There have been several recessions in our country’s history, but most think about the Great Depression that ended the roaring 1920s – a time when unemployment was at 25 percent for many years. There were expanded needs for rural nurses, but no money to hire them. Voluntary agencies who hired nurses were dependant on philanthropic support which had dried up. A majority of nurses worked in private duty and as the crisis hit their clientele, demand for their services sharply dropped.

Eventually as the country started a massive, government-sponsored recovery, the Civil Works Administration hired public health nurses in 1933. Many believed that while the Great Depression’s hardships permeated every facet of American life, that nursing, as a profession, emerged stronger.

Fast-forward to spring 2009. While there are many uncertainties in today’s economy, including an 8.5 percent national unemployment rate, nursing remains a recession-resilient profession. There are important shifts taking place within the nursing workforce in this climate, but the future for nursing is as bright as ever.

More Full-Time Nurses Calm

“The suddenness and severity with which this recession struck has caused many nurses to rejoin the workforce resulting in what appears to some as the end of the nursing shortage,” said Dr. Peter Buerhaus, director of the Center for Interdisciplinary Health Workforce Studies in the Vanderbilt Institute for Medicine and Public Health. “In the long-term, however, the shortage will remain significant.”

Buerhaus and his team collected registered nurse workforce data from 2002 through 2007 showing increases of 228,986 fulltime nurses in hospital settings and 136,779 in nonhospital settings during that time. Data from 2007 shows nurse wages decreased by 1.7 percent, which correlates to the economic slowdown that started in late 2007. With unemployment rates anticipated by many experts to increase by 8 to 9 percent by year’s end, nursing still emerges as a more resilient career compared to most others.

But more nurses are carrying larger responsibilities among their families because of the recession. “Seventy percent of nurses are married,” said Buerhaus. “This increases the pressure for RNs to work because they may very well be the sole breadwinner in the household.”

Lou Kailen is the clinical staffing manager for Vanderbilt University Medical Center Nursing and manages a pool of supplemental nursing staff that has a higher hourly rate than fulltime nurses, but no guaranteed minimum of work hours per week. In one recent month, 16 of her 17-person group moved to fulltime positions at VUMC.“Many nurses had to make personal decisions like ‘my husband was laid off and I need insurance benefits so I need to work more,’” she said. She has also fielded many calls from RNs who have been outside the clinical area for several years, looking to return to nursing positions.

More Attracted to Nursing

Experts agree the current economy is likely to result in retired nurses reentering the work world, parttime nurses increasing their hours to fulltime, new RNs finding more competition for jobs than in years past. According to Buerhaus, economic pressures will keep current nurse wages stagnant, a tradeoff for an otherwise recession resistant job.

More people are retooling their skills to become nurses. According to Buerhaus, a recent survey of Americans found that one in four has seriously thought of becoming a nurse. That and the pattern of seeking out further education in times of high unemployment, may be why many nursing schools are experiencing record numbers of applicants.

Paddy Peerman, assistant dean of Enrollment for Vanderbilt University School of Nursing, has seen a near doubling of applicants into the school’s master’s program in the last two years. Her admissions staff is weeding through 42 percent more applicants for fall enrollment than 2008. The School has 340 general openings for incoming M.S.N. students (including both nurses and non-nurses) and a total student body in excess of 700 students. “In addition to the quantity, the quality of our applicant pool just keeps getting stronger,” said Peerman. But, that’s the good news.

Faculty Shortage Looming

The bad news is that the faculty shortage is narrowing the potential pipeline for nurses desperately needed in the future. The National League for Nursing reports that an estimated 90,000 applicants are turned away from nursing schools, due in large part to a severe faculty shortage.

Dr. Lois Wagner, assistant professor and head of the Tennessee Center for Nursing, believes the faculty shortage is looming large. She represented Tennessee at a nationwide consortium earlier this year to figure out how to help alleviate the shortage of nursing professors. “What’s clear is that nursing can’t solve this issue on its own,” said Wagner. “We need to bring in business people, regulatory bodies, workforce investment and maybe even allied health to optimize health care at a time when the economy is imploding.”

She left the consortium believing that part of the problem was the typical career trajectory that includes a round of nursing education, associate or bachelor’s degree, followed by clinical practice for several years before considering pursuing advanced degrees. “The stopandgo education we are used to in nursing only results in longer spans of time to develop potential faculty.”

Across the country, faculty members typically make substantially less than their clinical counterparts – that’s where basic economics can step in, according to Buerhaus. “I would love to see a doubling of faculty salaries,” he said. “That would send a message to society and solve the faculty shortage problem very quickly.”

In the meantime, others point to examples of standardizing statewide nursing curriculums as Oregon has done or pooling faculty resources for various programs. While headway is being made, state schools have experienced significant budget cuts and many nursing programs, like the University of Tennessee, have been cut in half.“My fear is that the cuts, like the ones at UT, will come back to haunt us a few years out,” said Kailen. “The influx of nurses we are seeing at Vanderbilt Medical Center now is economy driven, but that won’t last.”

Nursing Shortage - Not Over

Buerhaus and his team have the data to back up Kailen’s hunch. Their long-term projections show the aggregate age of the future nurse work force will not be as old as previously forecast, but the lack of nurses in future years is still a significant issue.

By 2012, the largest age group of RNs will be between 5060 years old. Buerhaus believes this is a good thing since many seasoned nurses have internal surveillance systems that can help identify nuances to improve patient care and outcomes down the road. “It’s important to realize that this is probably the most experienced, wisest, knowledgeable workforce in the history of nursing in this country,” said Buerhaus.

His previous research projected a nursing shortage of 800,000 to 1 million by 2020. However, based on current trends, the nation will have 285,000 empty nursing positions by 2020, growing to 500,000 by 2025. “Increasingly, the projected nursing shortage is viewed as much as a quality and safety problem as it is a workforce problem,” said Buerhaus. “There is no way possible that our health care system could function without a half million nurses.” VUSN

Contact: Kathy Rivers, (615) 322-3894 
kathy.rivers@vanderbilt.edu