Consider this: In the San Francisco area, a nurse with a bachelor’s degree can hope to start out with a salary of $104,000. The salary for a nursing professor with a Ph.D. at University of California San Francisco starts at about $60,000.
This goes a long way toward explaining why nursing schools turned away 42,000 qualified applications in 2006-2007—even as U.S. hospitals scramble to find nurses. We don’t have enough teachers in nursing schools and the fact that the average nursing professor is nearly 59 while the average assistant professor is about 52 suggests that, as they retire, the shortage could turn into a crisis. The most recent issue of JAMA (October 10, 1007) reports that in 2005 we had 218,800 fewer nurses than we needed and by 2020, it’s estimated that we’ll be short some 1 million nurses.
Hospitals have had to raise nursing salaries (as well they should), not just because nurses are scarce but because, in our chaotic hospital system, the work can be extraordinarily stressful.
Nurses know better than anyone just how many “adverse events” occur each day –even in the most prestigious U.S. hospitals.
“I’m terrified of killing someone,” one young nurse confided to me
about a year ago. After working in a hospital in Bermuda for a number
of years, she was bored, and had come back to work in New York, where
she had friends and family. She had worked in New York before, but she
wasn’t at all sure that she would stay. “In our hospitals, it’s just
too crazy,” she said.
Her story also sheds light on why nursing professors are willing to
work for $60,000 a year when they could, no doubt, more than double
their salaries if they were willing to wade into the fray at local
But it’s not just a dearth of professors that prevents nursing schools
from admitting qualified students. The schools also lack the physical
facilities and equipment needed to increase enrollment. Medical Schools
receive generous contributions from their alumni. Nursing schools
don’t. (While nursing salaries have gone up, there are not many nurses
making $1 million or more.)
Meanwhile, hospitals continue to build and expand—without any clear
idea as to where they will find the nurses needed to staff new
facilities. (See my post “The Hospital Building Boom”.)
Today, hospitals report that they are not able to fill 6% to 8% of
their nursing positions, and surveys of doctors, hospital
administrators and nurses themselves confirm that the vacancies have
“seriously impaired communication between hospital staff members,
patient-nurse relationships, hospital capacity and patient-centered
Build the beds and they will come—but who will care for them?
In recent years, nurses from other countries have helped pick up the
slack. But now, the entry of foreign nurses is blocked or delayed for
years due to a failure to “increase immigration quotas or establish an
appropriate temporary visa category for nurses” concludes a new study released by the National Foundation for American Policy (NFAP), an Arlington, Va.-based policy research group.
“Fears that foreign nurses would overwhelm the U.S. labor market and
dissuade hospitals from active recruitment of U.S nurses are
unfounded,” the report observes. “Foreign nurses represent only 3.7
percent of the U.S. registered nurse workforce, well below New Zealand
(23 percent), the United Kingdom (8 percent), Ireland (8 percent) and
Canada (6 percent).
“Contrary to concerns that foreign nurses would harm the salaries of
U.S. nurses” the researchers add, a Department of Labor-funded analysis
on the impact of foreign nurses found no evidence that “foreign nurses
were paid less than U.S. nurses.”
Today, many believe that, in order prepare for an onslaught of aging
baby-boomers, we need to train more physicians—in particular more
But careful analysis suggests that this just isn’t true. What, we need
is more nurses—and more primary care physicians. I’ll write about this
in a later post.