When I graduated with a baccalaureate in nursing in 1971, it was easy for my classmates and I to find work in our chosen profession-a new nurse graduate could walk into almost any hospital and get a job as a staff nurse. This remained the case for many years; indeed, more recently, many such jobs came with extensive orientation programs at full salary. But the experiences of nurses graduating this year are more like those of nurses who graduated in the late 1890s and early 1900s (as some of those on this month's cover did), for whom paying hospital jobs weren't an option. Back then, students received "training," sometimes only a few classes a week, in return for long hours of work on the wards. Essentially, the students were the hospital's nursing staff, providing care under the direction of a few head nurses and supervisors. When the students graduated, the hospital didn't need to employ them-a new class was waiting to take their places on the wards.
Today's graduates are being shut out of jobs in hospitals for several reasons. The economic downturn has caused many nurses to delay retirement and others to return to the workforce or work more hours. According to the 2008 National Sample Survey of Registered Nurses, 85% of RNs are actively employed in nursing, the highest proportion in the survey's history. Hospital nursing vacancies are hard to find; for example, the Boston Globe recently reported that at Massachusetts General Hospital in Boston, the nursing vacancy rate is under 2%. The California Institute for Nursing and Health Care estimates that 40% of new graduates won't be hired by hospitals. At the National Student Nurses Association (NSNA) convention in April, I spoke with Evette Eubanks, a senior at the Research College of Nursing in Kansas City, Missouri, who said that of the 64 graduating students in her class, only she and eight others have found jobs. Diane Mancino, executive director of the NSNA, told me she's heard from a former member who, unable to find a nursing job, now works in an unrelated field and isn't sure whether she'll return to nursing. Similar stories are being heard across the country.
Although many people believe prospects for new nurses will improve as the economy recovers, the question is: what jobs can they find now? At the NSNA convention, military recruiters told me they're hiring. But hospitals are still favored as a first job setting, a place to gain experience in a generally supportive work environment-if you need help, there's usually someone within earshot. A colleague who teaches in a baccalaureate program told me she knows of one new graduate who found a job in a nursing home and is terrified because she'll be working nights, with little support. Will the stress of her first job drive her out of nursing altogether?
With funding from the Gordon and Betty Moore Foundation, the California Institute for Nursing and Health Care is developing a transition program for new nursing graduates who cannot find jobs in the San Francisco Bay Area. The program will provide internships, in both acute care and nonacute care settings, to help new graduates hone their skills and gain experience-while keeping them as part of the area's potential workforce. Hospital boards of directors elsewhere would do well to develop similar programs and reach out to foundations, corporations, and other potential local funders for support.
When I spoke recently with Brenda Cleary, director of the Center to Champion Nursing in America at AARP and leader of its workforce initiatives, she praised hospitals and organizations that are "taking the long view." Like many experts, Cleary thinks the current easing of the nursing shortage is temporary and that the situation will worsen in the next few years. She cautioned that it would be "reckless" to stop efforts to build the nursing workforce. She added that hospitals need to think strategically, with the future in mind. That future may arrive sooner than expected.