The Economy and Nursing

An article by Robert L. White, R.N.  ©2009

In today’s volatile market even professions like medicine and nursing are feeling the pinch of the economic vise-grips. How the market drives different aspects of nursing affect nurse’s on a daily basis, whether they are thinking of changing jobs or are looking forward to retirement, nurses today need to be aware of the market driven facets of their profession. 

• Job availability: perhaps the easiest area of nursing to understand as market driven is job availability. It seems almost tautological to say that any job market is market driven. Why, then do so few nurses take the market into consideration when considering their options at work?  Those reasons are many and complicated but it is of utmost importance to consider the market when looking at any profession, and nursing is no exception. So, what does all this mean?

1.      Nursing jobs get cut. Don’t ever make the mistake of thinking you have great job security. I have known many nurses that have passed up great opportunities because of seniority, only to find their position eliminated six months later.

2.      Nursing jobs are localized. Yes, there are long term care facilities in every state, but are they all hiring? Southern states are always looking for LTC help because the market is there.( how many people have you heard of or known who retire to say, Florida?) certain types of specializations are located at certain facilities, for example, local small hospitals rarely employ CVICU nurses. Even mid sized hospitals that are starting open heart programs (CVICU stands for Cardio-Vascular intensive Care Unit) rarely have positions that are exclusively CV. They are often mixed icu’s and the experienced, veteran CV nurse will probably not be overjoyed to have to care for bariatric, abdominal surgery patients.

• Nursing practice is affected by the market. Most of us would like to believe that this is not true, but our economy does not thrive on altruism.  Yes, medical and nursing clinical practices are largely market determined; just ask any drug company rep.

1.       Nursing practice is affected by the market. How many of you out there have been frustrated by your administration using cheap supplies, and not buying new technology because of economics? Yes, it makes us crazy but while the choice product may well be in the best interest of the patient, it is often not purchased because of cost. Most nursing is, after all, a business and until we have socialized medicine, only those with the best insurance get the high tech treatments. In case you find this hard to believe, I suggest you visit you local long term care facility.

2.      Even the actual clinical best practice guidelines are market driven. Never forget that cost effectiveness is evaluated when looking at clinical best practices. While something might work very well, if it remains costly, chances are it will not be oft used.

• Paper work is market driven as well. The way records are kept is controlled by the cost versus benefit analysis. However, certain caveats apply to this one; our government is not very cost effective! So when the government is involved (Medicaid and Medicare), things very quickly seem to get confusing and paper heavy.

1.       Record keeping is affected by the market. In my school, I have a 95 % Medicaid rate. What this means for me is literally hundreds of times the paperwork of some of my counterparts. Medicaid requires care plans with bi annual updates for all chronic patient problems. Most insurance companies do not; nor does the state require that all chronic problems be care planned. Consequently, if you are thinking of becoming a school nurse and don’t like care plans, do not take a position in a poverty-stricken district!

2.      the move to paper free environments(computerized charting) is essentially market driven, paper costs money both to purchase and to store.

• The Market also drives demographics. Where the jobs are is where it is cost effective to have the business. Again take the example of long term care facilities. Yes, they do have them in every state, but if the age demographic shifts (recall retirement in Florida) then the job availability demographic shifts as well.

1.   Where the local economy is poor, the types of nursing jobs, and the practices and products they use will be different. Earlier, we discussed the effect of the economy on clinical best practices as well as product usage. It follows, then that the demographics of the area will determine what happens there.

2. Clearly, products and services that are not economically viable in an area will not get used in that area. For instance, at a inner city hospital, one might not find certain specialists, even if medically needed.

• Another aspect is the actual outlook of the nurses and doctors in a given area. I have a friend that had recurrent abdominal severe pain, and went to an inner city hospital E.D. he was treated with nothing but suspicion that he was a drug seeker and abuser. Doctors tried to bully him into admitting he was a narcotic abuse (he is not) and nurse blatantly ignored him. He left that hospital in pain, and went the next day to a different hospital just across the river in the next state where the demographic is more suburban. He was treated with respect, asked frankly if he used drugs only once during the initial interview with the emergency physician. Shortly thereafter a flat plate was done and it was discovered that he was severely impacted. His pain was promptly relieved, he was given the correct medicine for the condition and two days later is well on the road to recovery.

So, what does all this boil down to? This: Never forget that although you may have become a nurse for altruistic reasons, we live in a capitalistic society and healthcare is market driven. Whether you are making the decision to change jobs or stay where you are, it would be foolish to ignore the market fluctuations when planning your career. Remember; Failing to plan is planning to fail, and forewarned is fore armed!