In 2009 Becky Jones was a University of North Carolina at Chapel Hill nursing graduate in the midst of recession. She said that even having graduated from the fourth-ranked nursing school in the country didn’t seem to help at first.
“Even we were sweating for jobs,” Jones said.
She did break through, but the cases of her and her classmates showed that the slow economy affected a profession pegged as a giant growth industry.
Now, she remains happily employed at University of North Carolina Chapel Hill Hospital, and the job market has recovered to a large degree. But it recovers in a changing world of medicine that will alter – and in many cases expand – nursing’s role in health care.
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Kim Thomas, a Registered Respiratory Therapist, checks and installs breathing tubes. Among Respiratory Care Practitioners, RRT’s roles have seen the scope of their roles expanding. About 80 percent of CRT’s work in hospitals.
It is no secret that the baby boomers are aging and health care reform will add to the rolls of the insured, creating a large medical need. More than 2.5 million people will become eligible for Medicare this year, and more than 70 million are scheduled to turn 65 in the next two decades. And with experts from multiple fields saying an industry-wide shift towards managed care has already begun and a large projected doctor shortage looms, the nursing industry will be crucial.
The industry was never as hard hit as other industries in the recession. In many cases, the downturn’s effect indirectly hurt the job market. Nurses with spouses losing jobs in other fields would move from part-time to full-time work or retire later, for example. Some hospitals also did have temporary hiring freezes.
But things have improved in the market, and American Nurses Association senior policy analyst Katie Brewer said that the next 10-15 years should bring a huge number of jobs opening up. And she doesn’t think it’s truly kicked in yet.
The changes will extend beyond the number of jobs affecting the scope and location as well.
An October report by nonprofit Institute of Medicine advocated for the removal of regulatory or institutional obstacles limiting nurse practice. The full extent of nurse training should be utilized in partnership with other health care professionals, the report said, so that the health care industry’s largest profession – at 3 million strong – reaches its full potential.
Melanie Dreher, dean at Rush University Nursing School in Chicago, said the future of the bulk of the nursing industry is shifting away from hospital-based care.
“We have to go where people are and where they are experiencing health problems,” said Dreher. “I believe we are in this kind of cultural lag. We are preparing most nurses for hospital roles.”
Aside from places like nursing homes and commercial clinics, Dreher also said nurses can be found working in people’s homes and workplaces. Home-based managed care has been cited by health experts as lower cost than its hospital and nursing home counterparts, often with better quality of life. And she believes a nurse in the workplace can help cut health care costs as well.
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A patient in a bed in the emergency unit at Washington Hospital Center.
“Employers are starting to catch on. They’ll say, ‘I’m paying all this money for health insurance, and if I had a practitioner in my office, a lot of these problems could go away,’” Dreher said. “The only reason for admitting patients to a hospital today is that they need 24-hour vigilance.”
Nurse practitioners in particular will play a particularly important role. Graduate degree-holders capable of, among other things, triage, diagnosing many conditions, prescribing drugs and health care outreach, they will be leaned upon more and more with a shortage of primary care physicians.
“We absolutely believe they can be primary care providers and help fill that shortage,” Brewer said.
With the industry’s growth, training more nurses becomes paramount. The Institute of Medicine stated a desire for 80 percent of nurses to hold bachelor’s degrees by 2020, and says more public and private efforts need to be made to encourage more nurses to pursue graduate education to enhance their capabilities.
“The health care system does not provide sufficient incentives for nurses to pursue higher degrees and additional training,” the report says. “Lack of academic progression has prevented more nurses from working in faculty and advanced practice roles at a time when there is a significant shortage in both areas.”
But with high demand and a large population desperate for an industry where employment is safe, Dreher acknowledged a potential for some to let quality slip for quantity’s sake. “The knee jerk reaction is to open more nursing schools and take anyone with a pulse. That’s wrong-headed. It’s bad for the people, and it’s bad for the profession,” said Dreher, who has modestly increased the size of the program at Rush, her fourth deanship. She upped the ante for admission, requiring a college degree, and said her applicant pool has grown in quality – and in quantity.
While students flock to an industry that should have plenty of jobs, another area is sometimes overlooked, according to the American Nurses Association.
“We’ve done such a good job of promoting nursing, but we don’t have enough teachers,” Brewer said.
The types of people who would be teachers or administrators, she said, make much more in the private sector, but said there needs to be a point of emphasis on training the next cadre of nurses.
Once trained, Jones echoed Dreher’s sentiment that jobs are out there, although both said holding out for the “perfect” job at a big name hospital could delay results. Jones, who said she works in a great clinical care unit, helps train nurses in their final months of schooling.
All three of the students she worked with this year have been able to get jobs.