Where Will the Nursing Shortage Be and How Can We Overcome It?

Registered nurses are a hot commodity in the U.S. labor market and the proof is in the latest data and statistics.

According the U.S. Bureau of Labor Statistics, job growth for RNs is expected to expand by 15% between now and 2026, with more than 438,000 new nursing positions needing to be filled.

The U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Workforce, and National Center of Health Workforce Analysis created a recent report. It predicts if the volume of U.S. healthcare usage remains the same as it is now,  seven states are expected to experience a nursing shortage by the year 2030.

The present level of nursing graduation rates and nursing employment trends must continue as they currently are for this nursing shortage prediction to hold.

Out of those seven states, four states are expected to have a significant RN shortage of greater than 10,000 full-time equivalent positions.

Per the HRSA nursing-supply-and-demand report, the four states projected to have nursing shortages of greater than 10,000 FTEs by the year 2030 are:

  1. California (44,500)
  2. Texas (15,900)
  3. New Jersey (11,400)
  4. South Carolina (10,400)

The other three states predicted to have a nursing shortage in 2030 are:

  1. Alaska (5,400)
  2. Georgia (2,200)
  3. South Dakota (1,900)

What’s a nurse recruiter to do?

For recruiters in states expecting a nursing shortage, staying ahead of the game with ongoing recruitment and retention efforts targeted specifically to RNs is essential, said Carol Boswell, MBA, human resource manager at Houston Methodist Hospital in Texas.

“We have a fully-staffed RN recruiting team at our flagship location with five full-time RN-only recruiters,” she said. “Houston Methodist is a Magnet-designated hospital, which certainly helps attract RNs. And we’ve enhanced our advertising, initiatives and events focused on nurse recruitment over the past few years.”

Houston Methodist uses a variety of methods to recruit RNs, Boswell said.nursing shortage

“We hold job fairs across the greater Houston area and participate in area nursing school job fairs,” she said “We’ve also increased our presence on social media to try and attract nursing candidates. Additionally, we offer sign-on bonuses as needed for highly competitive specialty roles. Like many hospitals across the country, we have opportunities to fill positions in the ICU and other specialty areas such as wound care.”

In states that pay lower nursing salaries, recruiting nurses to work there can prove challenging.

“I’m concerned about the predicted nursing shortage for South Carolina,” said Patti Hart, DNP, RN, CPN, NE-BC, associate chief nursing officer, nursing operations, at the Medical University of South Carolina. “Pay rates here are at the lower end of the spectrum for nursing and that can make recruiting more difficult, especially when looking for experienced nurses to work in specialty areas.”

Hart said MUSC is an academic medical center and a clinical site for several nursing schools which helps with the recruitment of new grads each year.

She said this summer the medical center will have 100 new nurses coming on board as employees from more than 350 applicants.

Other strategies MUSC uses to attract new grads is partnering with nursing schools out of the area via job fairs and Webex conferences for information sessions and remote, scheduled interviews with prospective new hires or soon-to-be new grads, Hart said.

One of MUSCs school partners is a local junior college called Trident Technical College which offers a program for high school students to train as patient care techs, then work full time in the summer and part time during the school year at MUSC. If they do well and meet the required criteria, students can apply for a partial scholarship funded by MUSC and Trident, to attend nursing school at Trident and earn an ADN.

Desperate times call for innovative recruitment measures

AT MUSC, Hart said they’ve used a strategy of over-hiring nurses in areas that generally experience higher rates of nursing turnover so there is usually another nurse or two in the queue if someone resigns.

“We’ll over-hire two to three nurses every six months in high turnover units,” she said. “This is not too lofty a goal, yet it’s smart and proactive to help prevent ongoing staffing shortages.”

Another recruitment strategy that has helped reduce RN shortages at MUSC is the practice of meeting weekly with every nurse manager, to discuss any critical staffing issues they may be experiencing, Hart said.

“If a manager has an opening, we discuss specific strategies to fill the position and fill it sooner rather than later,” she said. “Prior to doing this, it took us an average of 42 days to fill a nursing position after it was posted. After implementing these weekly meetings with my managers, we now fill positions much faster — in approximately 18 days.”

It’s important to make an offer as soon as possible to an RN you’re interested in hiring, Hart said.

“You have to get them right away, and you need to partner with recruiting to speed up the process,” she said. “We used to wait for a nurse to formally apply to a position before proceeding with the next steps. Now if we’re interested in hiring someone, the recruiter will propel candidates through some of the steps of the hiring process with just a resume.”

Areas such as the cath lab, dialysis and the OR are specialties that have been more difficult to fill with seasoned nurses, Hart said.

“When staffing shortages exist in these areas, we utilize travelers as needed. Another strategy we use for our specialty units is to pay retention bonuses every six months, to encourage our nurses to stay on the job,” she said. “We’ve also just finalized a plan to hire 16 experienced RNs from the Philippines to work in these specialties, each for a three-year commitment.”

Hart said by decreasing the number of vacancies and filling positions faster, it has helped reduce nursing turnover at MUSC, thwarting a nursing shortage.

“Our turnover rate has dropped from 18.3% to 15.1% since implementing many of these recruitment strategies,” she said. “When there are a lot of vacancies, nurses are concerned about practicing in a location that is chronically short staffed as they fear their license is in jeopardy. This also contributes to work-related stress. When the vacancy rate is low, it results in people staying on the job longer due to an improved work environment.”

Many hospitals take pride in not only their recruitment, but also the environment they provide after the hiring process and beyond.

“At Houston Methodist, our recruiters work closely with our hospital and nursing leadership, along with our staff, to identify the best candidates possible,” Boswell said. “With a fully-staffed HR nurse recruitment team, we can cast a wider net across the U.S., not only through recruiting firms but also through nursing schools, to identify possible candidates. We’ve had some nurses employed with us for decades and our RN turnover has decreased by about 4% from 2017 to 2018. I believe this is a result of our being a leader in nursing care in Texas and across the U.S.”