Letter to the Editor on Legislative: The Nursing Shortage: A Public Health Issue for All


June 26, 2009

Response by Sally Ellis Fletcher to Legislative: The Nursing Shortage: A Public Health Issue for All by Glazer and Alexandre (November 14, 2008).

Dear Editor:

This letter regards the Nursing Shortage topic and considers the effect of the current recession on the job opportunities for new graduates. New graduate nurses, as well as current and future nursing students, are struggling to separate the rumors from the facts surrounding employment opportunities for nurses during an economic recession, and especially during the current recession. I encourage these nurses and nursing students to consider employment as a partnership and to distinguish facts from rumors by exploring historical hiring trends in nursing, as described below.

Partnerships involve a relationship where individuals have mutual worth and make important contributions to the relationship (American Heritage Dictionary of the English Language, n.d.). In contrast, employment is the payment of skills or services that may or may not be mutually valued, and may reflect a unilateral power differential in favor of the individual providing payment (Merriam-Webster's Dictionary of Law, n.d.). Considering one's skills and services as contributions to a partnership can promote a higher level of personal value, foster confidence in exploring creative career opportunities, and prompt greater scrutiny in exploring professional partnerships. Therefore I encourage new nurses to consider seeing themselves as a valued partner as they seek their first position as a professional nurse.

In 1978 the American Journal of Nursing's (AJN) News Update Column shared a report from the American Nurses Association (ANA) noting that in 1977, 2.6 per-cent of registered nurses (RNs) were unemployed, in contrast to a '7 percent unemployment for all workers' in the United States.' This report added that 'economist generally consider 3-5 percent unemployment as acceptable for the nation as a whole' (ANA, 1978, p.1605). The AJN also indicated that from 1975 to 1977 new RNs had unemployment rates of 2.6%, 2.3%, and 1.9% respectively. One might be surprised that new graduate nurses experienced any difficulty in securing their first partnership in nursing. However, in 1975 and between 1980 and 1983 initial jobless claims hovered around 6% for the United States in general. These time periods included two recessions, one from 1973 to 1975 and another from 1981 to 1982 (Perry, 2009).

During the current recession, as in previous recessions, nurses who previously worked part time or per diem, or who were voluntarily unemployed in nursing, have begun to fill many of the vacant, full-time positions new nurses might otherwise have been offered (American Association of Colleges of Nursing [AACN], March 12, 2009). Additionally, the demand for healthcare has decreased, as consumers are delaying non-emergency healthcare and elective surgeries, and those who are underinsured or uninsured are electing to delay or go without healthcare services. This decreased demand has prompted hospitals to implement fiscal restraints (AACN). In today's economic environment if an agency can hire an experienced nurse to work full time, with a six to eight week orientation, versus a six to eight month internship necessary for new nurses, hospitals may hire the experienced nurse, as doing so will be less costly in terms of salary, risk management, and orientation hours to the agency.

It is important to remember the profession of nursing has often been described as an 'elastic workforce' (Leighty, 2009, para 7), where hiring practices reflect the growth or downturn of the economy. In the midst of the current hiring slow downs and hiring freezes, new nurses seeking first partnerships do face a challenging journey. Yet, no industry is immune from influences of economic highs and economic lows. The following ANA statement is as true today as it was in 1978: 'Employment opportunities for registered nurses in the United States are better than those available for the nation's general workforce...' (ANA, 1978, p. 1605). New professional nurses may need to be more creative, assertive, and entrepreneurial in marketing their nursing skills. However, as a professional, registered nurse, one has acquired a career and a unique set of skills that have endured, and will continue to endure through economic highs and lows.

Sally Ellis Fletcher, RN, MSN, APRN, CNS, NP
Doctoral Candidate University of Rochester School of Nursing
Senior Associate in Nursing; Entrepreneurship, NxSTEP Facilitator
University of Rochester School of Nursing
Rochester, NY


American Association of Colleges of Nursing. (March 12, 2009). Talking points: Impact of the economy on the nursing shortage. [Press Release] Retrieved from www.aacn.nche.edu/Media/pdf/TalkingPoints.pdf

American Nurses Association (1978). Two reports find unemployment rates low for nurses. American Journal of Nursing, 78(10), 1605, 1650).

Employment. (n.d.). In Merriam-Webster's Dictionary of Law. Retrieved May 12, 2009, http://dictionary1.clasic.reference.com/browse/employment

Leighty, J. (2009, April 6) California nursing grads see job choices wilt in broken economy. Nurse.com. Retrieved http://include.nurse.com/apps/pbcs.dll/article?AID=2009304070029

Partnerships. (n.d.). In The American Heritage® Dictionary of the English Language, Fourth Edition. Retrieved May 12, 2009, from http://dictionary1.classic.reference.com/browse/partnerships

Perry, M. J. (2009, April 3). Adjusted for the labor force, initial and continuing jobless claims are far below the 1970s and 1980s. Carpe Diem. Retrieved from http://mjperry.blogspot.com/2009/04/adjusted-for-labor-force-initial-and.html