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Monday, January 29, 2018

The Nursing Shortage That Doesn't Necessarily Come Up Short

You may have seen a few of the high profile newspaper and magazine articles highlighting a growing nursing shortage in the United States.  But, as with so many things in health care, the shortage of nurses is not evenly distributed across the states or even within a state. Seen from this perspective, we may have more of a distribution problem than a shortage. In health care, geography is destiny. 

When I look at Missouri and note that the communities in greatest need of more registered  nurses are disproportionately rural and low income, I am not surprised. Rural and low income communities often experience shortages of many different kinds of licensed health practitioners, which can then produce shortages of local delivery of certain kinds of health care services. For example, lack of adequate nursing staff for an obstetric unit may mean that a hospital closes that unit or some beds in that unit.  

Just how stark is the labor supply differential for nurses in Missouri? One study reports that " Missouri’s nursing shortage reached a record high in 2017, with almost 16 percent - or 5,700 - of positions vacant, up from 8 percent last year. Thirty-four percent of Missouri registered nurses are 55 or older." So, yes, we have a shortage of nurses in Missouri as many baby boomers age out of a career that may have been one of the few professional careers open to women and we also have a shortage of nursing professors, whose formation has a longer lead time.  All of this is happening along with a great push to move all registered nurses to qualifications including a four year degree, no longer sufficing  with a two year degree

To complicate things more, it is reported that for every small rural hospital struggling to fill RN ranks, there is a larger more urban facility that increasingly prefers to hire an advanced practice nurse with a masters or a doctorate. Unless a career in the service of a rural area or the historically under-served is the goal, some prospective nursing students may feel concerned about an inability to tell which way all of this is going to break. 

Might you be both today's hot commodity and tomorrow's anticipated leftovers, simultaneously?

Posted by Ann Marie Marciarille on January 29, 2018 at 09:00 AM | Permalink


On John's comment about the inability to make a living in rural areas, I have to respectfully disagree as to my state.

I can place people in rural attorney jobs with small firms that provide a decent income in relation to their indebtedness and cost of living. Students rarely't take them. Fortunately, they're doing pretty well where they are, but many graduates seem to prefer a somewhat prolonged job search to an instant job, and we have a couple of graduates doing paralegal work in the city instead of a much higher-paying rural job.

From the published articles on South Dakota, the same seems to be true there.

A real challenge of rural life is managing a family. A partner may not be willing to follow you, and at least in the state I'm in, rural schools are much worse than city schools.

Posted by: Anonymous | Jan 31, 2018 12:01:53 AM

jack sounds like a secret Trump supporter who wants to demonize law school professors by making them sound like clueless, arrogant ignoramuses who deserve to be punished.

Posted by: PaulB | Jan 30, 2018 5:03:20 PM

Maybe the people that live in these rural communities shouldn't have voted for a xenophobe. There are plenty of hard working, well educated, and very willing to live and work in rural areas Filipino nurses. Or maybe those rural dwellers prefer to go to their graves untreated but secure in the knowledge that helped keep America white.

Posted by: jack | Jan 30, 2018 10:42:09 AM

Supposedly we also have a shortage of attorneys in these underserved rural communities, but the same problem applies to that profession also: there's little or no money to be made working there. And nurses and doctors at least can bill Medicaid.

Posted by: John | Jan 30, 2018 8:29:52 AM

I did some work for a health care institution in a rural(ish -- the town had about 10,000 people) part of one of the sparsely-populated Western states. They had to bring in contract nurses from out of state even though there was a nearby community college with a decent nursing program, because all of those grads wanted to flee to the bigger urban areas in the region.

Posted by: My $0.02 | Jan 29, 2018 1:05:16 PM

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