Healthcare reform has sparked dramatic change in healthcare delivery, providing new opportunities for nurses. The AACN reports that the number of hospital nurses caring for inpatients dropped by 6% between 1992 and 1996, but the overall number of employed nurses rose by more than 3%. Outpatient settings and labor and delivery departments saw a 25% increase in RN employment, and emergency departments and surgical facilities hired more nurses as well.

Employers who thought that an answer to cost containment was to eliminate nursing positions are now looking to hire nurses, particularly in specialty areas such as critical care, home health, and community health. Student nurses can take advantage of the shifting needs for RNs.

Nursing Enrollment Doesn’t Match Need

Recruiters and healthcare planners are emphasizing bachelor's and graduate degree tracks. Unfortunately, as demand for nurses with a baccalaureate degree in nursing escalates, AACN reports that enrollment in baccalaureate programs has fallen by 6.6% in 1997, following several years of decline. For the ninth time in 10 years, graduate programs saw a 1.6% increase in enrollments.

Diane J. Mancino, RN, EdD, CAE, executive director of the National Student Nurses Association, says one reason for lower enrollments was the excess supply of nurses following hospital restructuring and downsizing. “Many schools have shifted their resources from undergraduate programs to graduate programs to prepare advanced practice nurses,” she says. Because of decreased enrollments, Mancino points out that a shortage of baccalaureate-prepared nurses already exists; the shortage will be severe by the year 2010.

Other factors contributing to decreased enrollments include fewer faculty, reduced numbers of clinical training sites as a result of hospital closures, and the media’s alarming reports regarding downsizing, RN terminations, and unsafe working conditions. Grim media reports give a false impression that nurses are expendable in the quest for cost containment and that the need for nurses is on the wane.

Need for RNs Will Continue to Increase

According to the Bureau of Labor Statistics, nursing is listed as an occupation projected to have the fastest growth in new jobs for the future. The latest government estimates put the number of RNs at 2.5 million with an average age of 44. As the nursing work force ages, health executives predict that the number of RNs leaving nursing will soon exceed the number of nurses entering the profession.

This reduction in supply occurs as the fastest-growing segment of the population is reaching 85 years of age. In addition, large numbers of baby boomers will become Medicare-eligible in the next few decades. This population shift is expected to significantly increase the need for geriatric nurses to care for the elderly, who suffer a high incidence of chronic disease.

Outpatient settings will continue to show a dramatic increase in employment opportunities for RNs. Patients discharged to home are requiring increasingly complex care, and nurses with higher levels of education will be better equipped to function in these settings.

The need for RNs is already here. Hospitals have found that cost efficiency can’t be achieved with higher caseloads and the use of unlicensed assistive personnel. This realization has stimulated RN hiring in many areas of the US, with the return of such tactics as large sign-on bonuses for specialty nurses.

Changes Needed to Meet Demand

Today 31% of RNs are baccalaureate prepared, according to the federal Division of Nursing statistics. The National Advisory Council on Nurse Education and Practice recommends that by 2010, two-thirds of the nurse workforce should have a bachelor's degree or higher.

The law of supply and demand will soon favor nurses seeking employment. However, experts agree that simply preparing more nurses to meet the demand will not fully address the problem. Nurse educators must study the trends and adapt their curricula as quickly as possible to prepare graduates with the skill mix needed. To boost enrollments, educators will need to modify recruitment strategies to attract men and minorities to the nursing profession.

Student Nurses Can Take Charge of Their Future

Karlene Kerfoot, RN, PhD, CNNA, FAAN, internal consultant, Memorial Hermann HealthCare System, Houston, TX, lists several actions student nurses can take to better compete in the employment market:

• choose a professional career track
• acquire financial management skills
• read professional and healthcare journal
• be active in professional organizations
• find a special program or mentor
• reevaluate the future of healthcare every six months.

In addition to acquiring a bachelor’s degree, Kerfoot notes the advantage of financial management skills acquired through short courses and continuing education programs. She says that if nurses don’t understand where the money comes from, they won’t be able to plan cost-efficient, quality care for patients and will be less attractive to recruiters.

To meet the demand for specialty nursing, student nurses should consider employers who offer special programs, such as an internship in neonatal intensive care. A student may also want to work with a mentor who is successful in the healthcare setting and has a finger on the pulse of change.

Bright Future for Nursing

Despite unsettling healthcare reform, Mancino insists that the future of nursing is bright. “Nurses are taking on more professional responsibility and can therefore better meet the healthcare needs of the public,” she says. Astute student nurses will take action to prepare themselves to meet the changing future in the nursing profession.