By Jennifer Thew, RN
Are you experiencing a nursing shortage at your organization? Are you flush with job candidates or is it a struggle to fill open nursing positions? Are new graduates beating down the door while experienced nurses become harder and harder to come by?
"We certainly have seen a lot of news over the past couple of years about the potential for nursing shortages, and concerns—particularly from hospitals [and] across [all] settings—about there being a nursing crisis or difficulty in recruiting staff," said Joanne Spetz, PhD, professor, Philip R. Lee Institute for Health Policy Studies at the University of California, San Francisco, during the June webinar, Nursing Demand and Supply in California: Current State and Strategies for the Future, hosted by UCSF.
Yet, despite this widespread concern, some nurse workforce forecasts do not seem to support this fear.
"This has been interesting to watch because, at the same time, national federal forecasts and other local state forecasts generally suggest that the labor market is producing adequate numbers of nurses," she said. "This produces a bit of a conflict about what's going on and thus, we've been engaged in surveillance of data across a variety of different sources to try to understand what's happening, specifically in California, but [also if] what we're seeing here resonates across other states in the U.S."
During the recent webinar, Spetz and fellow panelists shared a variety of data points and insights regarding nurse supply and demand, including California chief nursing officers' perceptions of the RN labor market.
While the number of nurses needed to fill open positions seems to match up, there is more to nurse supply and demand than just numbers. Variables like geographic location, desired candidate skill sets and experience, and education requirements influence whether CNOs are able to find the right nurses for open positions.
"A consistent story that seems to be emerging is that, the overall numbers look roughly in balance, but there is an imbalance in what employers seem to be wanting and what they are finding in the workforce," David Auerbach, PhD, director, research and costs trends for the Center for Interdisciplinary Health Workforce Studies at Montana State University, said during the recent event.
"You have a lot of very experienced baby boomer RNs who are leaving the workforce. Employers [want] to replace that experience but [have] a large pool of new graduates who don't really have what they want, and sometimes, they're either keeping those vacancies open or turning to traveling nurses, and you do have a disconnect in various parts of the market."
Below are some of Spetz's insights garnered from data about California CNOs' perceptions of the RN labor market that she shared during the webcast.
CNOs see a growing nursing shortage
Since the fall of 2010, USCF has conducted a survey to gauge California CNOs' perceptions of the RN labor market. In 2018, 118 hospitals responded to the survey, and CNOs were asked to rate their perception of the labor market in their region of California on a scale from "high demand: difficult to fill positions" to "demand is much less than supply available."
"In 2010 when we began these surveys, there were more hospitals reporting a surplus of nurses than a shortage. But, by the time we get to about the past four years, we have the vast majority of hospitals reporting that they perceive a shortage of nurses in their region, and very few hospitals saying they perceived any surplus of nurses in their region," Spetz said.
Supply and demand varies by region
Spetz points out that there are regional differences in the overall labor market.
"What you can see in the data is some regional variation with the perception of the shortage being generally less in the San Francisco Bay area and somewhat more in Central California and the Southern Border Counties," she said.
Experienced nurses are hard to find
Additionally, nurse leaders are reporting a significant shortage of experienced nurses, particularly since 2014 and 2015. Again, this varies across regions in California.
"It's less of an issue in the San Francisco Bay area and more of an issue in most of the other regions in California," Spetz said.
This contrasts quite notably to CNO responses for the degree of shortage for newly graduated nurses.
New graduates are plentiful
As reported by the survey, in 2018, as in previous years, employers in nearly every region in California perceived a surplus of new graduate RNs.
"This surplus is less of an issue in the Central California region where hospitals actually reported, on average, a balanced labor market. Then Sacramento and the Northern Counties and Southern Border Counties also indicated, perhaps, less of a surplus of new graduate RNs. But in San Francisco, Los Angeles, and the Inland Empire, the CNOs, on average, are reporting a pretty notable surplus of newly graduated nurses," Spetz said. says.
Urban vs. rural settings
"There are some differences between rural and urban regions, with rural hospitals being more likely to report a shortage than the urban areas, and this has been pretty consistent over time," Spetz said says.
The use of travel and temporary nurses
In the survey, CNOs were asked about the employment of temporary and travel nurses. "Statewide, more hospitals reported lower use of traveling nurses over the past year compared to the prior year, while the use of local temporary RNs appears to have been fairly stable," Spetz said. says. "So, there's a little bit less use of traveling nurses, which is important in thinking about the degree of shortage hospitals might be experiencing."
International nurses on the rise
According to survey respondents, international recruitment has increased over the past few years.
"Last year when the data came in it was a little unclear to us whether that was because the group of hospitals that happened to respond that year were more engaged in international recruitment or if it was the beginning of a trend. Now that we have two years of data, I think it's possibly the beginning of a trend," she said.
Spetz said of the hospitals reporting international recruitment, most were in the Inland Empire area.
"This is consistent with the perception of a shortage of experienced registered nurses, but it isn't consistent with the perception that there's a surplus of new graduates," she said.
Regarding the hiring of new graduate nurses, CNOs were asked about their hiring requirements and preferences. About 18% said they have no specific hiring preferences, which was similar to data in 2011.
"There was a notable increase in the percentage that reported that they require a bachelor's degree this year compared with prior years. In the past, that share was stable around 5% and this year it was up to 18%," Spetz said says. "The hospitals that were reporting that they required a bachelor's degree for their open positions were almost all in the Los Angeles, San Francisco, and Southern Border regions. Now, these are regions in which larger hospitals seem more interested in pursuing Magnet status, and nationally this tends to happen in regional clusters as a part of hospitals competing with each other for patients and for experienced nurses."
Additionally, about half of the hospitals responding said they had a minimum experience requirement for RNs.
Future hiring plans
When asked about hiring expectations in the survey, more hospitals reported they planned to increase their hiring over the next year.
"We have more than half say that they expect to do more hiring they did in the last year. They were also asked about their hiring expectations for new graduates and nearly one-third expect to increase their hiring of newly graduated nurses over the next year, while only 9% expect to decrease their new grad hiring," Spetz said.
When asked why they planned to increase new graduate hiring, the most common response was "high [nurse] vacancy rates," she said.
"Other common reasons were that they are anticipating more retirements and want to do some hiring in preparation for that, that they're developing programs to mentor new graduates, and that they've improved relationships with nursing schools, including collaboration on residency and onboarding programs," Spetz said. says.
Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.