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Since 2008 – Progress Through Politics

The Myth of a Recession-proof Job- Nursing

Nursing has long been looked at as a career with almost impeccable long-term prospects. People always get sick, right? On top of that, the United States has a rapidly aging population, spends more on health care than most of the rest of the world combined, and is currently facing a nursing shortage that estimates suggest will broach half a million unfilled positions in the next few years.

As the current recession has materialized, we’ve heard those statistics bandied about time and time again. This, alongside stories about hospitals throwing themselves on top of each other going after new recruits, offering them sign-on bonuses, tuition reimbursement, travel packages- just to land a few newly-minted RNs. There are years-long waiting lists to get into Nursing programs at schools nationwide; thousands of newly-unemployed Americans are now looking to Nursing as a stable career that can put them back on track.

But the economic crisis currently facing our nation quickly calling this “conventional” wisdom into serious question- and it seems that no career is immune to the effects of this recession.

At first glance, you’d never know anything was amiss. Yahoo!Jobs writes, in a fluffy article about “recession proof careers”, that:

As long as people continue to get sick, there will be a need for nurses…. the Bureau of Labor Statistics predicts nearly 30 percent growth in nursing jobs through 2014, the second largest increase of any occupation. chimes in:

Weak job growth. A slowing economy. A declining housing market. Troubles in the financial sector. The news is full of worrisome developments that may indicate instability for workers in many professions and industries. Yet one area appears to be unaffected by threats of a recession: nursing…

The Associated Press discusses how the extreme lack of nurses contributes to a 20% burnout rate on newly licensed nurses- but never fear! Hospitals are ready to throw as much money at that problem as it’ll take to make it go away!

So more hospitals are investing in longer, more thorough residencies. These can cost roughly $5,000 per resident. But the cost of recruiting and training a replacement for a nurse who washed out is about $50,000, personnel experts estimate.

And do you want to know what CNN thinks is the most important consideration in choosing Nursing as a career?

Most importantly, the job security is iron-clad.

Even the recently-released jobs report from the Bureau of Labor seems to give credence to these claims. Amid the bleak numbers from the worst month of job losses in this recession comes this:

Nonfarm payroll employment continued to fall sharply in February (-651,000), and the unemployment rate rose from 7.6 to 8.1 percent, the Bureau of Labor Statistics of the U.S. Department of Labor reported today. Payroll employment has declined by 2.6 million in the past 4 months. In February, job losses were large and widespread across nearly all major industry sectors… Health care continued to add jobs in February, with a gain of 27,000.  Job growth occurred in ambulatory health care (16,000) and in hospitals (7,000).

Twenty-seven thousand jobs in a month with one of the worst job reports we’ve seen since the Depression, most of which are in very well-paying fields (including nurses, but also including physicians, CNAs, medical technicians, receptionists, etc). Not too shabby- until you take a closer look at the numbers. Since 2004, the health care industry has been adding somewhere around 30,000-40,000 jobs per month, on average. Here’s a chart of the last two years for comparison, in percentage of jobs added:

As recently as Summer 2007, the health care industry was adding an average of 50-60,000 jobs a month to their payrolls. However, in mid-2007, as the current recession began to rear it’s ugly head, those numbers dropped significantly. They rebounded temporarily twice last year- but since the credit crisis materialized, and unemployment has skyrocketed, the number of jobs added in the health care industry has been steadily declining.

“But four million jobs have been lost in the last four months!” you might say. “This all seems kind-of melodramatic, especially in the face of a 168,000 manufacturing jobs, or 104,000 in construction jobs, both lost in the last month alone!” But even a slowdown in the number of health care jobs added has implications for the rest of society.

The first thing to go during economic slowdowns are elective surgeries. People are less inclined to have these “unnecessary” procedures done, due to their high-cost, and the time they have to spend away from their job recovering. These procedures are generally low-risk, high-economic yield (knee replacements, gum/tooth reconstruction, plastic surgery)

Due to unemployment or loss of medial insurance, people shake off “insignificant” problems, eschewing primary care and “unnecessary” things like a yearly checkup or to check on that cough you haven’t been able to shake. When problems do manifest themselves, sometimes they have been so exacerbated by inaction that requires intense medical intervention- like a trip to the emergency room in an ambulance- which could have been avoided with a five-minute chat with the nurse practitioner at the local walk-in clinic. Not only does this put an enormous strain on the health care system, patients are much less likely to have the ability to pay these bills off.

The fewer people that seek health care, and an increase in the number of unpaid accounts of those who do, all limit the ability for health care facilities to provide services to some degree. While in “short” recessions, this may only have the effect of delaying a reinvestment in a facility’s infrastructure, or increased focus on efficiency, the effect of longer-lasting economic slowdowns and recessions begin to cascade- and no part of our country is immune to this.

In Idaho:

what’s happening now is that hospitals all over are tightening their financial belts, and are seeing lower vacancy rates. While Eastern Idaho Regional Medical Center has 200 inpatients today, there were about 100 one day in January — a month when, for example, just 4 of 29 beds in ICU were occupied. That’s a four year low.

In Chicago:

At Rush-Copley Medical Center in Aurora, there are more applications for staff nursing jobs than there are positions available, said Shawn Tyrrell, the chief nursing officer. Nurses aren’t leaving their jobs, according to Tyrrell. Instead, she said, they’re picking up additional hours and are choosing to keep working beyond ages when they originally planned to retire.

In Ohio:

“At the Children’s Medical Center of Dayton, the turnover rate among nurses was 5.2 percent for the first two quarters of the current fiscal year, down from 6.8 percent the previous fiscal year,” said Renae Phillips, chief nurse executive. “We have a lot of employees whose family members have been affected by the downturn,” Phillips said. “People aren’t as eager to change positions.” The Dayton Veterans Affairs Medical Center’s turnover rate has steadily declined from 11.2 percent in June 2006 to 7 percent in September 2008.

In Florida:

The nursing shortage in Sou
th Florida and across the nation is deepening, and now experts say the recession is undercutting the power of institutions to attack it. The economic downturn is drying up money that hospitals and nursing schools were spending to recruit and attract people to the profession. That means health institutions may remain understaffed longer than expected, health officials said.

I’m certain we can agree that this is all bad news, of course- but what does it mean for the rest of us? Well, you might be able to imagine it as- of all things- a trip to the local Home Depot store.

After getting out of the military, I went to work for The Home Depot for five years. Associates at The Home Depot all had “specialties”- Flooring, Plumbing, Hardware, the different departments that make up a home improvement warehouse. Ostensibly, there was an elaborate training program for each “specialty”, which included state-of-the-art computer training modules, a specific tier of time set aside for shadowing a more-experienced associate in the same department you were in, tests required to demonstrate proficiency. All geared towards being able to take someone with no background in home improvement, and making them experts in their field.

This would have been all good and well, except those circumstances were rarely met. I starting working for Home Depot just as the housing boom peaked; perhaps before that, when the money flowed freely and we were staffed at 110% of our capacity, that training regimen was followed. The situation I encountered, however, was much different. As home sales began to decline, so did any programs deemed superfluous. Associates quit, and weren’t replaced, meaning the remaining associates had their workloads steadily increased with no support to back it up. We were trained, as managers, to micromanage our associates’ “hours” down to the minute; if one of your associates had any overtime for the week, it was often grounds for a job-ending writeup. And, of course, instead of implementing that elaborate training regimen, we threw barely-trained associates to “the wolves”, so to speak- straight out onto the sales floor and into dealing with customers.

Customers, obviously, didn’t understand the vagaries of the situation we faced from day-to-day dealing with these problems. The way they saw things was, if you worked in the Paint department, then you were supposed to know everything about how to faux-finish that wall- and rightly so. If things had worked properly, this would have been fine, but the lack of training and the “jack of all trades, master of none” meme the company pushed led to an incredible amount of stress, and broke more than a few newly-minted Home Depot associates after days, or even hours.

However, the worst case scenario in the situation described above is a wrongly-tinted can of paint and a miffed customer, who could head over to the Lowe’s or Ace Home Improvement to get their problem taken care of. Sadly, it’s just not that easy when you’re dealing with health care issues.

How many of you have ever had to wait for hours in a waiting room, or triage center, before being able to see more than a fleeting glance of a medical professional? Now, imagine throwing millions of more people without jobs or health insurance into the mix.

One of the biggest problems in nursing prior to the recession was retention and turnover- in 2007, research showed that upwards of 1 in every 5 newly licensed RNs had changed principal jobs after one year, and the overall average nurse turnover rate in hospitals nationwide was 8.4%.

As the money to health care facilities begins to dry up, so will the money to hire and train new workers. Vacancies left by retiring or terminated employees will may not be replaced; hiring for previously-open slots may freeze. Indeed, we have already begun to see both of these circumstances coming to pass. And the underlying problems that led to the burnout and turnover described above certainly not have disappeared. And it only takes one bleary-eyed, distraction-driven innocuous mistake to be the last mistake a patient suffers.

We can see how this affects anyone who needs health care in this country- but for those unsure if their current job will last, or the newly unemployed looking at Nursing as an option, what’s the answer here?

For those who are set to graduate from nursing school in the 2009 and 2010 school years, the only difference you will (hopefully) see in the job market is having to do what any other newly-graduated college student has to do- work your butt off to convince employers that you’re the right person for the job. And thanks to the American Recovery and Reinvestment Act (otherwise known as the “stimulus” bill), $500 million was allocated for health professions training- $200 million specifically for the Nursing Workforce Development Programs. On top of that, $17.4 billion was included for the National Institutes of Health (which includes the National Institute of Nursing Research). This means that as long as things don’t get drastically worse, you’ll be in good shape- for now.

For those of you in the first year or two of a four-year program? The answer for you all depends on how successful President Obama, Congress, and the American people are at tackling this recession and getting us back on our feet- and what you can bring for potential skills to the table for prospective employers. Remember, it can sometime take upwards of $70,000 dollars for a hospital to hire, orient, train, and acclimatize a new RN Clinician I. To boost your chances, take a closer look at hospitals offering externships; see if you can publish a scholarly article in a nursing journal; volunteer with charitable organizations related to health care; and polish up on your resume-writing skills!

And for the rest of you- don’t dismiss Nursing as a career. Remember that no job is “recession-proof”, Nursing included. It is certainly not my intention to dissuade anyone from pursuing Nursing as a career. Nurses are on the frontlines of the health care crisis in our country. They are the ones who spend the most time ensuring patients get better, they’re the ones managing care plans, and as advanced-practice opportunities open for Nurses, they are sometimes even supplementing doctors in many stages of patient care. It’s a challenging, but rewarding, career.

Just keep these facts in mind as you draw out the potential personal pitfalls of pursuing a profession that, when cut back in a time of recession, will lead to even worse health care situations for those who are now unemployed and without health care- and that, as any other profession, finding a job is never a “sure thing”.


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