A Closer Look at the Nurse Recruitment Landscape

Lately, we’ve been reading (and talking) about the doctor shortage. But as healthcare recruiters know all too well, there is no shortage of challenges in finding and landing qualified nurses. Keeping nursing positions filled, at the staff and advanced practice levels, has major implications for patient satisfaction, quality of care, and financial performance.


What’s taking shape in the nurse recruiting landscape, and what do recruiters need to think about to attract, hire, and retain highly qualified nurses? Here are some “big picture” trends and resources we’ve been reading about lately—highlighting the challenges posed by the building nursing shortage, amid an uncertain future for the healthcare system.


Demand Is Growing – Supply Can’t Keep Up

It all boils down to supply and demand. A report by the Georgetown University Center on Education and the Workforce projects that demand for nurses will top 4 million in 2020. The CEW estimates that during 2010-2020 there will be 1.6 million job openings created—most due to retiring nurses. Overall, there will be a shortage of 193,000 nursing professionals by 2020.


With so many good jobs going begging, it’s easy to imagine that nursing schools will be attracting more students. The data back that up—the American Association of Colleges of Nursing reports an “enrollment surge” at US nursing schools, including baccalaureate, graduate, and “RN to BSN” programs. As reported in a recent Wall Street Journal article, the enrollment surge is coming up against a “retirement wave.”


But the increase in nursing students faces a countervailing shortage of nursing faculty. AACN data suggest that US nursing schools turned away more than 64,000 qualified applicants last year. While budgets and lack of clinical placements play a role, the ceiling on enrollments is largely due to a lack of nursing faculty—an AACN survey suggests nearly 1,600 faculty vacancies. In addition to retirements, it can be difficult to get qualified nurses into teaching positions: especially when the salary for an assistant professor of nursing may be $20,000 less than for a nurse practitioner in clinical care or the private sector.


Predicting the Unpredictable

But forecasting the future is always a dicey proposition—never more so than attempting to read the tea leaves on what’s next with healthcare. As just one example, the 2015 CEW report referenced above cites the Affordable Care Act as a major driver of the increased demand for nurses. Now in the wake of promises to “repeal and replace,” it seems likely the ACA will be “interrupted,” to say the least. The changes sought by Congress are likely to increase state control over health care while increasing patient exposure to costs. Meanwhile, there is concern about instability in the insurance market now and increases in the uninsured rate in the future.


Meanwhile, the uncertainty is creating stress around nurse staffing issues, including questions about the immigration status of RNs working in the United States. But no matter how or when the political process shakes out, it’s difficult to imagine that the demand for healthcare will do anything but increase—not with a new “Baby Boomer” aging into Medicare eligibility every 8 seconds. Demand for healthcare is only going to increase—and dedicated healthcare professionals and organizations will have the responsibility and opportunity to meet the demand.


That includes the ongoing trend toward new ways of providing care. These alternative approaches include expanded roles and responsibilities for “advanced clinicians” such as nurse practitioners and physician assistants, especially (though not exclusively) in primary care. According to one recent survey, nurse practitioners have become the fourth most-recruited healthcare professionals, after family physicians, psychiatrists, and internists (and physician assistants were in eighth place).


Other innovative strategies are advancing as well, such as value-based care and the patient-centered medical home. The evolution of these new healthcare delivery models seems likely to accelerate, challenging healthcare systems and practitioners, once again, to do more with less. Many different types of advanced practice nurses and specialist nurses will play increasingly important roles—although those extra skills and experience come at a cost.


Not enough nurses to meet demand and difficulties in increasing the supply of new practitioners, amid a shifting political and policy future. How can healthcare recruiters and employers shape their strategy to meet these challenges? We’ll discuss some trends and ideas in the second part of this blog post.


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