Immigrant Nurse: Part I

And now, for something a little different.

No, I haven’t been too busy to post.   I am technically employed with a US-based tutoring agency, but my singular, lonely client finished his 16 hours of TOEFL lessons months ago, and I’ve heard nothing about future requests for a tutor.  I must have been that bad.  One of my lesson plans included this creative compare/contrast exercise.  They also haven’t paid me yet.

I have, however, been learning.  Evidence from recent conversations suggest that I now know more about Dutch nursing workforce market forecasts than do my cardiologist neighbor, my dermatology resident friend, and my surgical technician friend combined.  I will assume that means I also know more than the majority of the Dutch population about the state of nursing in this country… and that I definitely know more than you.  If you have patience, soon you, too, will know more about Dutch nursing than the average Dutch person, and I suggest that you give yourself a pat on the back and an extra helping of stamppotje at the end of this post.  Today, from the ranks of the nursing unemployed, I address the big picture of the ubiquitous “nursing shortage” while grimacing my way through a cup of black decaf because we are out of milk and I have yet to make today’s grocery trek.  Tomorrow, I will provide you with a snapshot of what it is to be a non-EU immigrant nurse hopeful in the Netherlands while dressed in real clothes, not the clothes I’ve been intending to run in for the last five hours.

First, when healthcare experts, economics experts, the media, and other “people in the know” talk about “the nurse shortage” or “the nursing shortage,” they refer to nurses in hospital settings.  The economic data on “the shortage” compares inflow and outflow of nurses in hospital workforces.   I am not a hospital nurse, but my specialization necessitates that I am well-acquainted with hospital nursing, and that I treat the entire nursing profession as one that will impact the future of US health practice and policy in big, important ways.   Slowly, but surely.

The drippy and misinformed sentiment in both the United States and here in Europe seems to be overwhelmingly that, if you are a nurse, you are needed, e.g. “They need nurses everywhere,”  “There’s a shortage of nurses,” “Well, you certainly won’t have trouble finding a job as a nurse,” etc.  In the U.S., the current “shortage” was forecast in the 1980’s, with more precise estimates of just when and how bad it would be arriving with research in the late 1990s and 2000s.  As a giant cohort of baby-boomer nurses started getting excited about retirement in the 2000s… economics happened.  Older nurses either opted to stay working for a few more years or opted to head back to work.  When I was gaining experience as a hospital RN, one of my RN coworkers was 70 years old.  She sure wasn’t there because she loved the work.  The current median age of a nurse in the U.S. is 46 years old (there are as many RNs over age 46 as there are younger, as opposed to the mean age, which I don’t know), and the largest cohort of RNs is ages 50-59 (see table).  In other words, there is actually… NO shortage right now, courtesy of the recession.  The real shortage will hit us in a couple of years, and it will hit us like a 6:58 a.m. code blue.

Buerhaus, P. and Auerbach, D. (2000). Implications of an Aging Registered Nurse Workforce Journal of the American Medical Association (JAMA). http://jama.jamanetwork.com/article.aspx?articleid=192782

Don’t be miffed.  You haven’t been entirely deceived.  There was a nursing shortage, before the recession, and there will be another.  It started in 1998 and reached its apex in 2001, the “highest of the low,” if you will.  A few years later, experts picked up on the fact that the recession was helping the nursing shortage, and articles like this one in 2009 and this one in 2012 made the information public, at least to those who read economic news.  Those of us in nursing school at the time certainly did not hear faculty shouting this information from the rafters.  In preparation for “the big one,” colleges doggedly persisted in recruiting and belching out BSNs, twice as many in 2010 as they did in 2000.  Fast-track MSN programs cropped up in almost every state, offering a sparkly package of an RN certification in one year and a masters degree in two-to-three.  Bright-eyed new nurse grads, my own 2010 cohort included, continue to emerge from the wombs of their colleges and, within a month or two, wonder sadly why nobody wants them, like puppies abandoned once they’ve matured to slobbery adulthood.  I knew several extremely competent, passionate people who applied to hundreds of nursing jobs before getting hired.  Personally, it took me 55 job applications and three months.  These new grads don’t realize that they are The Replacements, to be called in when the veteran troops are at last depleted.  There’s likely not much consolation in that knowledge, since there’s no paycheck or career opportunity in being a Replacement.

So, the shortage was just a prelude, it's taking an intermission, and the main feature is slated for 2015-2020.  Depending on when the research was done, estimates vary on exactly how severe the nurse shortage is going to be, but it will be big.  One forecast is that the RN workforce will be 20% below “projected requirements” by 2020, or somewhere between 700,000 and 800,000 RN jobs.  In 2010, the first of 78 million baby boomers qualified for Medicaid.  Picture the baby-boomer workforce going from bed-side to bed-in… very slowly.  It’s not happening quickly, because those baby boomers are tough and taught my generation about work ethic, but, as one researcher puts it,

 “unlike past shortages, the coming RN shortage will be driven by fundamental, permanent shifts in the labor market that are unlikely to reverse in the next few years.”    

That’s one way of saying that people, eventually, get too old to work really demanding jobs.  I don't blame them.  I couldn't hack night shift longer than ten months.

As fast as colleges are spitting out RNs (more bodily fluid metaphors for you), it won’t be fast enough to meet the anticipated demand.   Nursing may be the fastest-growing healthcare occupation, and there are many of us standing around thumb-twiddling and drinking grainy coffee at the moment, but in another few years, there won’t be enough nurses to go around.  

Is immigration part of the solution?  For the U.S., it is, and will be.  For some European countries, researchers and policy makers say "yes."  For other European countries, the Netherlands included, it's "no" (at least not right now).  And that’s part of why I need to re-market myself.  

More on Europe, immigration, and nursing after I’ve seen daylight and bought some milk.

Marketing myself as a nurse consultant is like trying to find Flevopark in the snow.