There are not enough nurses to take care of everyone who needs care, and it's getting worse....

[bdcolt45er]

Some of these same issues apply to the market for EMS workers. The shortage for paramedics is significantly more acute, with some ambulance services simply staffing with basic level providers instead of paramedics.

Link to paramedic wages below, note that to become a paramedic requires about two years old college, start to finish. Median salary of 34k a year. That’s it.

Our wage problem is that our patient population is dominated by Medicare and Medicaid, who reimburse barely over costs. Medicaid under cost. Employers aren’t getting rich, they can’t afford to pay more. Prospective students ask why should they become paramedics when they can do nursing for the same length of school?

I would suggest that there is a limited market for associate degree nurses. At least that is what I've seen. Our system generally doesn't hire associate degree nurses. When they are hired it's usually because they are working as an tech or aide when they got their license and they are expected to have a plan for getting their BSN.

 

[cfbfan23]

 

[seminole97]

Healthcare is a different animal that won't fit into the free market box. It's just not realistic to rely on market forces when the reality of the situation is the only choice we have at the end of the day is between getting care and forgoing care. You can't expect people to ignore the drive to live for the sake of allowing the market to dictate rates.

Explain how something like food fits your logic.
I’d argue it’s more necessary than healthcare to our ‘drive to live’, but we readily acknowledge the superiority of consumer choice driving production and meeting needs there, don’t we?

 

[Jerome Silberman]

Explain how something like food fits your logic.
I’d argue it’s more necessary than healthcare to our ‘drive to live’, but we readily acknowledge the superiority of consumer choice driving production and meeting needs there, don’t we?

Our ag production sector is highly subsidized with programs targeting all levels of the supply chain. The fact that there is choice beyond the minimum for those with means while still taking care that the most vulnerable have access to enough to survive probably only reinforces the idea that a mixed-economic model continues to be the best way to achieve a positive outcome for the health of the nation.

 

[Hawk_82]

Explain how something like food fits your logic.
I’d argue it’s more necessary than healthcare to our ‘drive to live’, but we readily acknowledge the superiority of consumer choice driving production and meeting needs there, don’t we?

food is a consumer product. You can't force someone to buy something they don't want. which is different from healthcare, because most don't realize they want it until you need it. free market has created the fat epidemic.

However, just like healthcare, the people at the top put their own profits above all. That is why sugar, salt, hfcs is added to everything. These are addictive substances. most people don't want to be fat and feel like garbage but they are addicted to these substances. They try the diet fad of the week but quickly revert back to the pre packaged, processed garage because they don't have the will power to break the addiction they don't even know they have.

The food industry has actually taken the free market out of the free market.

 

[markfromj]

Iowa
Alabama
West Virginia
Kentucky
Nebraska
Mississippi
Oklahoma
Tennessee
South Dakota
Kansas
Arkansas

Source?

 

[Jerome Silberman]

Source?

Those are the states with the lowest average nursing pay. The average hourly rate for an RN in the US is a little over $35 per hour. All of the states listed fall below $30 per hour.

 

[theiacowtipper]

I would suggest that there is a limited market for associate degree nurses. At least that is what I've seen. Our system generally doesn't hire associate degree nurses. When they are hired it's usually because they are working as an tech or aide when they got their license and they are expected to have a plan for getting their BSN.

Every system here locally, with perhaps the exception of UIHC, makes no distinction between BSN and ADN nurses. They received basically the same patient care training and pass the same boards. The only real difference is opportunity for advancement.

At one time UIHC did not hire nurses without a BSN. Then they changed as they couldn’t get enough nurses. They may have changed back. There is no way any health system hires RNs as techs.

 

[bdcolt45er]

Every system here locally, with perhaps the exception of UIHC, makes no distinction between BSN and ADN nurses. They received basically the same patient care training and pass the same boards. The only real difference is opportunity for advancement.

At one time UIHC did not hire nurses without a BSN. Then they changed as they couldn’t get enough nurses. They may have changed back. There is no way any health system hires RNs as techs.

They will hire techs who already work in the health system as RNs once they obtain their license if they have an associates degree. Otherwise you have to have a BSN or you're not getting hired. As you noted you can't advance without a BSN. Going further up the chain I've seen unit managers forced out for not having an masters. I don't think there is any question that nursing is a better option than being a paramedic. Better wages, more opportunities for advancement.

 

[seminole97]

food is a consumer product.

So is healthcare. Food is just more important.

Why do you think the production process is fundamentally different between bananas and band aids?
In the end they’re competing for the same resources in labor. It’s only through supply and demand we can truly know how many bananas and band aids to produce.

people at the top put their own profits above all.

Profits in a market economy are a signal. They provide information regarding demand and supply. This information drives the increase or decrease of production.
Profits are not an evil, they’re critical to finding out what people want.
When prices are fixed the information delivery is subverted and production chaos (shortage and overage) is the result.

 

[bdcolt45er]

So is healthcare. Food is just more important.

Why do you think the production process is fundamentally different between bananas and band aids?
In the end they’re competing for the same resources in labor. It’s only through supply and demand we can truly know how many bananas and band aids to produce.



Profits in a market economy are a signal. They provide information regarding demand and supply. This information drives the increase or decrease of production.
Profits are not an evil, they’re critical to finding out what people want.
When prices are fixed the information delivery is subverted and production chaos (shortage and overage) is the result.

Consumers and most providers for that matter do not know the cost of services in healthcare. The consumers often don't understand the product they are purchasing. They aren't particularly well equipped to identify differences in quality. Transactions in healthcare almost always involve a 3rd party (insurance companies) that have very different interests than the providers and the patients. Technically consumers have choices in providers and insurance but in reality most people's insurance choice is limited by their employer and their provider choices are limited by their insurance. A subset of providers cannot refuse care based on inability to pay. Healthcare violates many of the principals of the free market.

 

[seminole97]

Imagine if instead of purchasing our food directly it was handled in the same Byzantine third party system that hid from us the information conveyed in prices.

 

[Hawk_82]

So is healthcare. Food is just more important.

Why do you think the production process is fundamentally different between bananas and band aids?
In the end they’re competing for the same resources in labor. It’s only through supply and demand we can truly know how many bananas and band aids to produce.



Profits in a market economy are a signal. They provide information regarding demand and supply. This information drives the increase or decrease of production.
Profits are not an evil, they’re critical to finding out what people want.
When prices are fixed the information delivery is subverted and production chaos (shortage and overage) is the result.

Spoken like a true CEO.

Band-aids are not healthcare. They are an over the counter product. Just like a snickers. People will survive just fine without either.

Profit is not necessary to determine supply and demand. Consumption of product is necessary for this determination. Profit is just a result. How many times have your insurance rates gone down after the company recording record profits. How many times have they gone up after recording not enough profit or a loss.
I bet you only see rates increase, just like the rest of us.

 

[bdcolt45er]

Imagine if instead of purchasing our food directly it was handled in the same Byzantine third party system that hid from us the information conveyed in prices.

Imagine telling a parent we can keep your child alive but we're not going to because we think it is unlikely that you will pay the bill.

To be fair I do think we need more cost transparency. I'm just not convinced that healthcare can operate as a free market.

 

[Hawk_82]

I'm curious how people think nursing wages will change based on supply and demand?

Do you think sales jobs are based on market value, supply and demand.

 

[RNHawk]

Every system here locally, with perhaps the exception of UIHC, makes no distinction between BSN and ADN nurses. They received basically the same patient care training and pass the same boards. The only real difference is opportunity for advancement.

At one time UIHC did not hire nurses without a BSN. Then they changed as they couldn’t get enough nurses. They may have changed back. There is no way any health system hires RNs as techs.

actually bachelors prepared nurses provide better patient outcomes per some studies

 

[seminole97]

Band-aids are not healthcare. They are an over the counter product. Just like a snickers. People will survive just fine without either.

You’re not welcome to your own definitions, and even if we settle on EKG machines or corn the underlying requisites in meeting supply and demand remain.
You can’t rationally allocated goods and services without real prices. Faking it creates chaos and increased dissatisfaction relative to price driven markets.

Profit is not necessary to determine supply and demand. Consumption of product is necessary for this determination.

Consumption is demand.
Prices arise from the market’s balance of supply and demand.
Profits arise when producers can reduce their costs below the price.
The existence of profits is an inducement for more production to meet demand.
The other side is just as critical, losses tell you where to lower production.

Prices allow us to determine how much production effort should go to bananas, band aids, MRI machines, corn, ice cream, underwear and everything else you can think of including the technical expertise to accomplish each of them.

The economic interventionists always look upon prices as a lever to be manipulated when they’re really a needle on the dial to be read.

 

[Jan Itor]

I'll need a nurse the last few weeks of my life beyond the normal appointments, barring some unforeseen "random" accident.

Wow, you've got it all figure out... Until you don't.

 

[Hawk_82]

You’re not welcome to your own definitions, and even if we settle on EKG machines or corn the underlying requisites in meeting supply and demand remain.
You can’t rationally allocated goods and services without real prices. Faking it creates chaos and increased dissatisfaction relative to price driven markets.



Consumption is demand.
Prices arise from the market’s balance of supply and demand.
Profits arise when producers can reduce their costs below the price.
The existence of profits is an inducement for more production to meet demand.
The other side is just as critical, losses tell you where to lower production.

Prices allow us to determine how much production effort should go to bananas, band aids, MRI machines, corn, ice cream, underwear and everything else you can think of including the technical expertise to accomplish each of them.

The economic interventionists always look upon prices as a lever to be manipulated when they’re really a needle on the dial to be read.

How are nursing wages based on supply and demand and real prices?

 

[Joes Place]

How do we solve this problem? It's serious.

Makin' sure we keep deportin' immigrants will help, for SURE!!!

 

[Joes Place]

The "for profit" part of health care is killing healthcare.

https://www.forbes.com/sites/brucej...ate-health-insurer-profits-soar/#4e2b2d3d532b

2 insurance companies alone made 1 billion dollars each in one quarter in 2018.

This is how private industry does not work. Who decides how much profit is enough for 1 company.

100% of that money does NOT go toward ANY actual healthcare.

Another reason we spend ~25% of our healthcare $$ on "administrative" expenses, while the rest of the Western world spends 6-8%.

 

[Monzon]

Wow, you've got it all figure out... Until you don't.

There's a few of us that don't plan to be in a nursing home and are already taking the preventative measures to increase those chances as much as possible.

Not nearly enough of us, unfortunately.

 

[Hawk_82]

You’re not welcome to your own definitions, and even if we settle on EKG machines or corn the underlying requisites in meeting supply and demand remain.
You can’t rationally allocated goods and services without real prices. Faking it creates chaos and increased dissatisfaction relative to price driven markets.



Consumption is demand.
Prices arise from the market’s balance of supply and demand.
Profits arise when producers can reduce their costs below the price.
The existence of profits is an inducement for more production to meet demand.
The other side is just as critical, losses tell you where to lower production.

Prices allow us to determine how much production effort should go to bananas, band aids, MRI machines, corn, ice cream, underwear and everything else you can think of including the technical expertise to accomplish each of them.

The economic interventionists always look upon prices as a lever to be manipulated when they’re really a needle on the dial to be read.

Nursing is the component that can be cut. at a state facility like UIHC nurses are given raises as a whole. There is no feedback in the system for nurses to negotiate an increase if they are doing an above average job. If one person gets a raise so do the other 3,000.

It is nearly impossible to have a supply and demand model when pay raises are determined as a whole instead of individually.

Lets say there were 3000 sales employees in a city. They all received the same pay according to their experience. They all received the same salary increase each year. If someone quit then the other employees had to take over their area without additional pay or compensation. If one person exceeded their goal by 100% and another came 50% short, they both got the same raise at the end of the year. Is their pay really representative of the free market.

 

[ThorneStockton]

The ambulance in our town can’t actually take you to hospital because it lacks a paramedic. They just stabilize until a “real” ambulance comes.

Probably get charged twice too.

 

[theiacowtipper]

actually bachelors prepared nurses provide better patient outcomes per some studies

And by some they don’t. Point remains, that in most hospitals, it makes zero difference if you want to be a staff RN. Make the same money. Do the same job. I talk to high school kids weekly about health careers. I tell those interested in nursing to get an RN, then, take advantage of tuition reimbursement to geta BSN.

 

[theiacowtipper]

They will hire techs who already work in the health system as RNs once they obtain their license if they have an associates degree. Otherwise you have to have a BSN or you're not getting hired. As you noted you can't advance without a BSN. Going further up the chain I've seen unit managers forced out for not having an masters. I don't think there is any question that nursing is a better option than being a paramedic. Better wages, more opportunities for advancement.

At every hospital I’m familiar with, with the possible exception of UIHC, a associates nurse and bachelors level nurse will walk into the same job at the same pay with the same responsibilities. In fact, i had a conference with a VP of patient services who prefers associates nurses as they have more clinical experience.

Interesting the bolded. Shows societies preoccupation with salary. For many many people, EMS is a better career than nursing. More autonomy. More responsibility. A broader scope of practice. The only deficiency is salary.

 

[markfromj]

Those are the states with the lowest average nursing pay. The average hourly rate for an RN in the US is a little over $35 per hour. All of the states listed fall below $30 per hour.

But how do you know those states “underpay” nurses? Isn’t labor supply and demand at work there? The cost of living also being considered?

Some states have to be below the average (math technicalities aside).

 

[The Tradition]

But how do you know those states “underpay” nurses? Isn’t labor supply and demand at work there? The cost of living also being considered?

Some states have to be below the average (math technicalities aside).

Interestingly, we don't have problems in certain markets (Palm Beach County for example), but we're getting slaughtered in other markets (Raleigh/Durham for example).

It really is localized.

 

[joelbc1]

There are shortages in many healthcare professions. Pay is not keeping up with the demand. Most workers are lucky to keep up with the price of inflation. The jobs are becoming increasingly demanding and morale is poor.

To a point, the healthcare industry has no one to blame but themselves. The industry is almost totally dependent on 3rd party pay-off on negotiated services. There is damn little, if any "cash" to boost their revenues. Healthcare features "new and best" equipment, exhorbitant facilities, a demanding, persnickety customer base and high cost professionals in their employ. THey have gotten themselves into this (unsustainable) mess and the solutions are not very attractive. Add to this, the issue of the urbanization of population and services as the costs rise in rural, less populated areas of the nation. There is only soooo much money out there and unlike many capitalist ventures, one provider cannot provide services efficiently to all.

 

[claykenny]

actually bachelors prepared nurses provide better patient outcomes per some studies

Agree. There has been a noticeable decrease in nurse quality in our hospitals. Per one nurse educator I work with, has a lot to do with “accelerated nursing” programs that are essentially “pay for a degree” and churn out incompetent nurses.

 

[seminole97]

Nursing is the component that can be cut. at a state facility like UIHC nurses are given raises as a whole. There is no feedback in the system for nurses to negotiate an increase if they are doing an above average job. If one person gets a raise so do the other 3,000.

It is nearly impossible to have a supply and demand model when pay raises are determined as a whole instead of individually.

I'm glad we agree that government price fixing screws up the balance of supply and demand.
I'd suggest the solution is to be found not in additional price fixing, but in genuine price discovery.

Sort of boggles my mind people complain about prices, but expect a monopoly to address that concern most effectively.

 

[The Tradition]

I did not know you were in that field, but you're not in the classic hospital setting, either. Lots of male nurses here in Jax, and as I said I attribute that to a supply of retired military medics.

Goldie, my company manages dozens of nursing homes throughout the southeast. We have a couple of locations in the Jacksonville area.

We DON'T have locations in Broward, Dade or Naples (the top three highest-average paying areas according to the chart that was posted earlier).

In any case, the local labor market conditions can be SIGNIFICANT even within the same region of the state.

Our location in the "Redneck Riviera" can't get any CNAs in the busy summer tourist season because they make more money cleaning hotel rooms than doing the job they're licensed to do.

But in the winter? No shortage of CNAs....

Meanwhile, our location 45 minutes north of there has zero seasonality issues.

 

[goldmom]

I'm glad we agree that government price fixing screws up the balance of supply and demand.
I'd suggest the solution is to be found not in additional price fixing, but in genuine price discovery.

Sort of boggles my mind people complain about prices, but expect a monopoly to address that concern most effectively.

Were you an economics major ?

 

[markfromj]

Interestingly, we don't have problems in certain markets (Palm Beach County for example)...

What problem are absent in those markets?

 

[HawkeyeShawn]

Iowa
Alabama
West Virginia
Kentucky
Nebraska
Mississippi
Oklahoma
Tennessee
South Dakota
Kansas
Arkansas

Lowest wages does not equal the largest nurse shortage. The states with the most significant shortage are: PA, CA, NY, MA, ND, WA, OR, NV, HI and AK.

I work in the nurse staffing industry. My company provides temporary labor solutions to healthcare providers, primarily hospitals, LTC centers, Skilled Nursing Facilities and Rehabilitation Hospitals.

100% we need to find a way to incentivize high school graduates to go into the nursing field. I fully support forgiving the cost of college education for RNs, LPNs and CNAs.

I have a client in PA that offers a $30k sign on bonus if you are a med surg RN. The commitment is only 3 years for the incentive. Yet this hospital system has a shortage of over 500 FTE nurses.

The research shows that the states with the greatest shortage have the following characteristics: High cost of living, very large cities combined with very rural communities a significant distance from the metro areas and less than desirable living conditions (weather).

 

[MplsHawk]

Our nursing school here at the college was not full for the first time this fall. First time since I’ve been here. Our fall 2019 nursing classes were 72/28 female male on the first day of class. 38% of the class is non traditional, people reentering school from the workforce.

I’ve met probably a dozen nurses who left the field of traditional nurses in the past year or so. Most of those, went back to school to become a nurse practioner. The common theme among the others are that they get treated like shit by the doctors and don’t want any part of it.

With all of the talk of not enough people wanting to be nurses, I was going to comment that most nursing programs are full and extremely competitive to get into. Perhaps that is changing. My daughter had wanted to be a nurse for as long as I can remember, but when touring colleges she heard that admittance rates were fairly low and that you needed pretty much a 3.9-4.0 GPA to be admitted. She opted for special education teaching instead of spending a year or two taking prerequisites and then risking not being admitted to nursing school.

 

[bdcolt45er]

With all of the talk of not enough people wanting to be nurses, I was going to comment that most nursing programs are full and extremely competitive to get into. Perhaps that is changing. My daughter had wanted to be a nurse for as long as I can remember, but when touring colleges she heard that admittance rates were fairly low and that you needed pretty much a 3.9-4.0 GPA to be admitted. She opted for special education teaching instead of spending a year or two taking prerequisites and then risking not being admitted to nursing school.

One problem in nursing is that it is hard to obtain nurse educators. The pay isn't always that great. I would argue that the bigger issue is that structurally there isn't a natural pipeline for nurses to work on an academic track as educators. It exists but I don't see it functioning similar to other disciplines where there is a natural tendency to create educators.

 

[theiacowtipper]

One problem in nursing is that it is hard to obtain nurse educators. The pay isn't always that great. I would argue that the bigger issue is that structurally there isn't a natural pipeline for nurses to work on an academic track as educators. It exists but I don't see it functioning similar to other disciplines where there is a natural tendency to create educators.

Nursing faculty have to have a masters degree. I think either in nursing or education. For comparison sake, say you want to teach welding. You only need 3500 hours work experience in that field in the past two years.

As far as pay, it’s an issue. Spitballing, but masters educated nursing faculty would top out at about 85,000 or so. Maybe slightly less. A nurse practitioner, with similar education, would top out at more.

A bigger issue for our college is getting sufficient clinical opportunities for the students.

 

[Titanhawk2]

There's not enough of anybody in care facilities to take care of people, not just nurses. You can make the same at McDonalds as in a care facility

 

[billanole]

Legalize prostitution!

They can take up a side hustle on the job. Excellent pay without a raise.

How does this side job do without a “raise”?