New Nurses Report Tougher Job Market

The economic recession may be to blame for a downturn in demand for newly licensed registered nurses, suggests a survey from the Robert Wood Johnson Foundation. The lead author speculates, however, that demand will grow stronger as healthcare reform is implemented.

For years we've been told about the nursing shortage and the thousands of jobs awaiting newly minted registered nurses. Now a survey of newly licensed registered nurses suggests that this might not be completely accurate.

Compared with six years ago, newly licensed registered nurses (NLRNs) who completed their studies in 2010–11 have greater job commitment, but are more likely to work part-time, and to report that they had fewer job opportunities, according to the survey from the RN Work Project, a program of the Robert Wood Johnson Foundation.

Of those in the 2010–11 cohort who reported being unemployed, 31.1% said they could not find an entry-level RN job in their area, compared with only 11.8% reporting this in 2004–05. More specifically, one in 10 of the 2010–11 cohort said they could not find a job they liked.

Christine T. Kovner, RN, a professor at the College of Nursing at NYU and lead author of the survey, says that some of the perceived downturn in demand for nurses may have been a byproduct of the recession.

"It's more difficult to get jobs for new graduates now than it was prior to the recession," she says.

"We think what happened during the recession was that as people's partners lost their jobs, a lot of nurses increased the hours that they were going to work. We looked at data and found that nurses had increased their hours of work. Some of that was part time to full time. Some of it was doing extra overtime more often. That may have been one of the factors that for this group that graduated in 2010–11 made it more difficult for them to get jobs."

A Tighter Market, But Still 'Lots of Jobs'
Kovner concedes that the data and survey returns compiled by RN Work Project and other objective data compiled about healthcare employment are not granular enough to provide empirical evidence on the state of nurse employment.

"We think the best measure is how the nurses perceive what is going on because at the end of the day, that is all that matters," she says. "If they perceive that there is difficulty in getting jobs they are likely to be more reluctant to leave their current jobs. We think that is what's happening here."

While the job market may have tightened, at least temporarily for nurses, Kovner says there are still "lots and lots of jobs" with tremendous opportunities for career growth, especially when compared with the prospects of other recent college graduates.

"If you look at the data, most of them still all got jobs. At NYU our graduates have the highest average salaries than any of the other schools at NYU including the business school," she says. "People that aren't in the sciences, a lot of them work in publishing. A lot of them are unemployed, I don't know for NYU in particular, but in general, liberal arts graduates have a more difficult time finding jobs. So nursing is still a great job opportunity, but it is not as great as it was."

Fewer Hospital, ICU Jobs for New Nurses
As in past years, most NLRNs began their nursing careers in hospitals. However, that percentage dropped for the 2010–11 cohort, with 77.4% of the NLRMs finding jobs in hospitals, compared with 88.8% in the 2004–05 cohort. Of those in the 2010–11 cohort 13.5% were more likely to work in a magnet hospital compared with 10.3% of the 2004–05 cohort.

They are also less likely to work in intensive care units (18% in the 2004–05 cohort, compared with 11.6% in 2010–11) and more likely to be working part-time as a nurse (10.5% in 2010–11, compared with 7.8% for 2004–05), the survey found.

Kovner finds this movement away from hospital work for NLRNs over the past several years one of the more "telling" parts of the survey, but it's not quite clear exactly what the data is saying. Does this trend reflect the move toward lower inpatient volumes and toward outpatient services?

"I don't think so, but I haven't looked carefully at the number of occupied beds in those two time periods," she says. "Fewer baccalaureate graduates are getting jobs in hospitals than they were six years ago, but still way more on a percentage basis of baccalaureate graduates are working in hospitals compared with associate degree graduates in their first job."

And there does appear to be more interest in pursuing advanced degrees among the NLRNs, as 16.6% of them reported that they were enrolled in a formal education program compared with 11.4% in the earlier cohort.

"I don't know what that is going to mean long term," she says. "I don't know whether people did that because they were having difficulty getting a job or they could only get a part time job. A lot of the associate degree graduates are going back to school to get a bachelor's degree. I don't know about baccalaureate graduates and what they are planning to do. A lot depends upon the job opportunities. If you can work at an outpatient department and help people take care of their chronic illness as a registered nurse, which I believe you can, they may choose to do that."

Demand Expected to Grow
While she can only speculate, Kovner says she believes the trends in demand for nurses will grow stronger as the Patient Protection and Affordable Care Act takes hold, and as providers move away from fee-for-service care and toward value-based care and population health.

"They will have an easier time getting a job," she says. "First of all there are the numbers of older nurses who are going to start retiring. We thought that was going to happen earlier than it did but again we think that with the recession people decided who might have retired decided not to retire."

"Beyond that the opportunities for nursing are going to be humongous. Accountable care organizations, helping people manage chronic care, working in walk-in or outpatient departments; a lot of organizations are still thinking through how best to use the registered nurse. There are a lot of opportunities and even lot what nurse practitioners do registered nurses can do."

"There is going to be a demand for care coordination. You need to have skilled people doing that. It's not training someone who has a degree in English for how to make a list of what all the services are. You really need a skilled medical professional to make the judgment and the problem solving involved in that. We will see how it plays out."