If you're looking for a new nursing job (or your first), you might think heading to the nearest city is your best bet–lots of people needing lots of nursing care, right? Or maybe you're considering rural areas–with everyone concentrated in cities, they must need nurses desperately in the country! The truth is, no matter where you live, nurses are vital for healthy communities. From the quiet countryside to bustling urban centers and everywhere in between, nurses are at work in hospitals, clinics, physicians' offices, and many other health care settings. Though nurses have felt the effects of the economic downturn (a tight job market coupled with fewer nurses retiring), experts predict the future holds nothing but opportunity for those who weather the storm.
Which nursing specialties offer the most opportunities? And in which areas of the country can minority nurses make the largest impact? Though the job market continues its slow creep toward recovery, it's still an excellent time to explore burgeoning nursing specialties and areas of the country that need skilled nurses. As the country emerges from the recession, nurses will be in demand everywhere, so it's simply a matter of geographical preference.
"We are on the brink of a very significant nursing shortage, so any tight job market we're seeing right now is probably going to change on a dime in the next several years," says Donna Cardillo, M.A., R.N., nursing career specialist, author of A Daybook for Beginning Nurses, and "Dear Donna" columnist for Nurse.com (www.nurse.com).
Nancy Pokorny, M.S., R.N., a nursing career specialist at Albert Einstein Healthcare Network in Philadelphia, Pennsylvania, says she hopes the current job market won't discourage people from going into nursing or staying in the profession, because an impending nurse shortage is real, even though it's not evident at this time. "Certainly everyone is hoping for an economic resurgence, but people still need to pursue nursing as a career," Pokorny says.
Despite the current bleak job market, the Bureau of Labor Statistics' (BLS) 2010–2011 Occupational Outlook expects job opportunities for registered nurses to be excellent, with job growth much faster than the average for all other industries. The BLS reports that hundreds of thousands of new nursing job openings will emerge from the need to replace retiring nurses in the years to come. Employment is expected to grow by 22% between 2008–2018.
"Right now the demand for nurses is lower, and I think that is a result of the bad economy and folks that would normally be retiring waiting to retire," says Darlene Curley, R.N., M.S., Executive Director of the Jonas Center for Nursing Excellence, a foundation that works to increase ethnic and racial diversity among the nursing workforce. "I think for the next two to five years there will be fewer opportunities for initial employment in the specific areas that a nurse may want to go into when they graduate. However, I think that a nurse that comes from a diverse background will have more opportunities because employers will need to have those nurses to be able to provide the best care for the patients."
"Nursing is very portable–more portable than most careers," Cardillo notes. This means that a nurse can choose to live and work anywhere, though some areas offer more opportunities than others.
The Northeast region of the United States has the highest overall concentration of registered nurses; specifically, Massachusetts, Rhode Island, and Delaware rank in the top five states for nurses. South Dakota in the Midwest and Mississippi in the South are also in the top five for a high concentration of RNs (Source: Bureau of Labor Statistics. See sidebar for more info).
The Northeast also scores big for annual mean wages, with Massachusetts, Maryland, and New Jersey ranging from the mid-$70,000s to low $80,000s. In the West, Hawaii and California rank in the top five for nursing salaries, both in the low to mid-$80,000s, according to the Bureau of Labor Statistics.
Cardillo says she doesn't consider any area of the country a "hot spot" for nurses right now, but, "for the most part, there are opportunities everywhere, and typically you've got a proportionate number of nurses to job opportunities, so I don't know that anybody needs to necessarily relocate in order to find what they're looking for," she says. "The great thing about nursing is there are opportunities all across the country, so sometimes nurses can do some travel nursing–work for a travel nurse agency to try out different areas, experience different geographic locations, and work in different specialties for different employers. That's maybe a way to try different things out."
"The demand in nursing is strong enough that it transcends race, gender, and nationality. Minority nurses are needed in all areas, regardless of rural or urban settings," says Jill Jarufe, M.B.A., a nursing practice search consultant at Kaye/Bassman International Corporation, a recruiting firm based in Dallas, Texas.
Jarufe agrees that the general future job outlook for nurses in all regions is outstanding and is only expected to continue to grow over the next 10 years, but she points out that warmer climates in the Southeast and Southwest are generally showing the most opportunities for growth, as the baby boomer generation tends to relocate to these areas.
Minority nurses come from a variety of geographic areas and often feel a strong desire to give back to their communities by working within them. Nurses in rural areas can help people who often have limited access to high-quality health care–then again, they can head to more urban areas and find the same problem. The need for nurses is widespread and growing, so no matter where you chose to practice, you'll make a difference. Of course, nurses must consider many factors when deciding where to work, including the number of potential job opportunities, cost of living, personal preferences (e.g. city versus suburban or rural areas), and where their passion lies within the health care arena.
"We have a responsibility toward our own community, first and foremost," says Adrian Juarez, B.S.N., M.S.N. "Go out there and get yourself the training and skills that you need and then give back to the community that's given so much to you. Never forget where you're from." For some minority nurses, that means going to work for an organization like the Indian Health Service, focusing on American Indian and Alaska Native tribes. For other nurses it means working in inner cities or rural areas that suffer from health disparities and lack access to quality care.
Missy Gilford, B.S.N., R.T. (R), Assistant Manager of Emergency Nursing at Children's Healthcare of Atlanta at Hughes Spalding in Georgia, has been a nurse in the area for 15 years. "The area that I work in is in downtown Atlanta. Most of our patients are minorities. In our emergency room we see 4,000 or more patients per month, and the majority of them are minorities. I would say about 85% are minorities."
Juarez has firsthand experience working as a nurse in various regions of the country, including his home state of Texas. He's also worked as a nurse in Los Angeles and California, and he is currently pursuing his doctorate in nursing at New York University on a Jonas Center scholarship, focusing his research on addressing the lack of access to health care for marginalized populations. He describes the quality of life on the East Coast as one of the best in his experience.
"Here, at least in the New York City metro area, there's a strong economy and there's always opportunity and potential for a job," Juarez says. "You have public transportation to get to your job and high-quality schools. I would have to say that Southern California has a higher quality of life as well, though not as high as the East Coast [in my opinion]. But in the West and Southwest where I'm from, one of our biggest issues is a basic need like water, so there is definitely a difference there."
Upon completing his degree at New York University, Juarez says he plans to return to his roots and work in Texas. With his doctorate in hand and high level of commitment to give back to his community, he will be a welcomed asset. "There's definitely a need for advanced practice nurses in rural areas where there is often a shortage of physicians," Cardillo says. "Advanced practice nurses are taking on a bigger role in many rural areas."
The staggering shortage of physicians in rural areas often drives the need for advanced practice nurses. Only 10% of physicians work in rural areas, compared to 90% in urban areas.1 Nurses, particularly minority nurses, are needed to fill these gaps in the availability of primary care practitioners.
While the coasts always draw large numbers of people, nurses shouldn't overlook the Midwest. "The Midwest has some great opportunities also; there isn't any particular decline out there," Cardillo says. "In fact many hospitals in the Midwest are hiring and there's good quality of living. I was in Illinois recently and there seems to be a lot happening there [in health care]–in the Chicago area certainly."
With such a bright future forecasted for nurses nationwide, there are several areas of nursing that experts agree are destined for strong growth–and the need for minority nurses in these specialties is crucial for delivering culturally competent patient care.
Cardillo highlights one nursing opportunity in particular: advanced practice nursing (APN), which includes certified registered nurse anesthetists, certified nurse midwives, clinical nurse specialists, and nurse practitioners. APNs hold master's degrees in their field of concentration and are licensed to perform assessments and prescribe medications to patients.
"Nurse practitioners work under the advisement of a physician, but they are really independent practitioners. This is really a huge growth area and is related to health care reform since one of the components of health care reform legislation is the increased need for primary care [providers]," Cardillo says. That need is ever-present for minority patients who sometimes have limited or no access to physicians. Nurse practitioners are not only more accessible and affordable in facilities such as pharmacy clinics, but Cardillo says patients often feel more comfortable seeing a nurse than a physician.
"Advanced practice nurses are filling the gap in primary health care and becoming major providers of primary care" Cardillo says. "In some cases it's because of a shortage of primary care physicians, but also, there's a growing body of research that shows that advanced practice nurses are providing high-quality care at a more reasonable price. Also, we've long known that the health care consumer has a high degree of trust in nurses and is very comfortable being treated by nurses and talking to nurses–sometimes more so than they are with physicians. That's not an anti-physician statement; it's just the nature of what's happening out there."
Pokorny agrees that the greatest growth lies in advanced practice nursing. "That doesn't help the new graduates coming out the door with their bachelor's degrees, but advanced practice nursing is definitely growing. It looks like the government is putting the educational dollars into it with the changes in health care coming upon us quickly. Primary care, nurse-run centers–that's really going to be the key," she says.
In addition to advanced practice nurses, critical care nurses (ICU, ER, operating room, recovery room, etc.) remain and will always be in high demand across the country. "In fact, some people speculate that hospitals will eventually be one giant intensive care unit, as we continue to find alternate ways to treat people outside of the hospitals," Cardillo says.
Another growth area is outpatient nursing or ambulatory care nursing, which Cardillo says is "growing by leaps and bounds because we are delivering much more care outside of the hospital. Ambulatory care nursing is a term that encompasses many different practice settings to include any outpatient services, and it also includes tele-health or tele-nursing where nurses are giving advice via telephone or doing telephone triage. I consider it a sub-specialty of ambulatory care nursing. Some consider it tele-nursing."
Many nurses only think of more traditional clinical roles, but Cardillo urges them to consider some of the non-traditional nursing careers showing strong growth. "I have a very broad view of who a nurse is and what a nurse does," she says. "So I would say one nursing non-traditional growth area is nursing informatics–nurses combining their clinical knowledge with computer science. Computers are being used in increasing ways in health care, and that's a very exciting, hot growing field right now for nurses."
Another field worth investigating is forensic nursing, a combination of the legal arena and nursing science. Forensic nursing is also an umbrella term encompassing specialties such as sexual assault nurse examiner, nurse investigator, and nurses who work with patients of suspected elder or child abuse.
If you see yourself in a more advanced nursing role, now might be the perfect opportunity to get the education required for these growth specialties. While nurses can take a number of educational roads, from associate degrees to graduate-level studies, the fastest growing specialties (such as nurse practitioner) require a master's degree. "It's a really good opportunity for individuals who are currently practicing nurses to jump back into the educational waters and get back to school for advanced practice positions or nurse educator positions, because certainly faculty is needed," Pokorny says.
Finally, for nurses with a flare for business, another area to consider is entrepreneurship. "First of all, nurses make great entrepreneurs. There's great opportunities for them to do things independently, to do education, CPR training, open adult day centers, child daycare centers–there's a whole host of things. For example, I heard about some new grad nurses who couldn't find a traditional job because of the current tight job market, so they opened a sick child daycare center. And what a great idea that is. How innovative. And who better than nurses to operate such a center?" Cardillo says.
Whatever road you decide to take and no matter where it leads you, one thing is certain: minority nurses are needed everywhere in order to deliver the best culturally competent patient care possible. "Nurses are multi-talented and versatile," Cardillo says. "There are many ways and places to make a difference. There's no one right path for every nurse to follow. Each individual nurse has different interests, different backgrounds. Nurses really need to follow their heart in nursing and carve out their own path. Many people will tell you that this is the way you have to start in nursing; this is the way you have to build your career in nursing. But there is no right way. We're all different. The opportunities are endless. There are many different things we can do, so you really have to follow your heart and make it work for you."
1. Rural Healthy People 2010. "Healthy People 2010: A Companion Document for Rural Areas," www.srph.tamhsc.edu/centers/rhp2010.