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Why does it take so long to hire a nurse?

HOUSTON — The skyscrapers at the Texas Medical Center are filled with hospital beds. The commuters waiting in the heat for the train wear scrubs. The young woman dodging traffic on a bicycle may be studying to be a doctor, a nurse or a dentist.

Houston is known for its energy jobs, but registered nurses are the most in-demand workers in town.

“Whatever jobs we have, we keep expanding. And our competitors are doing the same,” said Thomas Vernon, a human resources director for Houston Methodist, which has a large hospital at the medical complex here. Last year the health system hired about 1,200 nurses across its seven hospitals.

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Nursing jobs in Houston sit open for a long time. It takes Houston Methodist an average of 55 workdays to hire an RN. Nationally health care jobs take longer to fill than jobs in most other industries: 49 workdays as of the last count in September, according to DHI Hiring Indicators, a research group.

It’s tempting to argue that nurse hiring difficulties, in Houston and across the nation, would go away if more people graduated from nursing programs. And many cities do need more graduates — but that’s not the only problem.

Hospitals, nursing homes, home care agencies and doctor’s offices, like a lot of employers across the country, have a specific resume in mind. Employers often want new hires to have experience in a specialty such as operating room nursing. They may not be able to raise wages to easily attract that experience. Meanwhile many new nurses, armed with a degree that’s supposedly a ticket to the middle class, struggle to land their first job.

Colleges aren’t equipped to deal with this disconnect. Some employers, such as Houston Methodist, are addressing the problem by beefing up their internships and in-house training. New York City is testing a transition program to help new nurses get work experience.

A long-term solution for the nursing workforce also would have to resolve critical pay issues, including whether Medicare and Medicaid fee schedules support competitive wages, and figure out how to make sure nurses don’t get burned out and quit.

Most nurses are RNs, the single largest occupation in the sector that’s set to become the nation’s largest. They’re the millions of men and women who give patients their medicine, monitor their vital signs and symptoms, and help them understand how to manage their conditions at home. Licensed practical and vocational nurses, who are credentialed at a lower level than RNs, provide more basic care, such as helping patients dress.

Over the past decade people have flooded into nursing programs at two- and four-year colleges, seeking good jobs in a growth industry that’s all but recession-proof. The federal government projected that by 2025 the nation would have more nurses than it needs, but the study didn’t consider the potential need for nurses in new roles as the health care system changes.

Today, as the number of graduates continues to rise, employers are increasing their requirements. A decisive shift occurred in 2010, when the nonprofit Institute of Medicine, now the National Academy of Medicine, recommended that 80 percent of all nurses earn a bachelor’s degree by 2020.

A generation ago, all RNs had to worry about was getting their nursing license, which they could do without going to college by completing a nursing diploma or certificate program at a hospital. Now nurses with an associate degree, who still make up 40 percent of newly licensed nurses in Houston, have trouble getting an interview, let alone a job at a prestigious hospital.

Many employers across the country raised their degree requirements during the Great Recession, according to Burning Glass Technologies, a company that analyzes online job postings. It’s not clear whether this was because there were so many desperate job seekers that companies could afford to be picky, or because higher skills really were needed — or both.

The decision to hire nurses with higher degrees was backed by research that found that patients did better at hospitals with more highly educated nurses. But there was an opportunistic element to it in some places, too.

In New York, for instance, there are more licensed RNs in the state than there are jobs for them. “So employers are raising the bar, saying, ‘Hey, if I can get a (nurse with a) bachelor’s degree, why not?’” said Jean Moore, director of the Center for Health Workforce Studies at the University of Albany.

Elite hospital systems can offer raises, bonuses and other incentives to attract the perfect candidate. Last year Houston Methodist offered a $10,000 employee referral bonus and a $10,000 sign-on bonus to new nurses — a deal so popular the system barely had to promote it.

When all else fails, the hospital will take on temp workers such as traveling nurses, who charge high hourly rates.

To one economist, raising compensation is an obvious response to a hiring problem. “I’ve never heard of jobs going begging. Remember, this is a labor market. Unless you underpay, you can fill jobs,” explained Peter Cappelli, professor of management and director of the Center for Human Resources at the University of Pennsylvania Wharton School.

But some employers just can’t do that. Low wages consistently create hiring problems for government jobs, from state troopers to prison guards.

Smaller health care providers can’t raise wages, particularly those that rely on public funding such as Medicaid, the joint federal-state health program for the poor and some people with disabilities. “You can’t tell Medicaid, ‘Well, we need to charge more, because we need to pay the nurses more to work nights,’” said Dawn Bloomer, a former administrator for a home care agency in Houston.

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