Transition and Crisis in New Jersey's Nursing Profession

For Julie Williams, RN, it was a typical shift as critical care coordinator in the surgical ICU and telemetry units at HackensackUMC Mountainside Hospital in Montclair: clock in at 6 a.m., care for ICU transfers, ready patients for surgery, summon a team to resuscitate a critically ill patient, and clock out more than 12 hours later.

It's a challenging, constantly changing environment, observed Bonnie Michaels, vice president and chief nursing officer at the hospital -- as well as a member of the board of directors of the Organization of Nurse Executives New Jersey.

Her comments are equally apt when it comes to the field of nursing itself. Today's nurses do far more than take temperatures and jot notes on clipboards. In hospitals and doctor's offices across the state they help patients manage their diabetes, prescribe medicine for high blood pressure, scan ID bracelets to confirm medication, and use mobile phones to update doctors on patient status.

And in some cases, advanced practice nurses (APNs) are taking on many of the jobs once the province of primary care physicians.

Yet even as nurses assume greater responsibilities, the nursing profession is in a double bind. Many older nurses are looking to retire; according to a recent survey they'll do just that when the economy rebounds. Meanwhile, their replacements will likely be in short supply. But the key obstacle to filling the demand is not lack of nursing applicants or potentially qualified candidates -- it is a lack of available training.

By 2020 the supply of registered nurses in the state will be nearly 50 percent below demand, resulting in a shortfall of more than 42,000 registered nurse (RN) positions, according to projections by the Health Resources and Services Administration of the U.S. Department of Health.

Surveying Older Nurses

The average registered nurse licensed in New Jersey is age 56 and works more than 10 hours a day, according to a new survey of 1,000 older nurses who responded recently to questions posed by the Collaborating Center for Nursing based at Rutgers University.

“They work on their feet typically eight- to 12-hour shifts, three to five days a week, in a job that requires high energy and critical thinking skills,” said Michaels.

“When you’re in a fast-paced unit, you’re lucky if you get a break to go to the bathroom,” added Jeannie Cimiotti, the Collaborating Center’s executive director.

Cimiotti, a former pediatric nurse for critically ill children who switched midcareer to academia, heads the center’s research on the nursing workforce and its impact on patient care. The most recent research on older nurses, the Nurses' Retirement Planning Survey, surveyed a random sample of 2,000 nurses between the ages of 50 and 70. It is currently under review and the center plans to present its results to Gov. Chris Christie this fall. Among its findings: 58 percent said the current economic climate has delayed their retirement plans.

The expected exodus is leaving many in the field of nursing wondering who will take their place.

“It’s going to be scary,” said Mary Krug, one of the masters-prepared APNs practicing in the state. “We tease each other,” she said referring to her colleagues, other nurses also in their midfifties. “We better stay healthy. Who’s going to take care of us?”

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