or considering the American Red Cross, global nonprofits, the military, U.S. Public Health Service, community-based agencies, schools, and public health departments. “It’s a way to stay connected,” she says.

Job hunting farther from home also might prove effective. Donna M. Herrin, MSN, RN, NEA-BC, CENP, FACHE, president of the American Organization of Nurse Executives, says the job market for nurses varies regionally. “Some areas have lots of opportunities for new grads.”

Bednash says she’s seen a lot of job openings in Texas, for example. And relocating can offer diverse benefits. “If you can move,” she says, “you might be able to expand your view of the world, and you might be able to find some other position you didn’t think would be available.”

Boller, project director for the California Institute for Nursing & Health Care’s White Paper on Nursing Education Redesign, says new graduates shouldn’t get discouraged because the nursing community is working aggressively to change the situation.

Nurse executives, meanwhile, remain focused on the long-term pipeline as well as short-term staffing needs, says Herrin. “Many organizations are finding innovative ways to bring in new graduates. We know that the situation we find ourselves in is temporary.”

Those innovations include six- to 12-month paid internship programs where new nurses can experience a variety of specialties and apply for any jobs that open up, Herrin says. Another approach has been to provide new graduates general med/surg orientation as well as exposure to a specialty area, then deploy them systematically to assist nurses and gain more experience.

After a difficult search, Dimino landed a job at a nursing home. “I wanted a job so bad I just took it,” she says. But she was quickly overwhelmed when her employers wanted her on the floor before she felt prepared. She left after three months.

Dimino is working at a Boston dialysis clinic that pairs classroom training with clinical time to ensure mastery of skills. “I’m not stressed the way I was at the nursing home,” she says.

Dimino’s story is not uncommon among new nurses. Better preparation of new graduates is crucial in an increasingly complex workplace, Boller notes.

The California white paper calls for expanded orientation and residency programs and seamless coordination between academic and clinical preparation. “We need to set up learning experiences to integrate theory and science with the clinical work and real-world practice,” Boller says.

Like their colleagues in California, educators and employers in Massachusetts and Oregon recognized that fluidity is essential to a successful transition from the classroom to clincal practice. The Orgeon Nurse Leadership Council Education Committee and The (Mass.) Board of Higher Education and the Massachusetts Organization of Nurse Executives have developed initiatives in their respective states that address improving the competency of new graduates.

In the meantime, new nurses need to develop top-notch job-hunting skills. Herrin suggests joining professional associations, developing a standout resume, and polishing one’s appearance.

Hopkins likewise urges professionalism: Wear a suit to interviews. Be sure all correspondence — even a text message — is phrased and spelled correctly. Be clear and polite on the phone. “You have to shine,” she says.

One more essential skill is patience. “Once the recession ends and eventually unemployment rates start to fall,” Buerhaus says, “this will release the pressure on nurses to be working, and many of them will decide to leave the marketplace.”

“We’re going to see this pent up explosion of demand for nurses,” Bednash predicts.