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Fewer Nurses Starting Their Careers in Hospitals

A brand-new report out of New York University demonstrates a slow but very definite shift in the nursing industry. The report shows that fewer nurses are starting their careers at hospitals, choosing instead to look for employment through community-based employers. It is a trend that is picking up steam as we transition from fee-for-service to value-based care.

The report, put together by the RN Work Project and New York University, says that hospitals employed just 76% of all new nurses who took their first jobs in 2012. That is down from 87% in 2005. Such a stark difference in just seven years shows how quickly this trend has emerged. But keep in mind that the data compiled in 2012 came at a time when the concept of value-based healthcare was just being introduced. We now have three years of transition under our belts. That is three years of additional time to develop new community healthcare options.

Working Outside of the Hospital

At the center of the nursing shift is the idea of the medical team approach to healthcare. Where nurses were previously seen primarily as staff members in support of doctors, they are now more readily seen as equal members of a healthcare team that can include all sorts of professionals including patient advocates, nutritionists, dietitians, and clinical specialists.

Another thing to consider is the growing trend to increase the scope that care nurse practitioners are allowed to provide. One state after another is changing its regulations in order to allow nurse practitioners to provide primary care without being directly supervised by a doctor. In those states, pharmacy chains and big box retailers are competing for nurses as they endeavor to open on-demand primary care clinics. With every nurse practitioner who answers the call is the need for additional nurses to round out clinic staff.

Lastly, the value-based model of healthcare delivery relies on a proactive approach to patient care. Rather than waiting for patients to come to the clinic already suffering from an injury or illness, we now want to take healthcare consumers and make an effort to keep them as healthy as possible for as long as possible. Nurses play a vital role in this proactive approach. They fill positions that see them providing everything from home-based primary care to telemedicine.

A Trend That Could Last

There is no doubt that hospitals still create the largest number of new healthcare jobs for nurses. That is not going to change. But one must wonder how long the trend of new nurses entering community jobs will last. That is anyone’s guess. There are several factors in play to suggest the trend will continue at least for a few more years. We expect to see the number of new hospital jobs remain level while community jobs grow.

The first factor is the implementation of the Affordable Care Act. Healthcare reform has created a scenario in which tens of millions of people now have access to health insurance where they did not before. Among all of the new subscribers will be those who live in rural areas and have no access to hospital facilities.

The second factor is an aging population supported by a large number of baby boomers set to enter retirement over the next 5 to 10 years. They will need more access to healthcare than ever before. In fact, some estimates say that the baby boom generation will be the greatest consumers of healthcare services for the next several decades. That is good for nurses who need and want work.