Are colleges oversupplying nurses?

With our aging population, it’s been a given that health careers will be in high demand and that we have a huge shortage of nurses heading into the future.

But is that conventional wisdom wrong?minnecon.smallicon.gif We started asking that question last week as the Twin Cities one-day nurses strike loomed.

We highlighted projections from the research group Economic Modeling Specialists Inc.

Researchers there saw our post and did some more digging.

The result? Data that should have us all asking if the nation’s public and private colleges are producing too many nurses.

Below is a chart EMSI created showing the number of students completing a nursing program last year and its projection of annual registered nurse openings through 2015. (Definitions are at the bottom of the post).

Nurses_Openingsvs.Comp_09.jpg

At first glance, it’s jaw dropping — Minnesota schools with nearly 4,300 students completing a nursing program last year with only about 2,600 openings expected annually through 2015. Nationwide, EMSI estimates an oversupply of more than 85,000 nursing graduates a year, with only Alaska and Nevada facing a shortfall.

Yes, there are caveats.

No data is perfect. The completions data from the federal government’s Integrated Postsecondary Education System (IPEDs) don’t indicate if those who completed a program went into nursing. It likely also counts people who are in nursing currently and moving up the degree ladder. It also assumes the projections are valid.

But I’m highlighting the EMSI research for a couple reasons. The Minnesota State Colleges and Universities system uses EMSI’s projections. And EMSI is using IPEDs data, which is about as consistent as it gets.

As with our our first post, we don’t have all the answers. We have some data and it’s pretty compelling.

If you have insights or better data, let us know and we’ll highlight it in future posts.

Later this week, we’ll be posting from interviews with Minnesotans who follow nursing graduate trends, including Jane Foote of HealthForce Minnesota , a public – private effort to increase the number of workers in the state health system.

“The situation in most areas probably isn’t as out of whack as the numbers suggest,” says EMSI’s Josh Wright.

“There are still lots of job postings for RNs and other more specialized nurses. But anecdotally, we’re hearing more and more how nurses in certain areas can’t find jobs. It’s a complicated issue, but clearly there is a supply / demand imbalance — as EMSI’s data suggest.”

Part of the problem is that no one collects all the data in one place in a form that’s most useful. So we’re still groping to understand the data and answer the question about the supply of nurses in the education pipeline.

It may not be a crisis but with the numbers in front of us now, it’s an issue we need to probe.

*************************************

Here are the definitions for the EMSI data:

Completions: The number of students in a given year that completed a specific course of study as reported to the federal government

Integrated Postsecondary Education System (IPEDs), the federal government’s

IPEDS accounts for all colleges and universities that participate or are applicants for any federal financial assistance program authorized by the Higher Education Act (HEA), which includes most of the well-known federal loans (e.g., Pell Grants, Stafford Loans). All public colleges and universities and a number of private postsecondary schools accept federal assistance loans and therefore are included.

Annual Openings: The sum of new and replacement jobs (see below) in the occupation over the entire selected timeframe (in this case 2010-2015), divided by the number of years in the timeframe. Just as a caveat: Our 2010 numbers are only partially projected, so we divided by five (2011-15).

Replacement Jobs: The number of job openings (over a given timeframe) expected in an occupation as the result of turnover–e.g., employees changing occupations, retiring, etc. It is derived by multiplying estimated annual turnover by the number of years in the given timeframe.

  • Mary Bennett

    Interesting data, thanks for sharing. As the director of a BS nursing program, we have not had a lot of difficulty placing graduates, even in this tight economy. However, as you noted, a lot of schools have increased the number of students admitted because we have all be warned about the impending nursing shortage due to retirements and aging baby boomers etc.

    It may be that we are now overproducing. However, I think there are some factors that should be considered. Historically there is a significant loss (5 – 10 % or more) of people from the profession within the first two years of graduation. Some overproduction is therefore needed to replace the loss. Some of the loss is due to young women deciding to become mothers and either work part-time or not at all. Others just decide that other careers might be more attractive for various reasons.

    Of course, it is easier to find a non-nursing job when more jobs are available in general. Right now, the economy is definitely affecting the way people accept positions and stay in nursing positions. Currently we are not losing as many people from the profession. I was just contacted by a 1996 grad who never worked as a nurse, did not even take the NCLEX state board exam, and now she wants to take the exam and become an RN, due to a loss of other job.

    Another factor that your data may not take into account is Associate Degree RN’s who are already working as nurses but then graduate with BSN degrees. They could be showing up on your list as new graduates, but in fact these are current RN’s who already have jobs in the system. As many as half of our graduates fall into that category. So these are not really new or additional nurses, they are just nurses with additional education. They don’t need another job opening (or if they do take a new job they leave an old job open for someone else). A final factor I can think of is RN’s who continue their education and become nurse practitioners or nurse educators ect. They still show up as being RN’s, but they are leaving bedside nurse to enter advance practice or educational roles. These two areas are still having significant shortages and RN’s are returning for advanced education to take these positions.

    I think the numbers right now may be misleading, partly due to an underestimation of the real number of jobs open in all of the areas of nursing, an over estimation of the true number of new nurses being produced, and due to the effects of current economy on nursing workforce retention. When the economy turns around we will see people retiring, working part-time rather than full time, and nurses optioning out of nursing again. I would hesitate to make system wide changes in our educational production until we can see how the economic turnaround affects the job market and how the health care system responds to the increased number of persons who will have access with the new health care reform legislation.

  • Tracy Wharton
  • Joan Morris, RN, DNP, CNE

    This article presents the true facts. Thank you for telling the unbiased real story. I have been a full time nurse educator for the last five years and became a nurse as a second career in 1996. Since December 2009 to present, I am working part time.

    I review the local Florida want ads and internet job search engines regularly .There are very few openings and many of the ones available do not offer full health insurance and full time benefits that were common just two years ago.

  • Manjula Paul

    Thanks for the timely article . I am hearing the same concern from the local community college and was wondering whether employers are looking for different set of skill, knowledge and competency level and prefer one versus another (Associate degree versus BSNs) .It will be helpful to know the number of AAs and BSNs graduated and licensed and their employment rate annually.

  • Catherine Delva

    The data obtained appears to be

    generalized at best. I am a baby boomer RN.

    There was a severe shortage of nurses two years ago. Now employers have cutback and made us do without help or else. Many hospitals I have seen are mainly hiring low cost new grads or part time nurses without healthcare. It’s not really a shortage when you

    rearrange the job description to get one to do the work of two, it no longer becomes a shortage but a surplus.

  • Jennifer Bolger

    Finally! Its about time someone publicized the lack of opportunities for graduating nurses in too many communities. We’ve gone from grads with handsome signing bonuses and their choice of employers to Dec ’09 Madison WI area grads still looking for full time work. It flabbergasts me to see the number of students leaving other careers to pursue nursing… and they won’t be leaving nursing to have kids because they are well past that! Please spread this work nationally.

  • Jeanne Hately

    I agree with Mary Bennett’s comments. Since this survey was conducted in 2009 and reflects our current economic status and all that entails in the job market, it is not a true representation of what is to come. I think we should remain forward thinkers and know the shortage is still out there-just impacted now by the recession.

  • L.G. Murray

    In my 35 years in nursing, I have seen that with each economic recession the availability of staff nursing positions declines. Reasons for this are multifactorial: hospitals reduce their nursing staff to economize, RNs who had been out of the workforce re-enter, consumers who have been “down-sized” lose their health insurance and consequently do not use the healthcare system causing hospitals faced with declining revenues to lay off nurses, etc. Each time the recession was over, the so-called “nursing shortage” resurfaced. Unemployed nurses will find jobs when the economy improves!

  • Linda RN

    I found these statistics particularly disturbing as I live and work in Central Florida (Leesburg, FL). During the recent economic crunch, our hospital did not lay off any nurses, but did cut back on PTO time for a three-month period, doubled our health insurance premiums, and did not replace flex-time employees (24 hrs every weekend while paid 36 hrs per week — previously paid 40 hrs per week) and retirees. However, the hospital in a neighboring town actually laid off nurses.

    But with increased census, in spite of it being off season here in Florida, we’ve actually added on travelers and have hired a group of new grads. It seems as though we are always adding nurses to our staff as well as CNAs.

  • Ginger MSN, RN

    This is a blip on the radar screen. When the baby boomers (who delayed retirement after the crash on Wall Street) retire and the nurses who went to full-time after the economy went south, there will be a profound need for nurses as the baby boomer population will swell over the next 20 years. Besides which, some new nurses only stay at the bedside for a year or two before they realize how hard the work really is, and they leave.

  • NEW GRAD 2010

    The older nurses may be retiring but seriously when there are 6 times at many nurse graduates you still think there will be a shortage BS//. Graduating massive amounts of nurses is PROFIT. Look at all the pay schools. All the accerated BSN schools. Kaplan, Concord, Exselsior, Univ of Phoenix, National. Charge students .. MONEY.. MONEY… ya there is a nursing shortage. Not to mention the regular university grads ASN, BSN, MSN… who cant find jobs Tell that to the thousands and thousands new grad RN’s and experienced RNs who are having a hard time changing or finding jobs. Many new well trained grads have been searching for jobs for OVER A YEAR some even 2. THERE ARE TOO MANY GRADS. People will be retiring but there will still be too many nurses to take their place.

  • Dick Daffin

    I’m 65 years old and continue to work in the PRN pool of a large, level I trauma center in the cardiac surgery operating rooms. Current nursing literature suggests that the average age of practicing RN’s in the US is approaching 50 years. I started Social Security in 2008 and must limit how much I work until I’m 66 in September 2010; after that, Social Security doesn’t care how much I work or how much money I earn. I suspect I’ll continue to work part-time as long as I’m healthy since there seems to be an on-going need for nurses in operating rooms everywhere (not just the US but globally). Any perceived abundance of nurses may be just that–a perception rather than either present or future reality. The economic down-turn is lessening in terms of the supply of EXPERIENCED nurses to work in jobs that are presently vacant.

  • e

    If, as Mary Bennett says, up to half the graduates are those already employed, then the math suggests that we indeed still have a shortage. If some graduates are reporting difficulty in finding jobs, it likely means that there is a problem with distribution. More or fewer nurses will not correct this without further incentives to work in underserved areas.

  • Patrick Budny

    Unfortunately I would have to disagree with these findings for a few reasons.

    1.) IPEDS numbers are not very reliable for the point you are attempting to get across.

    Mary eluded to my concern in her post above. If you are looking at Completions on IPEDS they include RN to ASN, RN to BSN, RN to MSN completions in their data set. These are people who are in fact usually working and taking these accelerated programs on-line. The enrollment in these programs is growing exponentially. So right there your supply and demand numbers are skewed.

    2.) You are interchanging the definitions of Nursing Degree Completers with Registered Nurses. One has to sit and pass the NCLEX to become a registered nurse. You would be best served on replacing the IPEDS completion numbers with first time NCLEX passing students. That number would best reflect the number of new grads who are entering the marketplace.

    Let’s take Texas for example. According to their Board of Nursing website in 2009 7,413 candidates passed the NCLEX for the first time. There are 9,415 annual openings for that state according to your table. That still leaves a shortage of about 2,002. Now that doesn’t take into account intramarket churn but it paints a different picture.

    Hope this post was helpful and best of luck with your future nursing workforce data reports.

    Best,

    Pat

  • Jagjeet Kaur Khalsa RN, CPAN

    Patrick I am a seasoned nurse and am competing my BSN with a view to obtain a Master’s degree to teach or conduct nursing research. So many of us are going back are in the labor pool already. I am wondering if that is taken into consideration. Since I am working, supporting my family and paying a mortgage an on-line school makes perfect sense and will open new avenues especially in this age of health reform.

  • Deloras Jones

    I am wondering where EMSI obtained their data? In 2009 California had 10,570 completion from the state’s schools of nursing – not 17,933 as quoted in the article. Did their number also include degree completion students, graduate nurses, or vocational nurses? The articles gives a distorted figure of the state of the emerging workforce.

  • http://www.WACenterforNursing.org Linda Tieman

    Your information omits critical data and doesn’t offer a full picture. IPEDS reflects all students, both pre-licensure and those obtaining “completion” (RN-BSN) and post-BSN degrees. What you need to look at are newly graduated RNs only. So the first number is inflated, as others have said. This report fails to include the fact that with the average RN being 46 nationally (48.5 in WA) we can anticipate significant retirements regardless of the economy. The average nursing faculty person is >50, and replacements, who need at least a Master’s degree, are desperately needed. One has to have a BSN to get a Master’s. The impact of healthcare reform has not been factored into the “Demand” side yet, and people smarter than me are already working on those calculations. What we see right now is a “blip” in the workforce screen, soon to be erased as reform rolls forward, the influx of boomers turning 65 this year becomes eligible for Medicare, and the economy improves. You’ve not done your usual thorough NPR job on this. Go deeper for the facts, please and leave the sensationalism to others.

  • http://www.nursingworkforcecenters.org Jen Nooney

    The National Forum of State Nursing Workforce Centers, the nurse workforce experts from 30+ states, is concerned about a recent study conducted by Economic Modeling Specialists, Inc. (EMSI) suggesting that the nation is currently over-producing RNs. We offer remarks on the study’s data sources and on the possible consequences of publicizing misleading information. The original study can be found at http://www.economicmodeling.com/2010/06/11/comparing-the-output-of-nurses-with-estimated-demand/

    Regarding the data:

    Supply-side estimates of new nurse production are based on data from the federal Integrated Postsecondary Education System (IPEDS). IPEDS data do not separate pre-licensure from post-licensure students, so it is not possible to count new nurses separately from post-licensure students returning to complete a higher degree (baccalaureate, master’s, or doctorate). Additionally, IPEDS counts are produced using a program-to-occupation crosswalk that may misclassify some educational programs whose graduates typically go into other fields.

    A better measure of new entrants to the profession comes from the National Council of State Boards of Nursing NCLEX examination statistics. Even if IPEDS were a good source for data on the number of pre-licensure graduates, new graduates cannot legally practice until they pass the NCLEX-RN exam. A comparison of the two sources shows the extent of the discrepancy:

    o EMSI # of “nursing completers” in 2009: 190,615

    o NCSBN # of people passing NCLEX in FY 2009: 148,266

    o Difference: 42,349, an overestimate of 28.6%

    Demand-side projections of job openings due to growth and replacement seem to be based on Bureau of Labor Statistics employment projections, though the exact source of data for these estimates is not clearly stated on EMSI’s website. BLS projections of nurse demand have a number of limitations. In fact, federal forecasts of nurse demand produced by the Health Resources and Services Administration (HRSA) use a completely different forecasting method.

    BLS projections of employment assume a labor market in balance; labor shortages or surpluses are not modeled. They are projections of employment, not necessarily total demand for nurses. Since unmet demand for nurses (in the form of vacancies) exists in the historical employment trends projected forward, BLS may be underestimating the total demand for nursing labor.

    BLS occupational projections use a methodology designed to maximize accuracy across the many industries they study. This allows broad comparisons across industries that are useful for understanding the nature of national economic growth in the coming years, but the method is not specific enough to the nursing profession to produce accurate projections of total demand. Like IPEDS, BLS uses a crosswalk to convert industry employment to occupational employment. The process is subject to error.

    National nurse workforce experts have consistently projected a shortage of RNs owing to an aging population and eminent retirements from the aging nurse workforce. The recession has temporarily eased the current nursing shortage by increasing the supply (more licensed nurses are working in the field) and decreasing the demand (fewer vacancies in healthcare facilities). The long-term drivers of shortage, however, are still in place. Peter Buerhaus and colleagues (2009) project that a national shortage will re-emerge by 2018 and grow to approximately 260,000 RNs by 2025. To prevent that shortage, funding decisions must acknowledge the coming problem. When researchers who are not experts in the field create and publicize projections that not only deny the coming shortage but posit that a surplus of nurses is in our future, dangerous funding decisions may be made. For example:

    • Reducing the capacity of our nursing education system now may have long-term consequences for our efforts to prevent a nursing shortage. Nursing programs cannot start and stop on a dime; it takes years for the flow of a curriculum to become established and the production of quality graduates to be achieved. If we reduce funding for nursing education now, our education system will not be able to produce the nurses we need in the future.

    • Employers have been incentivized by the recent shortage to explore improvements in the nursing work environment. Nursing turnover – both job turnover and professional attrition – is impacted by factors such as workload, participation in organizational decision-making, and opportunities for career advancement. Changes to the work environment can be costly and time-consuming, but they pay off for organizations through reduced turnover expenditures and retention of valuable experiential knowledge. If focus on the work environment is shifted because of employer perception that nursing labor will be easy to find, the result will be an intensified nursing shortage owing to high levels of professional turnover.

    The National Forum of State Nursing Workforce Centers encourages those involved in nurse workforce policymaking to consult national and state-level nurse workforce experts for information on nursing workforce availability and demand. Our subscriber state centers are typically the best state-level source for information. Visit our interactive map at http://www.nursingworkforcecenters.org/WorkForceCenters.aspx to find your state center for nursing.

    Reference: Buerhaus, P., Auerbach, D., and D. Stiger. (2009). The recent surge in nurse employment: causes and implications. Health Affairs, 24(4), w657-w668.

    For more information about the Forum of State Nursing Workforce Centers visit http://www.NursingWorkforceCenters.org.

    Contact:

    Linda Tieman, RN MN FACHE

    President, Forum Board of Directors

    lindat@wcnursing.org

  • Candace Berk

    I’m curious what the early 2000 nurse completion numbers were for graduates when everyone was citing shortages and what the forecasted demand looked like then? Has enrollment for nursing degrees gone up and/or demand gone down to cause such a gap? Is there really more people entering nursing programs relative to jobs or is it just a sign of the economy – RNs going back to work who previously were not working, lower census levels, and higher productivity requirements.

  • http://www.nursinglut.com Mike Burdine, RN

    The numbers presented in the table may not be exact. However, the table reflects the future trend. There is a coming nursing glut. The nursing shortage has been oversold resulting in too many nurses and too little demand. Nursing salaries will suffer. Nursing school administrators will be the last to acknowledge this trend. At nursinglut.com and The Nursing Glut ( on facebook) the facts will be reported as they become availabe.

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  • Gaius Gracchus

    Patrick said:

    “Mary eluded to my concern […]’

    That should be:

    “Mary alluded to my concern […]”

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  • Crystal

    This is really untrue information. What amazes me is hearing, “oh their is such a nursing shortage, go into nursing because they need nurses” what a load of bull. That really isn’t true. And yes there is truly a nursing shortage but its not because there’s not enough people going into nursing, it’s because the nursing schools around the country are so difficult to get into. When the baby boomers do start retiring I really feel sorry for them. If most of these people do go into nursing homes there probably won’t be enough staff to take care of them. The bottom line is nurses would rather work in the hospital where there’s more money than in the classroom teaching new nurses. So with that, along with the bad economy there’s fewer “nurses teaching nurses.” So in return there are fewer spots in nursing school for good potential nurses. I am applying for nursing school and will get the judgement if i get in or not in June. We have to take a entrance exam and have nearly a 4.0 to get in. You would say “well thats good we want the smart nurses.” However, the are just basing it on good performance, but really we’re forgetting about character. There are great potential nurses that don’t even get a chance to prove themselves in nursing school. We all think its good, we need the top of class elite nurses, however you don’t like to wait 10 hours in the emergency room. Its because there isn’t enough doctors or nurses. Its because of our economy but it also starts in the classroom!! We need more “nurses teaching nurses.”

  • Crystal

    Also…wanted to add something else. Maybe it only makes sense that more people are going into nursing. There’s more people to take care of (the baby boomer population). For an insider, this was when every one was having babies when the war had ended. This is a huge population, so those “difference” numbers will soon be decreasing and if they don’t its only because the United States is denying the baby boomer population healthcare or there putting such a strain on the current nurses rather than hiring more.