6 Considerations about the Geography of the Nursing Shortage

Geography and/or regional issues are often cited when referring to the nursing shortage. The idea is that certain areas of the country have a surplus of nurses while other areas of the country are faced with severe shortages. The net result is an overall nursing shortage. These regional imbalances lead to recommendations that nurses, especially those having difficulty landing a job, should seek employment opportunities in regions exhibiting shortages. However, others contend that such recommendations maybe without merit. Understanding the issues at play will help nurses form a clearer picture of the nursing labor market and possibly assist them with their job searches.

A review of articles and research on the nursing shortage reveals broad consensus that certain geographical regions have far fewer nurses than others. For example, the Kaiser Foundation reports that Nevada has 605 registered nurses per 100,000 residents while the District of Columbia has 1,728 registered nurses per 100,000 residents. Many other studies offer similar results.

Debate Over the Nursing Shortage

What the Proponents Say

When explaining these differences, many sources speculate that they’re due to the difficulties that rural communities experience when trying to attract qualified healthcare professionals. For example, Sarah Kliff of the Washington Post’s Wonkblog points to a statistic that 83% of registered nurses live in large metropolitan areas as evidence that new grad RNs may encounter more demand for their skills in rural areas.

Meanwhile, a study conducted by the Robert Woods Johnson Foundation concluded that registered nurses exhibit a “lack of mobility” compared to other professions. In other words, registered nurses are more likely to take a job within the general vicinity of the nursing school from which they graduated.

Referring to the study’s findings, Christine Kovner, one of the study’s authors, asserts that, “it’s not surprising that parts of the country with few or no schools of nursing are struggling to find nurses,” and, “more needs to be done in areas with few nursing schools in order to meet the health care needs of those communities.”

What the Critics Say

Critics argue that assertions like these rely on 2 big assumptions. First, they assume that areas with fewer nursing jobs per capita are rural. For example, it’s true that the vast majority of Nevada could be considered rural. However, 97% of Nevada’s population resides in metropolitan ares. Moreover, urban areas like San Jose, California have 637 Registered Nurses per 100,000 residents while rural states like South Dakota have 1,349.

Second, they assume that employers are seeking to hire registered nurses in the rural areas they’re referring to. In Kovner’s defense, her study did not ask registered nurses why they did or did not choose to move for work. In Kliff’s defense, she does not definitively state that newly graduated registered nurses would be better served looking for work in rural areas. Nonetheless, the assumption that both authors make is that jobs do indeed exist in rural areas where there are fewer nursing schools.

However, there are many reasons to believe that potentially fewer per capita employment opportunities exist for registered nurses in rural areas than in metropolitan areas. First and foremost, unlike physicians, registered nurses are very rarely able to be self employed in the provision of healthcare services. Point being, where there are fewer physicians there may be fewer jobs for registered nurses. It’s also possible that rural citizens seek medical treatment less frequently than their urban counterparts. This may be due to a greater propensity for self reliance. It could also be due to lower health insurance coverage rates in rural areas.

Job Vacancy Rates and the Nurse Shortage

There is no question that rural communities have a stronger tendency to have fewer employed healthcare professionals per capita than their urban counterparts. For example, the California Institute for Nursing and Healthcare reported that San Francisco had the state’s most RN jobs per capita while rural communities like Merced and Fresno tended to dominate the lower ranks. However, such research considers only filled RN jobs per capita.

Perhaps a better barometer to consider when gauging a nursing shortage would be job vacancy rates. Again, just because there are fewer nurses per capita in a given area does not necessarily mean that there are more available nursing jobs in that area. It maybe true that communities exhibiting a lower number healthcare professionals per capita are underserved from a healthcare perspective. But this problem may be due to factors outside registered nurses’ control rather than their lack of desire to move to these locations.

The problem is that job vacancy rates can be difficult to measure. One option is to look at job postings by location. But this approach is spotty at best. Jobs posted on job boards may already be filled by internal candidates. In addition, many job openings are never made public. Another approach to measure job vacancy rates is to survey hospitals and other healthcare employers. However, surveys are costly and only measure a specific point in time.

The Shortage and Your Nursing Job Search

Less Competition in Rural Communities

So what is the take-away here for nurses engaged in job searches? While it may be true that there is not a direct link between fewer nursing jobs per capita and higher nursing job vacancy rates, nurses who are willing and able to move for work should expand their search to these areas nonetheless for two reasons.

First, it’s reasonable to expect that areas with fewer nursing schools have a higher propensity to experience difficulties attracting candidates when job openings exist. Moreover, considering more areas exposes you to a larger job market.

More Competition in Urban Communities

Second, it’s also safe to assume that competition for nursing jobs will be greater in metropolitan areas than in under-served rural areas. For example, the California Institute for Nursing and Healthcare reports that the San Diego Metropolitan Statistical Area has 681 Registered Nursing Jobs per 100,000 residents, which is very low. However, Scripps Health of San Diego reportedly received 100 applicants per RN job opening between 2011 and 2012. It’s fair to assume that hospitals in Fallbrook and Temecula, just an hour north of San Diego, received far fewer applicants per job opening.

Developing a Game Plan

Nurses interested in incorporating rural areas in their job search should first determine their areas of interest. Next, they should find the healthcare employers in the area. There are various resources for accomplishing this including the American Hospital Directory which provides hospital listings by city. Nurses can then visit the hospitals’ websites directly and/or attempt to contact the hospitals in an effort to express interest and find out if there are any unposted job openings.

Of course, the trends are bound to ebb and flow with the severity of the nursing shortage. Nurses can expect an easier time finding jobs in their most desired locations when the nursing labor market is tight. The can expect it to be more difficult when the nursing labor market is slack.