WANTED: One Million Nurses

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In 1991, Jennifer Mosier quit her job as a hairdresser and enrolled in nursing school. Later this year, the 37-year-old from Cleveland, Ohio, plans to quit her job as an acute care nurse and open up a beauty salon. Mosier says she turned to nursing 11 years ago to follow a childhood dream of “taking care of people.� Today, fed up with what she calls unrealistic nurse-to-patient workloads, she's ready to give up the eight years and $20,000 of educational investment for work that's not as high-pressured. “I'm burnt out,� she says. “I can't stand it. There are too many patients and not enough support.�

Demographic trends, cultural shifts and image problems are eroding the ranks of the nursing profession. Despite a slight post-Sept. 11 rise, enrollment in nursing programs has been declining at an average rate of 4.2 percent a year since 1993, when it peaked at 270,000. As of 2000, enrollments were down 33 percent, to 181,000, according to the National League for Nursing. If the trend continues, nursing will face more staff vacancies by 2010 than any other professional category, according to projections from the Bureau of Labor Statistics (BLS). The agency pegs the number at a staggering 1 million job openings due to more demand and net replacement needs between 2000 and 2010. The dwindling interest in nursing comes at a critical juncture: A chunk of the country's 78 million Baby Boomers are poised to retire by 2010 — creating a surge in demand for the health-care services associated with an older population at the very time that there will be fewer nurses in the work force. “We've got a real problem ahead,� says Peter Buerhaus, professor of nursing and senior associate dean for research at Vanderbilt University. “The magnitude of these shortages would be big enough to severely hamper health care.�

Formerly prized as one of only a handful of professions open to women, nursing has fallen out of favor with a new generation. Thanks to a wider range of career opportunities, young girls today seldom dream of growing up to be Florence Nightingale. According to the BLS, the median age in nursing in 2001 was 43, compared with 39 in 1989, the earliest age data available for RNs. The share of working RNs under age 35 dropped to 24 percent in 2001, from 37 percent in 1989, reports the BLS. The share of young registered nurses under age 25 sank to 3 percent in 2001, from 5 percent in 1989. Says Angela McBride, dean of Indiana University's School of Nursing: “Women used to become a grammar school teacher, a nurse or a nun.� The women's movement helped expand the range of career options open to women; at the same time, the jobs women historically gravitated to were spurned in favor of the more lucrative, formerly male-dominated professions.

Forget attracting new candidates, nursing is having trouble holding on to its own due to irregular hours, heavy patient loads and stressful working conditions. A 2001 American Nurses Association study found that nearly 55 percent of the 7,300 nurses surveyed would not recommend the profession to others. Another 23 percent said they would actively discourage someone close to them from entering the field. In addition, nurses display among the lowest “engagement� levels of any category of workers, according to the Gallup Organization. Nearly 24 percent of the 22,000 nurses surveyed between 1999 and 2001 say they are “disengaged� from their work, defined as physically present but psychologically absent, compared with 16 percent of workers nationally who feel the same.

The number of those exiting the field is rising: The 135,696 RNs who were employed in non-nursing occupations in March 2000 represented a 15 percent increase over the 117,820 such nurses in 1996 and a 36 percent increase over the estimated 99,955 in 1992, according to the National Sample Survey of Nurses, conducted by the Health Resources and Services Administration. The exodus is likely to continue. One of every five nurses plans to leave the profession within the next five years, according to a survey of 700 current direct-care nurses and 207 former direct-care nurses, conducted for the Federation of Nurses and Health Professionals in 2001. And half of current nurses say that within the past two years, they have considered leaving the patient-care field for reasons other than retirement. What's more, the number of nursing school grads who sat for the national licensing exam for registered nurses has declined 29 percent since 1995, figures from the National Council of State Boards of Nursing reveal.

The No. 1 problem nurses cite is staffing. According to the Federation of Nurses and Health Professionals' survey, nurses say they are fed up with working conditions. In addition to working too many hours and performing thankless tasks, nurses also complain about conditions that may adversely affect patient care. For Mosier, the final straw came last March, when she worked as a temp nurse at an assisted living facility where the ratio of nurses to patients was an astounding 1 to 84. “I never thought it would be like this,� she says.

Then there's Karla Monroe, 46, of Terre Haute, Ind. After 27 years of working nights, weekends and holidays, and being required to float to other departments (such as obstetrics, where she had no expertise), Monroe enrolled in a business school program in February 2001. After she gets her master's degree in management this year, she hopes to find administrative work at a university. “I like what I do. I'm good at what I do,� she says. “But I don't like how I have to do it anymore.�

Currently, hospitals are short an estimated 126,000 nurses, according to the American Hospital Association. The national vacancy rate for registered nurses ranged from 14.6 percent in critical care to 6.5 percent for nurse managers, according to a survey of 700 nurse executives commissioned in 2000 by the American Organization of Nurse Executives (AONE). The direct impact of the staffing shortage is substantial: 51 percent of those surveyed cited emergency department overcrowding, 69 percent reported higher costs to deliver care and 25 percent said beds had to be closed, AONE found.

To address the shortage, some hospitals are employing traveling nurses, offering sign-on bonuses, overhauling their recruiting approaches and recruiting out-of-state. The nursing profession may also benefit from casting a wider net to include a more diverse pool of workers: Compared with the national work force, which was 47 percent female and 83 percent white in 2000, the registered nurse population was 93 percent female and 87 percent white, according to the BLS. Blacks made up only 5 percent of the registered nurse population in 2000 and Hispanics only 2 percent, though each group constitutes 11 percent of the national work force, according to the National Sample Survey. Asians were 4 percent of the working registered nurse population and make up 5 percent of the work force.

It's therefore no surprise that marketing campaigns are underway to counter nurses' own bad PR about their profession and to influence the next generation's career choices. Johnson & Johnson launched a $20 million national television advertising campaign in February 2002 to stimulate interest in nursing. “By using images of more male and ethnically diverse nurses in our marketing materials, we hope to recruit from a broader group of people than nursing has historically attracted,� says John McKeegan, spokesman for the New Brunswick, N.J.-based health-care products manufacturer. “If we can lure a more diverse group of people into nursing, we may well be on our way to addressing the shortage.�

The Johnson & Johnson campaign created recruitment materials for distribution by school guidance counselors, a Web site that profiles a range of nursing specialties and scholarships for nursing students and prospective nursing faculty. A campaign has also recently been launched by the Nurses for a Healthier Tomorrow, a not-for-profit coalition of 37 nursing and health care organizations. The group's $1.5 million campaign of print and TV public service announcements aims to promote nursing as a career to Gen X and Gen Y. In May 2002, promos began to run in 436 movie theaters before such movies as Spiderman and Star Wars. The ads were expected to reach some 2.5 million people in 13 major markets. “It's a good way to reach young people who haven't considered nursing before, as well as older career changers,� says Kathy Bennison, the coalition's manager of marketing.

Suggestions abound for ways to stem the nursing shortage; among them is the notion that the field may appeal to second-career seekers as well as to more diverse recruits, especially young men. Recruitment and retainment policies must appeal to different generations' particular needs and values, says Will Ruch, CEO and managing partner of Milwaukee-based marketing/recruitment consultancy Versant Solutions, which counts the Visiting Nurses Association among its clients. He says it's important to help nurses develop their talent, because once they stop learning on the job, they're apt to look elsewhere. Indeed, because the parents of Gen X and Gen Y lost jobs during recessions, these generations may be less likely to be loyal to companies and more interested in learning what they can get out of a job, says Bruce Tulgan, CEO of New Haven, Conn.-based RainmakerThinking, a workplace research and management training firm. He recommends recruiters make a point of framing messages in terms of what the workplace has to offer new hires.

Meanwhile, Susan Mitchell, author of American Generations (New Strategist Publications, 2000), suggests employers play up the job security in nursing. The stability of the profession would appeal to Gen X, she says, due to its experience with a rocky economy.

A benefit that few realize the profession has to offer is competitive salaries, says Dani Eveloff, recruitment coordinator for the University of Nebraska Medical Center (UNMC) College of Nursing. Traditionally, nursing has been seen as a “calling� that many assume doesn't pay, Eveloff says. However, she adds that compensation varies considerably. While staff or general duty nurses averaged $42,133 in earnings in 2000, nurse practitioners averaged $60,534 and certified nurse anesthetists averaged $93,787. The UNMC's new brochures emphasize the potential for high salaries, including bonuses, loan repayment options and career flexibility. They also feature more male and minority students. The new brochures for UNMC's nursing school debuted in 2000; a year later, its applicant pool had increased by 29 percent and the number of minority applicants grew by 225 percent.

Health-care experts say it's never too early to start recruiting. The UNMC College of Nursing plants the seed for a nursing career by discussing the profession with preschool and elementary school children. The school has developed a coloring book that features males and minorities in varied nursing roles. Children in kindergarten and the first grade are invited to tour the medical center. For many, it's the first time they encounter nurses. Says Eveloff: “We start small.�

While the forces eroding the ranks of nurses may not be easy to reverse, there are some small glimmers of hope. A majority of nursing schools report that applications are up after years of decline, according to the American Association of Colleges of Nursing. For example, Georgetown University's School of Nursing saw applications rise 10 percent over last year. And applications to Saint Louis University's School of Nursing increased by 53 percent over 2001, reversing a steady decline that began in the mid-1990s.

Educators attribute the swell in applications to a shift in values post-Sept. 11, in which nursing and healing professions in general gained stature in the public eye. “Is this fleeting or will it last?� asks Margie Edel, director of the baccalaureate and master's programs at Saint Louis. “I'm hopeful.�


Registered nurses are far less likely to be black or Hispanic than the national labor force.

Registered nurses employed in nursing by racial/ethnic background:

1980 2000 2000 Natl. Civilian Labor Force 2000 Index*
White (non-Hispanic) 90.4% 85.9% 73.1% 118
African American (non-Hispanic) 4.3% 5.1% 11.8% 43
Hispanic-Latino (any race) 1.4% 2.2% 10.9% 20
Asian (non-Hispanic) 2.4% 3.8% 4.7% 81
Sources: National Sample Survey of Registered Nurses, 1980, 2000; Bureau of Labor Statistics, 200
*An index of 100 is the national average. For example, in 2000, whites (non-Hispanic) are 18 percent more likely than the average American to be registered nurses. African Americans are 57 percent less likely than average to be registered nurses.
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