By Rose O. Sherman, EdD, RN, FAAN
Will you be hiring new graduates this spring? That is the question that I have asked nurse leaders across the country during the last three months. The answers have ranged from “definitely yes – but not as many”, to “we really hope to but at this point are not certain”. Many of these leaders work in hospital settings where the census has either dropped or fluctuated. They are closely watching their patient volumes and studying the trends. They report that baby boomer nurses have begun to retire but their positions are sometimes left unfilled. This is a trend worth watching as I have written about in past blogs such as A World Without Hospitals. The future of health care will not be hospital centric but rather in community-based and long-term care settings. Future nursing opportunities will be in these areas. Yet historically, more than 80% of new graduates start their careers in hospitals. In 2014, many new graduates may need to consider other settings.
Where the Jobs Are
There will still be jobs for new graduates in hospitals in 2014 and some medical centers have already begun scheduling interview for residency programs. In many parts of the country, the competition for these jobs will be stiff, and those holding a BSN are at a distinct advantage. A recent study conducted by the American Association of Colleges of Nursing indicates that 39.1 percent of employers require the BSN for new hires, while 77.4 percent strongly prefer BSN-prepared nurses. With fewer jobs available today in hospitals, it is not surprising that many nurse leaders also prefer nurses with at least two years of experience. New graduates come with enthusiasm and many skills but the onboarding process is still expensive and the highest rate of RN turnover occurs in the first year of practice.
The overall employment prospects for RNs are quite positive. Technological advances, a greater focus on preventative care and the aging baby boomer population have triggered rapid growth in healthcare, and the latest report by the Bureau of Labor Statistics predicts that employment of registered nurses will jump 26 percent from 2010 to 2020. Yet, many of these positions may not be in hospitals. In my state, Florida, it is anticipated that data from the 2014 RN licensure cycle may indicate that more RNs now work outside of hospital settings. The fastest growth in new positions is occurring in five areas: long-term care, skilled nursing facilities, rehabilitation settings, home health and hospice. Yet few new graduates ever consider these alternative settings. In research conducted in Wisconsin, it was found that only three percent of BSN nursing students reported planning to work in long-term care settings after graduation. It was a widely held perception that only people who can’t find employment in other areas would work in long-term care. Yet with 3 million baby boomers turning 65 each year for the next 20 years and up to 69% of them projected to need some form of long-term care, many new employment opportunities for RNs are expected to be available in this specialty.
Changing the Paradigm in Nursing Education
Most nursing education programs are still hospital centric. It is not surprising that students are educated to believe that they should start their careers in an acute care setting. Yet the future growth in nursing will be outside of this arena. Unfortunately, many settings such as long-term care and home care don’t provide the orientation or mentoring that new graduates need to practice.
There are some new pilot projects under way that could serve as exemplars to change this paradigm. The New Jersey Action Coalition (NJAC) in 2013 received $1.6 million from the Centers for Medicare and Medicaid Services to prepare new registered nurses (RNs) for practice at New Jersey Long Term Care (LTC) facilities. Funds are used to develop, implement, and evaluate a model LTC residency program using a curriculum based on Nurse of the Future Core Competencies©. The project is intended to improve care for residents in long-term care facilities and help stabilize the state’s RN workforce. The Rhode Island Nursing Action Coalition also launched a statewide residency program where participants have opportunities to practice not just in acute care settings but also in community health clinics, visiting nurse services, long-term care facilities, behavioral health hospitals, and developmental disability providers. It is the first statewide program of its kind.
Our new graduates need our help. Many senior nursing students will soon become new graduates. They are already worrying about their job prospects based on the feedback that they have received from last year’s graduates and recent stories in the media. We need to offer our career guidance and encourage them to broaden their job searches beyond the hospital.
Read to Lead
Robert Wood Johnson Foundation (January 29th, 2014) Recent RN Graduates Report Fewer Job Opportunities than Earlier Graduates
© emergingrnleader.com 2014
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