Why it takes so long to hire a nurse

Despite a persistent nursing shortage in the U.S., nursing jobs remain vacant for a long time in many healthcare facilities.

It takes Houston Methodist 55 days on average to hire a registered nurse, according to a report from The Pew Charitable Trusts. This is consistent with all healthcare jobs across the U.S., where it takes an average of 49 workdays as of September, according to research group DHI Hiring Indicators.

Why does it take so long to fill nursing positions given their high demand? Here are six thoughts from The Pew Charitable Trusts.

1. Organizations seek specific qualifications. The need for more nursing graduates in many cities is partially responsible for the lag when it comes to filling vacant nursing positions, but it's not the only problem. Employers want new hires to have experience in certain specialties, such as in the operating room. However, they may not be able to offer wages high enough to attract candidates with such experience. In response to this dilemma, many hospitals are beginning to develop in-house training or internship programs for recent nursing graduates to help them acquire the necessary work experience.

2. Requirements are rising. In addition to experience, many employers are increasing their education requirements for nurses. This move was spurred by the nonprofit Institute of Medicine, now the National Academy of Medicine, which recommended in 2010 that 80 percent of all nurses earn a bachelor's degree by 2020. Previously, RNs needed only to worry about getting a nursing license, which they could obtain without going to college by completing a nursing diploma or certificate program at a hospital. Subsequently, many employers have raised their degree requirements, and as a result, nurses with just an associate degree often have trouble landing job interviews.

3. Nursing schools can't prepare students with much hands-on experience. It's illegal for unlicensed nurses to practice on real live patients. During the clinical rotation hours — about eight to 10 hours a week — nursing students practice only basic tasks under close supervision. New nurses need at least six months of on-the-job training and substantial mentoring before being able to work confidently and independently, according to the report.

4. Low wages render some hospitals uncompetitive. While elite hospital systems have the resources to offer bonuses and other financial incentives to attract candidates, some employers cannot afford to do that. Low wages are a consistent problem for smaller healthcare providers, especially those that rely on public funding such as Medicaid, according to the report. Across the U.S., average RN pay is $35 an hour in a hospital, $33 an hour in a home care agency and $30 an hour in a nursing home, according to data from the U.S. Bureau of Labor Statistics.

5. Many hospitals struggle with retention. The demanding nature of a nurse's job leads to attrition, especially among new nurses. About one in five new nurses quit their jobs within a year, according to a 2014 study cited by The Pew Charitable Trusts.

6. How to bridge the gap. The Pew Charitable Trusts outlined several steps policymakers and employers can take to improve the nurse hiring environment.

  • Student loan assistance to nurses who are willing to relocate to rural areas.
  • Comprehensive on-the-job training.
  • Clearer pathways into specialties.
  • More government funding for nurse residencies.

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