Slow & Steady

Recruitment experts don't deny the continued impact of the economy, but, just as spring flowers begin to poke their way out of the dirt and into the light, so has nursing recruitment started showing signs of new life.

Factors in Play

The economy remains the biggest reason for the lack of open nursing positions. "Over the past couple of years, people have not been moving jobs as much as they used to," said Ellen Heasley, MPA, BSN, RN, director of nurse recruitment at New York University (NYU) Langone Medical Center in New York.

Erin King and Michele Andrews, nurse recruiters at Massachusetts General Hospital in Boston, have noted the same trend continuing in the early part of 2011. "People aren't leaving their jobs. They like the stability of what they have," Andrews said.

King and Andrews also noted part-time nurses have been increasing their hours based on changes in the economy. "In the past, we might have had a full-time position open up, but now those hours are covered by part-time employees who need to pick up extra shifts and increase their hours," Andrews added.

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In addition to a tough economy, the healthcare system is in a state of flux. "Rules and regulations that deal with reimbursements have been changing. Some hospitals are having to rethink their hiring budgets because their sources of funding have changed," said Mark Damsell, manager of talent acquisition at Memorial Sloan-Kettering Cancer Center in New York.

All of these factors add up to low turnover and decreased hiring opportunities, particularly in general acute care units. "We have a nursing shortage that will continue to grow, but we've had a bottleneck for nurses with little experience, in areas that traditionally are good for new graduates to get training," Damsell said.

Signs Of Change

The news isn't all bad though. Recruiters are starting to see signs of change.

Heasley, president of the Greater New York Association of Nurse Recruiters, explained retirements all but dried up at NYU Langone Medical Center in 2009 as retirement-age nurses chose to keep working to offset dwindling retirement funds and spousal income. However, "we did see a little bump in retirements at the end of 2010," she said.

At Saint Mary's Hospital, Waterbury, CT, retirements are still low, but rising. "In 2009 we had one retirement. In 2010 we had six retirements," said Nancy Miko, clinical recruiter, "and so far, in 2011, we've already had six." So, said Miko, while the hospital is only halfway to its typical number of 12-15 retirements per year, "we're working our way back up to the norm."

Miko also recently saw bonuses advertised for hard-to-fill positions at two different hospitals in Connecticut - the first bonuses she's seen in her local area in years.

Specialty Units Hiring

All recruiters interviewed for this article noted most of their open positions are in specialty units, including oncology, critical care, ED, OR and ICU. Recruiting for advanced practice nurses, including NPs and clinical nurse specialists, is also on the rise, Damsell noted.

While many specialty units do take a limited numbers of new graduates, with the number varying based on facility and unit, recruiters are mainly looking for nurses with anywhere from 1 to 6 or more years of experience. "My shortage is with experienced nurses," said Sandy Ewen, PHR, of Bristol Hospital in Bristol, CT.

While many experienced nurses are staying in nursing, "a lot of [experienced nurses] don't want to take night shifts. Or, they might leave acute care to go to an outpatient surgical center where there's no call and they don't have to work holidays."

On the flip side, "there is a large volume of BSN graduates who want to go into med/surg units," King said.

"We realize there's a deeply qualified pool of nurses in general care, but not as many with experience in specialty areas," Andrews added.

In response to this situation, Mass General instituted a unique RN residency program. The 24-week program trains new graduates or non-specialized internal candidates in the intricacies of oncology or critical care nursing. Through the residency program, the hospital was able to utilize the large pool of non-experienced nurses looking for jobs, while filling critical needs in expanding specialty units.

Addressing New Grads

All recruiters recognize the tough position of recent nurse graduates. "I can only imagine how frustrating it is, wanting to put your license to work and not being able to find that opportunity," Damsell said. However, he advises new nurses to stay positive and be flexible.

"All new graduates want their med/surg experience in an acute care facility," but that's not always possible in the current hiring climate. "If you see a position for a specialty that isn't your first choice, consider it. There may be an opportunity to transfer to another unit down the road," Damsell said.

And, while job hunting, put patient care skills to use in any setting possible. "I've been impressed when new graduates told me they gave out flu shots for CVS over the winter, or did other things to keep them engaged in nursing while looking for a position."

The bottom line? "There are opportunities out there, but new graduates may have to be willing to do something else before they reach their dream job. The most important thing [over type of facility or unit] is to get into nursing and practice patient care," Ewen said.

Looking to the Future

"With the healthcare reform bill, however that works out, more people will have access to healthcare, so more people will need healthcare, especially in the ambulatory care setting," Heasley said. "In 2014 to 2016, the job market should open up. Because of the economy, it's taking a little longer than we initially thought it would."

Damsell is confident hiring conditions will improve. "As people feel more comfortable with the economy, they will become more comfortable trying out new challenges, like a new position or a new location," which makes room for newer nurses to gain much-needed experience and for experienced nurses to move around within the system.

In just a couple years, "we will be back where we were in 2006," Miko said. "We'll be desperate for nurses and we'll be paying bonuses to fill positions." That's a vision of the future all nurses can get behind.

Diana Friedman is regional editor of ADVANCE.