There's Something Happening Here - Emerging Nurse Leader

By Rose O. Sherman, EdD, RN, FAAN

“Where did all the RNs go?” I have been asked this question twice in the last month by Chief Nursing Officers in acute care settings who are perplexed by climbing vacancy rates, a noticeable shortage of experienced RNs responding to employment opportunities, a return of sign on bonuses and rising turnover especially among their Generation Y nursing staff. Many healthcare employers with historically high retention rates over the past decade are now seeing the return of 10-20% turnover.

These trends at this point have not validated by current workforce data but anecdotally are being reported by nurse leaders in many parts of the country. In my geographic area (South Florida), we are not yet in season but leaders are clearly worried about their ability to manage current patient care demands. During the winter months, the demand for healthcare surges and with it – the need for nurses.

So what is happening here. While the evidence is not yet complete, I am seeing the following trends from the vantage point of being a researcher looking at nursing leadership challenges and as coordinator of a nursing administration program with more than 70 graduate students, most currently in leadership roles:

Our nursing workforce is aging.

We have known for more than a decade that the demographics of the nursing workforce would eventually lead to shortages. Things did change with the economic recession and many nurse’s saw their retirement plans derailed. But the reality is that you cannot work forever. Many of our baby boomer nurses have either retired or are moving into nursing roles outside of hospital settings so they can continue working.

Competition for nurses with experience especially in specialty areas is increasing.

The generational cohort that followed the Baby Boomers – Generation X is much smaller demographically. With experienced Baby Boomer nurses leaving specialty areas, organizations are beginning to experience the loss of their years of experience and knowledge. Competition for experienced Perioperative, ICU, Emergency Room and Labor and Delivery nurses along with other specialties is growing.

There are more opportunities for nurses in community-based settings.

The biggest growth in RN employment over the past decade has been in settings outside of the hospital. The needs in home health, hospice, clinics and long-term care have grown with the aging population. Large healthcare insurers such as Humana and United Healthcare employ thousands of nurse case managers, many of whom do their work remotely in their own homes.

Generation Y nurses view their careers differently.

Perhaps the single, most significant change in the nursing workforce are the growing number of Generation Y nurses born after 1980. By 2020, Generation Y will be 50% of the nursing workforce. Many entered nursing as a first career at a relatively young age and are returning to graduate programs within five years of receiving their undergraduate degrees. There has been significant growth nationwide in Nurse Practitioner programs.

In contrast to Boomers, who were raised with a goal of job security; Generation Y nurses seek meaningful work and work/life balance. What is sometimes seen as disloyalty in this generational group may be their unwillingness to be loyal to an institution when it is perceived to be at the expense of their career growth and realization of their professional goals. They have no expectation of lifetime employment and are more likely than any preceding generation to leave a position if it is not meeting their needs. I have seen with my own graduate students that many of these Gen Y nurses will not take tuition reimbursement. They believe it will tie them down to employment that they may not want when they finish the program.

There was a song recorded by Buffalo Springfield in the 1960s that began with the lyrics, “There’s something happening here. What it is ain’t exactly clear” (Stills, 1967). Many nurse leaders would share that sentiment about leading in today’s environment. These are definitely trends worth paying attention to.