Nurses are great at work-arounds until they can find a permanent solution to a problem. That trait was evident as nurse leaders gathered in June to discuss the dichotomy of a still-growing nursing shortage and the lack of jobs for new nursing grads. All agreed the problem needs to be fixed as soon as possible. Just how was the question at hand.

The California Institute for Nursing & Health Care (CINHC) convened nurse leaders and other stakeholders at five regional meetings around the state to discuss the current situation with new graduates, with support from the California Labor and Workforce Development Agency, the Association for California Nurse Leaders (ACNL), the California Hospital Association, the Hospital Council of Northern and Central California and the Hospital Association of Southern California. Data from a statewide survey of hospitals and non-acute healthcare settings was used to determine where RN jobs are, with a focus on employment opportunities for new graduates.

Led by Deloras Jones, MS, RN, executive director of CINHC, the meetings gave leaders across the nursing spectrum an opportunity to discuss the plight of nurse graduates and its influence on the state's nursing workforce.

FINDING SOLUTIONS: Representatives of the CINHC, BRN, the California Labor and Workforce Development Agency, the ACNL and others convened in meetings across the state to address the lack of jobs for new nursing grads. BRN educational consultant Louise Bailey, MS, RN (left), Stephanie Leach, under secretary for workforce development, and Deloras Jones, MS, RN, CINHC executive director, attended the meeting held mid-month in Palo Alto. photo by Candy Goulette

"The shortage is not over," Jones emphasized. "It's masked by the economy. When the economy is bad, nurses work more. When it's good, they work less. As the economy worsened, older nurses who have been out of the workforce or working part-time have taken open slots, slots that might have been filled in the past with new nursing graduates. Nurses who were planning to retire have delayed their retirement plan. Once the economy turns around, these nurses will go back to part-time or retire. We will need new nurses to fill those slots."

Jones said California's nursing education capacity has increased 54 percent over the last 4 years, with enrollment up nearly 70 percent. However, the class of 2009 has little to celebrate as up to 40 percent may not find positions in hospitals. Recruiters are looking to fill only about half of the state's 10,000 open positions, and most of them will be taken by experienced nurses.

"There are 350,000 nurses in the U.S. with California licenses," she said. "That's a 32 percent increase since 2000, albeit about 17 percent of these reside outside of the state. We do not want to lose the gains we've made in building educational capacity and addressing the state's nursing shortage, but many new graduates are experiencing difficulty finding employment opportunities. Our task is to keep them engaged until the economy shifts and there are positions available."

While most new grads look for jobs in acute care, only 60 percent of nurses work in acute care. Jones said two-thirds of California hospitals are requiring RN experience and as few as 5,000 new grads may be hired in acute care in the state, meaning a majority of new grads won't have jobs in hospital nursing in 2009.

"The cost to transition a new grad from the academic to the practice environment is high," she said. "Some places are saturated with new grads and experienced nurses also are looking for work. Preceptors are stretched thin."

There are a number of other areas, including non-acute settings such as primary care clinics, skilled nursing facilities, correctional facilities and long-term care, where new grads could go. Jones acknowledged that problems exist with these placements.

"Many hospitals surveyed said they won't accept work in non-acute settings as experience," she said. "And most non-acute areas also prefer experienced nurses."

To that end, Jones proposed looking at new models for new grads, including regional collaboratives of college-based transitional programs for hospitals and non-acute settings. At the regional meetings, other solutions were suggested including volunteer programs, mentored float pools and experienced nurse/new grad job sharing.

"Extended post-licensure clinical education experience would be very helpful to prepare new grads for employment," Jones said. "A transition program would give the new grad an opportunity to have access to experiential learning, to be better prepared to be more marketable for employment."

Jones envisions an unpaid college-based internship program to help new grads bridge the gap between education and practice, increase clinical competency and confidence while building their current skill level.

"When the economy turns and senior nurses leave the bedside, we will lose a major resource with retiring nurses," Jones said. "We must find a way to smoothly transition these new grads into their places with the least amount of disruption to patient care while encouraging and leveraging new partnerships."

Candy Goulette is regional public relations/editorial liaison at ADVANCE.