Caroline Bower is a little behind on her job search compared with classmates, but she’s not too worried.

Unlike most recent college graduates, Bower, 23, expects to land a job in a couple months. She’s graduating on Sunday with a nursing degree from her Connecticut school. She chose nursing because, “even if you can’t get your ideal hospital position right away, there are so many different directions you can go.”

That, and the “very rewarding starting salary,” she added.

The increasing demand for qualified nurses, particularly advanced practice nurses is widening because of multiple environmental factors including expanding health coverage, a large cohort of retirees, an aging nursing population, a shortage of nursing professors and a physician gap.

These points were echoed by the Associate Dean of Student Affairs at the Columbia School of Nursing, Dr. Judy Honig, who estimated that starting salaries for nurses in New York City begin in the mid $60,000 range, and added that prospects for nursing graduates are very good.

Likewise, Student Success Coordinator Veronica Meraz at San Antonio School of Nursing noted that applications have increased year after year with many applicants attracted to the elevated starting salary. “Our students do not have much of a problem finding jobs,” with students starting at salaries above $50,000, she said.  “We are very happy with our turnover.”

Honig, who is not entirely convinced of the general staff nurse shortage, but is concerned about the advanced practice nurse shortage because as good as the prospects for graduating nurses are, supply will not be able to keep pace with demand.

“The health care environment has changed. And because of this everybody has to step up,” said Honig, a member of the Baby Boomer generation. “The supply is not growing at the rate it needs to grow and the complexity of the care that’s delivered is increasing.”

Unlike most national industries, nursing is experiencing an acute shortage in America, one that is projected to increase even as hiring surges over the next decade.

While Bower is enjoying graduation week and gearing up to enter the summer work force, many Americans are doing just the opposite.  Last month’s job report indicated that flocks of workers left the hunt.

In 2011, the first wave of Baby Boomers hit 65. This monumental shift in America’s people pyramid belies a silver lining in an economic recovery that is limping along at a snail’s pace.

Many of the 342,000 American workers who left last month were Baby Boomer retirees, who will fuel expansion in the health care industries, especially nursing.

“I’m bullish on nursing,” said Jeff Bauer, a health futurist and medical economist with over 35 years of experience working with hospitals. Bauer, who turned 65 this year and just received his Medicaid card, commented on the age pyramid of the nursing industry itself. “It’s remarkable how many nurses are of the Baby Boomer generation and thinking of retiring. I think that anybody that is a competent nurse will never have trouble finding a job.”

The Bureau of Labor Statistics estimates that the nursing industry will create more than 581,000 jobs by 2018. Already the nation’s largest health care profession, employing more than 2.7 million Americans, the BLS predicts greater growth.

In addition to the Baby Boomer effect, the Affordable Health Care act will extend health coverage to 32 million Americans and drive employment in this sector, said Peter McMenamin, a senior policy fellow with the American Nurses Association.

“RN’s are the number one [job] in terms of percentage growth. It’s the only professional occupation in the top 10 of employment in the US,” said McMenamin. “Still,” he said, “we are going to need a lot more nurses.”

More nurses will be needed to treat more complex patients and the nursing education system must take account of this. America is seeing a larger population of chronically ill patients and comorbidity—dealing with multiple diseases at the same time—which requires more evidenced-based care by nurses with doctoral educations, said Dr. Honig.

Treating an obese patient, for example, who likely suffers from multiple ailments, requires a more extensive set of skills than treating a normal sized patient, not to mention it is much more physically demanding. This type of patient would demand more evidenced-based care, the care of an APN. The CDC released a report that the current generation is the first in American history to have a shorter life expectancy due to obesity.

Clinical placement sites, the nursing equivalent to a residency, are severely lacking in US hospitals that get paid for educating physicians. “The hospital gets nothing to educate nurse practitioners. APNs are enrolled in school and those faculty have to ask a clinic or hospital to send a student,” said Honig. “It’s not built in to our health care system to educate nurse practitioners and it is built in to our system to educate physicians.

The generalist physician shortage itself is contributing to the increased demand for quality nurses. In recent years, physicians have trended away from the general practitioner role toward specialty positions either for economic reasons or preference. APNs have helped to fill the gap of the general practitioner.

Nursing education will also be put to the test, said Honig. Nurse educators are aging and “nurses are not going into nursing to be teachers or professors,” said Honig.

Long has the nursing industry been heralded for flexible work hours and high average starting salary (nearly $65,000 annually, according to the BLS). But this alone will not offset the increase in demand. The American Nurses Association projects that by 2025 America will be short more than a quarter million nurses due to health care expansion, retirees and obesity challenges.

“Boy,” said Bauer, “are we going to need nurses to work outside the hospitals and in the home.”


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