Nursing is a profession that can truly move with the person, wherever they choose to put down roots. The job prospects are solid for nurses with employers seeking minority nurses everywhere from small towns to urban centers. Because there is so much opportunity, deciding which nursing specialty and geographical area to live and work can take some soul searching.
While many older nurses are still hanging on to their positions and postponing retirement due to the economy, the job prospects for nurses in the future holds promise.
"There's certainly evidence to show that currently hospitals and other facilities are not hiring at the pace that they were, simply because people are not retiring or leaving their employment the way that they were, and that has to do with the economy," says Katie Brewer, a policy analyst for the American Nurses Association in Silver Spring, Maryland, discussing the region in and around the Washington, D.C., area. "It's hard to trend and analyze data; but from hiring employment data, anecdotally we know that there has been a general slowdown in hiring."
The nursing job market may be less robust in recent years due to the recession, but Brewer is optimistic about the near future of nursing jobs. "That [slowdown] will change in the next few years as people reach retirement age. They may have been close, but when the economy tanked, they weren't close enough in order to justify retiring. But in the next few years as the economy recovers and people's financial situations begin to improve, we'll see a bottom fall-out in terms of the amount of people that retire and the amount of people that can afford to go to part-time work or leave their job. So there will be another influx of needs in the nursing field."
One area in particular that Brewer says is on the cusp of major growth is geriatric nursing.
"There's definitely evidence that there's a great need in geriatric nursing. We're on the cusp of almost a 20 million person increase in the age population of 65 and older," Brewer says. "We're going to have a tremendous need for nurses that can take care of older adults as well as some of the conditions that those people generally have, such as osteoarthritis, diabetes, heart conditions, and cognitive impairment. So that's where the biggest growth in specialty needs will be. There's no question of that. It's definitely a nationwide need."
"Because a lot of nursing students are trying to specialize now, it has really placed a void for nurses at the bedside," says Linda Faye Hughlett, R.N., M.S.N., C.N.M., a certified nurse midwife for the Vanderbilt Nurse Midwives Practice in Nashville, Tennessee. "I see a great need for new nurses [at the bedside] because a lot of new nurses are coming out of school, inexperienced, and not wanting to deal with the challenges that many face on a medical-surgical unit. Also, the appeal of making more money as an advanced practice nurse (APN) is adding to this void. So they have no plan or desire to stay at the bedside and do that kind of grunt work."
Hector M. Benitez, R.N., B.S.N., M.S.H.A., Care Management Operations Integration Director at WellPoint, in Lebanon, Tennessee, agrees. "I think that minority nurses are really needed at the bedside in medical-surgical situations where they're on the floor," he says. "It's imperative that we have nurses at that level, particularly because that's when patients are the most vulnerable. They're lost and confused—especially if they don't know the language."
Medical-surgical nursing is an area where minorities, especially those with language skills, can make a huge impact on patient care.
"I've seen situations where the nurse comes in to assist a patient and they cannot communicate because of the language barrier," Benitez says. "The nurse will explain what they're doing and I always find it kind of comical because if you don't understand what they're saying to you most patients just smile and nod their head ‘yes.' That gives the indication that it's okay, although they have no clue of what was just said to them, and then the nurse proceeds to do whatever it is they need to do."
For Felecia B. Green, R.N.C., B.S.N., O.B., nurse manager in the high-risk O.B. unit at Texas Health Presbyterian Hospital in Dallas, Texas, a specialty that comes to mind with significant growth is the nursing informatics field. "The era of a paperless health care delivery system lends itself to a greater demand for nurses to be proficient and versatile in computer technology. Minority nurses are needed in this arena to help navigate and influence the changes that are occurring in health care documentation."
Finally, Brewer predicts that there will be a need for advanced practice registered nurses in the field as the health care landscape continues to change. "These are nurses that have advanced practice education training and can do things like prescribe medication, prescribe home care, and provide more independent medical and health care services to patients," Brewer says. "And as more people are getting into the health care system with the affordable care act being fully realized, there's going to be a huge need for providers in that sense. So advanced practice registered nurses can meet that need."
As more patients enter the health care system because of widening access to care, the increase in minority patients will require good culturally competent care. And minority nurses are needed across all specialties to meet those growing needs. "It is beneficial to the patients and their families to witness minority nurses thriving in areas that were historically all white," Green says. "Minority nurses can be advocates to assist in the cultural differences—whether beliefs or rituals—that many ethnic individuals may have. Minority nurses are a window into the future for the younger patients, and may influence perceptions that this career is within their grasp."
Nurses aim to deliver the best patient care no matter the city or town they practice in—whether it's a rural hospital or a thriving metropolis. But there are regional differences when it comes to job opportunities, average salaries, and the quality of living.
Benitez and Alan Morgan, chief executive officer of the National Rural Health Association based in Washington, D.C., both agree that the Southeast region of the country needs more nurses.
"In my experience, there's a lot of opportunity in the South. But for some reason, I've seen nurses who've completed school here and the first thing they do is move away," Benitez says. "But looking around, our salaries have always been fairly competitive with other regions. It's also been my experience that the cost of living is a bit easier to manage with a nursing salary [in the South] as opposed to moving somewhere in California or up North where your living expenses are going to be really expensive, in relationship to your salary."
Morgan adds that Southeastern states, such as Mississippi, Louisiana, Alabama, and Tennessee are experiencing nursing workforce shortages. "The Southeast would be where we're seeing the major need for additional health care and practitioners to be," Morgan says.
Rosario Medina-Shepherd, Ph.D., A.R.N.P., B.C.R.N., assistant professor of nursing at the Christine E. Lynn College of Nursing at Florida Atlantic University in Boca Raton, Florida, and Vice President of the National Association of Hispanic Nurses agrees that minority nurses are needed in the South. She adds that "minority nurses are presently needed in the higher populated minority areas, including New York, Florida, and states in the West. This is rapidly changing to include areas such as North Carolina that were once not thought to be affected."
No matter which area of the country you choose to work in, Brewer advises nurses to look for health care organizations that have obtained magnet status.
"Hospitals and other facilities that have magnet designation are definitely the places where nurses want to work because those are the places that are committed to nursing leadership and nursing excellence. And so when people are looking around for jobs, one of the first things that they should ask their potential employer is if they have magnet status or if they are working to become a magnet facility," Brewer says.
There are many pros and cons to working in both rural and urban health care settings. Many nurses are drawn to rural areas because of programs that recruit them and offer student loan repayment arrangements. Other nurses prefer the hustle and bustle of the city.
"I started my career in an urban environment and quickly adjusted to the multidisciplinary team approach to patient care," Green says. "It allowed for readily available resources, ongoing training, and utilization of evidence-based practices."
On the other hand, rural nurses are often considered primary care givers—often working with a greater degree of independence and without much support from physicians due to shortages.
Hughlett suggests nurses considering practicing in a rural area ask questions and understand the work environment and how it differs from a heavily populated setting. "They need to know what resources are available for them. These resources can be a very integral component of their survival as well as job satisfaction," Hughlett says. "If you are an APN, before you sign a work contract, ask who your consulting physician will be as well as the details surrounding that relationship. APNs in rural areas are often left out there by themselves to care for mass amount of patients without feeling support from the medical community."
Green says nurses considering practicing in a rural area should also consider a number of factors impacting the move. "Nurses should ask themselves whether they are comfortable, proficient, and confident to practice outside of the safety net of having an entire team available for emergent situations," Green says. "Are they willing to stabilize, prioritize, and give the appropriate intervention until a higher level of care is available? Do they want total autonomy—from admission to discharge?"
While there may be some unique challenges to working in rural areas, Morgan says job prospects are plentiful.
"The current job market for nurses in rural areas is outstanding," he says. "That's great news for rural nursing, not such great news for rural America, typically because there is such a significant workforce shortage now in rural areas."
Morgan also notes some of the perks to rural nursing. "The two selling points for practicing in rural areas: one would be quality of life," he says. "Living in a small town—it's a wonderful place to raise a family, and there's a tremendous sense of community that you have in small towns across the United States. Another benefit is that you're working in small organizations—small rural hospitals, full health clinics, and small community health centers. When you're in a small organization, there is a greater opportunity for leadership positions and for innovation in health care delivery."
Others, like Trang Nguyen, R.N., B.S.N., a nurse manager at Texas Health Presbyterian Hospital in Dallas, Texas, believe minority nurses are especially needed in urban areas. "I see such a diverse population where I am now and have really developed an appreciation for diversity," she says. "You learn how to care for different people and really tailor your care for them. As a minority, I find myself taking a step back and making sure that I am tending to culturally sensitive aspects for all patient populations."
RN hourly rate by state or province
New York: $20.08–$39.65
Source: Payscale.com; United States; updated: September 22, 2011; individuals reporting: 44,836
RN national hourly rate by years of experience
Less than one year: $15.93–$29.38
1–4 years: $19.16–$31.79
5–9 years: $21.19–$36.86
10–19 years: $22.47–$39.90
20 years or more $23.03–$43.11
Source: Payscale.com; United States; updated: September 22, 2011; individuals reporting: 44,858
RN hourly rate by skill/specialty
Acute Care: $19.94–$37.09
Intensive Care Unit (ICU): $20.21–$38.85
Labor & Delivery, Birthing: $19.17–$36.82
Source: Payscale.com; United States; updated: September 22, 2011; individuals reporting: 40,004
RN hourly rate by degree/major subject
Bachelor of Science (B.S.N.): $21.09–$40.90
Associate Degree in Nursing: $20.35–$36.77
Associate of Science in Nursing (A.A.S.): $21.23–$31.06
Diploma, Nursing: $20.53–$37.50
Master of Science, Nursing (M.S.N.): $22.67–39.25
Source: Payscale.com; United States; updated: November, 30 2011; individuals reporting: 15,555