What’s the right number of nurses?

Thousands of Twin Cities nurses on Thursday plan to stage a one-day strike. Staffing levels make up one of the fault lines in the talks over a new contract.

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I don’t want to dive into the specific staffing issues surrounding the strike. But it has me thinking about a question I’ve worried about for more than a year: What’s the right number of nurses?

With our aging population, it’s been a given that health careers will be in huge demand and that nurses, the people we rely on most in the health system, will be crucial.

It’s also been a given that we have a huge shortage heading into the future. But is that the case?

MinnEcon raised this issue last year when local hospitals were laying off nurses. It seemed like the market was all out of whack: nurses losing jobs while new nursing school graduates struggled to find work while record numbers of students continued to enroll in nursing programs.

The conclusion then was that it was simply a short term problem triggered by the recession. And yet:

The number of registered nurse job vacancies in Minnesota has plummeted, from 2,237 in 2008 to 536, according to data collected by the Minnesota State Colleges and Universities system (Click on the chart for a larger view).

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At the current rate, the market is producing more nursing grads than the system needs. MnSCU data show “the total supply of new nurse graduates at the professional-level (RN) from both public and private institutions has increased over the past nine years. In 2008 it reached 2,800.”

The state Department of Employment and Economic Development estimates about 2,340 openings for registered nurses each year between 2006 -2016.

Another group, Economic Modeling Specialists Inc., projects a need for about 2,577 nurses a year through 2019, according to MnSCU.

Between the two estimates, Minnesota schools are producing 9 to 19 percent more nurses than the state’s projected to need.

Of course, not all of those grads will stay in Minnesota. But grads outside Minnesota are also likely to seek work here.

As my colleague Mike Caputo noted last year, in 2008, all of the 130 baccalaureate graduates of the University of Minnesota nursing school had jobs waiting for them at graduation, In 2009, only 20 percent graduated with a job in hand.

This year, about one third of the nursing school grads had jobs, said Connie Delaney, dean of the U’s nursing school.

“As with last year, we expect all to have jobs within months,” she said. “Although health care needs are high, the financial pressures on our health system are impeding its ability to address these needs,” affecting when graduates get hired.

Another complicating factor in trying to manage supply and demand here is that Minnesota has one of the country’s highest rates of part-time nurses.

A 2004 federal survey estimated 44 percent of Minnesota’s RNs worked part-time. Only Vermont, with 45 percent, was higher. The national average was 30 percent.

MPR’s Lorna Benson, who writes on health issues and has been covering the contract talks, told me:

A few of the nurses I’ve talked to told me that they work part-time because it gives them more control over their schedule. So for example, a nurse might willingly accept a two-day per week shift because it’s easier to take vacations or plan things outside of work. They said nurses who work full-time have a very difficult time scheduling time off.

The part-time jobs come with benefits (you must work a minimum of 16 hours per week) and part-time nurses also have the option of picking up extra shifts at their discretion.

Some nurses still end up working a full 40 hours per week even though they are part-time.

That makes sense. It also makes understanding the market demand that more difficult.

So what do we have?

We see a huge push into nursing because of the perceived future need. It’s coming especially from MnSCU’s two-year degree programs. It’s been accelerated by the recession.

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We have a market that’s been able to handle high numbers of new nurses because many here choose to work part time.

But will that structure stay in place in the future? If more Minnesotans enter nursing programs expecting or needing full time work, what happens to the market then?

I’m laying out data and raising the issue not because I have answers but because we need a conversation about how many nurses the market can handle.

It’s an issue that’s popping up in other places this graduation season.

So take a look at the data and what I’ve written and answer the questions: What is the right number of nurses? Are we correctly supplied for the future?

Post something below or contact me directly at MinnEcon.

  • Sandra Shanley

    I’ve been in hospitals and care facilities several times over the last few years for blood poisoning, thymic cancer, fluid around the lungs,a broken ankle and a torn knee cartilage.

    All is well with me today because good nurses took good care of me at every step of the way. Nurses were there after surgery, and the emergency rooms and when my clinic couldn’t diagnose all my symptoms. They were on the front line being knowledgeable, kind and expert when I was in a world of hurt and really didn’t care about any thing but getting better and home. I support nurses, they are very much needed!

  • http://www.agingservicesmn.org Adam Suomala

    To date, the focus on the “right number of nurses” in Minnesota has been almost exclusively around positions in the hospital — I would encourage you to look at the demographic “boom” of older adults hitting our healthcare system, and the many careers available today in older adult services… specifically skilled care centers, assisted living, and home care.

    A common hope of emerging nursing graduates may be a day shift at Children’s Hospital, but the reality is where Minnesota needs their service most is in the many expanding arenas serving older adults.