Looking Out for Our New Nurse Grads

Laura A. Stokowski, RN, MS


June 17, 2011

In This Article

What Happened to the Jobs?

Most experts blame the crumbling economy for ruining the job prospects of new graduate nurses around the country, but as usual these days, the truth is more complex.

Uneven distribution. The demand for nurses was supposed to exceed the supply by the year 2010.[9] The question of whether we truly have a nursing shortage right now is a fair one. The answer, it seems, is "it depends." Apparently, it depends on where you live and where you are willing to work. Neither the distribution or supply of nurses, or the demand, is uniform. Some geographic (mostly rural) areas have a shortage of nurses, whereas some urban locations are witnessing an oversupply of nurses.[10] New graduates seeking jobs in these regions will face a very competitive job market.

Economic recession. The shrinking job pool is widely believed to be a consequence of the declining US economy. Temporarily at least, economic pressures and job losses in all industries have induced thousands of experienced but aging nurses to forego retirement and even increase their working hours to support their families. According to Buerhaus, more than 75% of new nursing jobs between 2001 and 2008 were filled by nurses over the age of 50.[11]

Combined with a lower hospital census (as a result of fewer elective procedures and loss of health insurance coverage), this has led to downsizing, hiring freezes, and even hospital closures.[9] When the cash flow diminishes, hospitals traditionally look to cut the nursing budget, the highest cost center in the hospital. The most expensive item in that budget is orienting and training the new graduate. Transitional programs for new graduates, such as internships and residency programs, have been sharply curtailed, and many hospitals stopped interviewing new grads altogether. It doesn't help that newly licensed nurses have a reputation for having the highest turnover rates. As many as 26% of new nurses leave their first nursing employer within 2 years.[12]

Shifting settings of care. Healthcare is largely moving out of the hospital and into community-based settings. Job growth for RNs is expected but not necessarily in the hospital. Significant job growth will occur in nursing homes, long-term care, home health, and even physicians' offices. Acute care hospital job growth will be the slowest.[13]

This contrasts markedly with what most new grads want. Hospital positions are, by far, the most sought-after jobs by new graduates. As a result of the shift in settings of care, however, hospital jobs could become increasingly difficult for new graduates to find, especially because it is typically more expensive to train them for acute care. Some hospitals are leery of hiring new graduates, believing that they will leave after a year or two, amplifying the overall cost of orienting new employees. Hospitals are able to demand experience (usually at least 2 years) of their new hires, and if they do have open positions, will offer them preferentially to those graduating with bachelor's degrees. Home care, long-term care, nursing homes, rehabilitation facilities, physician's offices, and outpatient clinics may be the only options for many new graduates.

Unrealistic expectations. Many, although by no means all, new graduates are holding on to unrealistic expectations about the type of nursing position that they will be able to find. Nurse recruiters report that they often interview new graduates who state that they are seeking only a day shift position, or one with minimal weekends. Others want to work part-time, right out of school, which is generally not acceptable to the hospital that must spend money to orient, or extensively train the new graduate, depending on the clinical area. Some new graduates even go into the interview requesting a position in critical care, the operating room, or other specialty area -- areas that typically hire few, if any, new graduates. Demands of this nature will significantly hinder the new graduate's chances of landing a job.


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