Slowdown's Side Effect: More Nurses

Economy's Woes Prod many Who Left Field to Return; Brushing Up on Anatomy

The ailing economy is helping to ease the nursing shortage.

With house prices falling and the cost of gasoline and food rising, many nurses are going back to work, in some cases to make up for the income of a spouse who has lost a job. Hospitals say part-time nurses are taking on extra shifts. And nursing schools are seeing an increase in people applying for refresher courses on the ins and outs of modern hospitals. Some older nurses are putting off a planned retirement.

"We are seeing a temporary lessening of the nursing shortage," says Jane Llewellyn, vice president of clinical nursing affairs at Rush University Medical Center in Chicago. But, she says, "as soon as the economy turns up we'll see them staying home again."

It's a familiar pattern during economic slowdowns. For years, the high demand for nurses has allowed them to design work schedules that suit their financial and family needs. Many start off working full time on difficult shifts and then reduce their hours when they have a family -- the profession is more than 90% female -- or as they approach retirement. But when the economy goes sour, many nurses go back to work full time.

Dana Goodin, a nurse at Chicago's Rush University, worked three evening shifts a week for nearly two decades, giving her time to raise her four children. But after her husband, a carpenter, was laid off late last year, Ms. Goodin began working four days a week to boost the family's income and to qualify for cheaper health benefits. Although her husband has since found a new job at a retail warehouse, he makes just half of his former salary, and Ms. Goodin is looking for another shift to push her above full time.

The nursing profession also is attracting greater interest among new recruits, drawn by expanding job opportunities and rising wages in some places. Nursing school enrollment surged in the wake of the Sept. 11, 2001, terrorist attacks and the economic slowdown that followed. Enrollment continues to grow apace, though at a reduced rate, and schools are turning away thousands of qualified applicants for lack of faculty. Even so, nursing experts predict shortages will grow in future years as demand for nursing services outpaces the number of professionals entering the field.

For hospitals, the renewed interest in nursing is a relief. Shawn Tyrrell, chief nursing officer at Rush-Copley Medical Center in Aurora, Ill., says that until last year the hospital used outside employment agencies when it didn't have enough nurses to cover the shifts. Now, despite an increase in patient volume, the hospital's own nurses want extra hours, so it doesn't need the agencies. "We've been able to handle that volume increase through our own staff members," she says.

The nursing shortage began in the 1990s as older nurses started retiring and there were fewer newcomers to take their place. The crunch got worse as baby boomers got older and demand for health care increased. By 2001, there were 126,000 vacant nursing positions in the U.S., according to the American Hospital Association. That means about 13% of all nursing jobs were unfilled.

Beefing Up Recruiting

To attract nurses, hospitals have increased wages and beefed up recruiting, including from overseas, and have offered potential hires signing bonuses of cash or even new cars. Hospitals have also taken steps to keep older nurses in the work force by making their jobs easier, including replacing hand cranks used to lift beds with automated lift devices, bringing in lift teams so nurses don't strain themselves picking up patients, or putting supplies closer to patients' rooms to cut down on walking. By the end of 2006, the nurse vacancy rate had fallen to 8.1%.

Of course, nurses who haven't been working for some time can't just jump back into the job. Nurse-education requirements vary from state to state, but in general the longer the nurse has been out of the work force the more likely it is he or she will have to complete a refresher course to be relicensed. The Mount Carmel College of Nursing in Columbus, Ohio, for instance, offers a refresher program for $700 plus the cost of textbooks that includes 230 hours of online courses, covering such topics as anatomy, new medications and privacy regulations. Students also log 100 hours working in a clinical setting such as a nursing home or a hospital.

Economic Indicator

For the past few decades, nursing has been a kind of reverse economic indicator. In periods of economic weakness or recession -- including in the early 1980s, the early 1990s and earlier this decade following the technology-company bust and the Sept. 11 attacks -- the number of full-time nurses grew at an average annual rate of 3.5%. By contrast, in times of healthy economic expansion, the increase has averaged just 2.4%, according to an analysis of government data in "The Future of the Nursing Workforce in the U.S.," a book by Peter Buerhaus, director of the Center for Interdisciplinary Health Workforce Studies at Vanderbilt University Medical Center, Douglas Staiger, a Dartmouth College economics professor, and David Auerbach, a principal analyst in the Health and Human Resources Division of the Congressional Budget Office.

Last year, there was a net increase of about 113,000 nurses in the work force, the largest increase since 2002, and most of the added nurses were over 50 years old, according to the Census Bureau. The pattern has continued this year. Although the U.S. economy lost 20,000 jobs in April, the fourth monthly decline in a row, health-care employment rose by 37,000 and is up 365,000 jobs over the past 12 months, according to Labor Department data released last week.

"In bust periods, unemployment is rising, which means there is a lot of pressure on married RNs to be working," says Mr. Buerhaus.

Jennifer Schlesser, a 57-year-old Ellicott City, Md., resident, says she worked as a nurse for 27 years before leaving the profession a decade ago, feeling overworked and underpaid. She went to work in the mortgage-lending industry, but the housing slowdown has forced her to change employers and has cut into her commissions.

Refresher Courses

Ms. Schlesser is currently enrolled in an online refresher course for nursing and she expects to be relicensed by next month. She plans to work part time in both nursing and mortgage lending. "Whatever works out best," she says.

But over the long term the nursing shortage is expected to continue and eventually worsen, as retiring baby boomers ramp up demand for care. In their book, Messrs. Buerhaus, Staiger and Auerbach use Census data to project that the nursing work force will plateau in 2015. By 2025, they estimate there will be a shortage of almost 500,000 nurses, representing a vacancy rate of 40% or higher.

By: Conor Dougherty
Wall Street Journal; May 7, 2008