Staying the Course

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There are signs of life in the job market for nurses in the West, despite continued high levels of unemployment in a tough economy. This eventually will be good news for nursing school grads, but not quite yet, said Maria Jean Caterinicchio, MS, RN, director of professional practice and workforce development at Saddleback Memorial Medical Center and MemorialCare Health System of Southern California. Like many other acute care facilities, Saddleback Memorial is running with a low vacancy rate and more applicants than it has open positions. ADVANCE spoke with Caterinicchio and others involved in nursing recruitment and retention to get a feel for the nursing job market. It's not all doom and gloom.

Job Challenges

With few openings, Caterinicchio said new grads may have to look outside of acute care for their first job.

"With healthcare reform, many healthcare systems, such as MemorialCare, are looking to broaden their sphere of influence in healthcare by partnering with outside options, such as physician groups, community-based care or ambulatory clinics - places new grads haven't historically practiced," she said. "We've put newly licensed nurses in the mindset that they have to go to acute care first to get experience before they can go into these other areas, yet these other areas rely on the skills these nurses come out of school with. It's about assessment, planning, patient education, prioritizing, delegating and supervising medical assistants or LVNs. But if they go this route, they need to make sure there is someone to precept and proctor them, to teach them the ropes."

Residency programs outside of acute care might be a way to address this, Caterinicchio said, noting these programs, currently active in California's Bay Area, would be collaborations between healthcare sites and nursing schools.

"Don't think your first job has to be in the acute care setting," she reiterated. "With healthcare reform, the goal is to focus on prevention and wellness, keeping people out of hospitals and managing their health and wellness. Nurses won't necessarily need acute care experience before working in fields supporting the new paradigm. In fact, in the future, many nurses will be working directly with patients in a variety of settings outside of acute care."

Susan Walczak, MS, RN, NE-BC, recruitment coordinator at University of California, San Francisco, Medical Center, agrees.

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"If you can't find a job in your area and you're able to move, this is a good time to relocate to other regions where jobs are more plentiful," she recommended. "If that's not an option, keep yourself immersed in nursing - in a skilled nursing facility, or a job in a physician's office, or a flu clinic. Even volunteer work that keeps you loosely associated with nursing or in a medical environment will go a long way when you're applying for positions."

"Find a way to stay clinically relevant," Caterinicchio added. "You can always volunteer. Patients would benefit from someone spending time with them, doing activities, talking - just spending time - someone who could come in for a couple hours and just sit with the patient, who without them would be getting out of bed, pulling their lines out. Even without doing hands-on work, these nurses get to use their therapeutic communication skills, connect with patients, listen to them, identifying their needs and are in the room when the nurse and doctor are there. They're still exposed [to medical situations] and able to learn. Volunteering provides the opportunity to engage in the environment.

"If I had to choose between a new graduate who took a job in retail waiting for a job to open up versus someone who also volunteered, the volunteering would push them over," she continued. "It also makes them visible inside an organization."

Choose Education

Job challenges could have a silver lining, Caterinicchio said. Newly licensed unemployed nurses could go back to school.

"They might need to look at the next step, to go on and get that next level degree," she said. "The market will turn and there is still a nursing shortage. The workforce continues to age. It's not like all of a sudden we're flooded with a younger workforce. We still have a large percent of nurses over the age of 50, and when they feel comfortable leaving, they will.

"They're going to start by decreasing their hours worked, then ultimately make that exodus," she continued. "I don't have the feeling that one day we're going to wake up and have 80 vacancies. I think it's going to be a progression, so the nurses need to be prepared when they come out of school. They need to look at marketing themselves to be the most competitive - going back and getting the credentials or certifications they can to support the work they're looking for. For example, if they're looking at working in an acute care facility and they want to go into a monitored unit, they should be taking a telemetry class or an ACLS class."

Nurses who already have jobs should hold on to them.

"If you're interested in doing something different, look at continuing education," Caterinicchio shared. "Now is a great time for nurses to advance their degrees. There are more pathways and funding sources and nurses can move from an ADN to an MSN through a lot of programs, many online."

She explained many recruiters look at the applicants' educational level during interviews. Some facilities only hire nurses with bachelor's degrees or higher; others use behavioral interviews in which the additional skills learned through BSN programs are apparent to the interviewer. In any event, Caterinicchio said, the better prepared for the interview the nurse is, the better the interview goes.

"You just don't graduate from school and it stops there," she said. "Nurses have to continually stretch their knowledge base."

Recovery Steps

Dennis Yee, CHCR, recruitment consultant at Children's Hospital Central California, Madera, and president of the National Association of Health Care Recruiters, said the West is mirroring the nation. There are pockets of recovery where jobs are starting to open up, but it's nothing close to what it was in 2007 at the hiring zenith. Most hospitals are in the same boat. He indicated that high unemployment - at nearly 17 percent - in California's Central Valley is keeping this tight.

"There is some movement in some of the larger healthcare organizations, where there are a few more open positions, but I don't see the vacancy rate going up significantly," Yee said. "There is more activity in both hard-to-fill positions and in general nursing positions, but I've never seen such a large number of applicants for nursing positions in my career."

Derek Cunningham, PHR, CHCR, talent manager for Scripps Health in San Diego, also sees some movement, with volumes and openings increasing within since the beginning of 2011.

"We're still taking new grads, though in limited quantities," he said. "Most organizations in the area are looking to take on their own staff graduating before considering those outside."

Yee said some facilities have instituted a freeze on salaries, but no one is taking anything away from current salary and benefit packages. As far as compensation goes, most facilities are staying the course, keeping things flat and riding out the storm, hopefully to improve by the end of 2011 or 2012.

In fact, salaries regionally have remained stable. According to ADVANCE's Salary Survey data, nurses in California top the regional salary list, making an average of $45.73 an hour for an average annual salary of $90.815. Colorado, Arizona and Oregon nurses make as much as $10 less at $37.56 ($76,286), $35.11 ($73,007) and $35.07 ($72,667), respectively. Rounding out the region are Idaho ($33.93/$63,995), Nevada ($31.02/$61,117), Wyoming ($30/$69,090), Washington ($28.30/$58,150), Montana ($26.29/$54,683) and Utah ($25.30/$60,100). Data for Alaska, Hawaii and New Mexico were not available.

Hiring Trends

"Like many areas, the Central Valley is very cautious going into next year for hiring," Yee said. "Many are reluctant to put themselves in precarious positions looking at declining reimbursements."

Cunningham sees the same trend in San Diego.

"Overall, organizations in the area are taking a conservative approach to hiring, even while the needs seem to be growing," he said. "Healthcare reform and all its components seem to have leaders being skeptical about the job market."

For Caterinicchio, that may mean the evolution of a more standardized, structured approach to transitioning nurses to practice following graduation.

"There is a heightened awareness of the gap that exists between the day the student nurse graduates and the day she actually takes her position independently," she said. "That time is so critical from a competence and confidence level.

"The push for nurses to go back to school will also continue, driven by many factors," she added. "As a profession, the work that's ahead of us will require a deeper, broader knowledge that comes with advanced education. That doesn't mean the ADN is a lesser degree, just that it can't be the terminal degree. It's the first step on the journey of lifelong learning, providing the initial skill set as the professional role evolves. We can't leave it up to chance; it has to be mindful and purposeful."

Candy Goulette is regional editor at ADVANCE.

Focus on New Grads

While the job market is still tight in the Pacific Northwest, some facilities are focusing efforts on new grads.

"Hospital salaries have softened considerably, so this has slowed the typical demand for hiring," said Carol Bradley, senior vice president and chief nursing officer at Legacy Health, Portland, OR. "We have made a focused effort to hire new graduate nurses because we are looking at the long-term workforce needs of Legacy Health. Despite the current environment, [we] made a commitment to begin a residency program for new graduate RNs."

Noting the job market for new grads has been tight in San Diego County over the past couple of years, Lorie Shoemaker, DHA, MSN, RN, NEA-BC, chief nurse executive at Palomar Pomerado Health (PPH), Escondido, CA, highlighted a program that's opening up some positions.

"We recently received a $250,000 grant to develop a program with California State University San Marcos," she said. "Senior baccalaureate nursing students take an advanced med/surg, critical care or OB course at the college and then work part-time at PPH to practice their skills. They're guaranteed a job when they graduate."

- Sandy Keefe, MSN, RN