Creative Commons Licensed (Joan Thewlis)

The nursing profession takes a certain dedication to love. After all,
most office jobs don't involve standing for 12 hours at a time,
scarfing a bite of lunch between "clients" or handling gallons of
bodily fluids on a daily basis. But for years, nursing schools lured
students with the promise that they would be snapped up by prestigious
hospitals upon graduation, remunerated for their hard work with good
pay and enviable job security.  

And they were right - until now, that is.

It's
a paradox straight out of "Freakonomics:"  Even though California still
faces a shortage of nurses, up to 40 percent of nursing school
graduates will be unable to find jobs, according to the California
Institute for Nursing and Health Care.

The recession set off a domino effect that has caused California hospitals to virtually stop hiring newly-minted nurses. The Institute estimates only half as many
nurses will be hired this year as in 2008.

It's all thanks to Botox,
healthcare reform and other people's husbands.

Back from retirement

Nine
years ago, a severe nursing shortage was giving policy-makers night
sweats. In 2001, national vacancies in nursing reached 13 percent, and
over 120,000 nursing positions went unfilled, according to a report by
the American Hospital Association. The numbers were especially dire in
California, and in 2005 the state began funding and aggressively
promoting nurse education.

"With this new initiative we are
going to improve the quality of health care everywhere in our state. We
are going to provide more classes, more teachers and more resources to
expand the ranks of nurses in California," Governor Schwarzenegger said
in a press release at the time.

It worked. California nursing schools saw enrollment rise by 70 percent over four years as the profession became increasingly touted as "recession-proof."

But the recession found a way.

A
funny thing happened when the economy began to crumble. Peter Buerhaus,
a nursing expert at Vanderbilt University, found that an astounding
number of experienced nurses left their non-hospital jobs to work in
hospitals.

Though only about 60 percent of nursing jobs are in
hospitals, recent nursing graduates often rely on resource-rich
hospitals to provide them with the extensive training they need to be
considered ready to work with patients. In addition to having the best
training opportunities, hospitals also happen to have the best pay, the
best benefits and the best shifts.

"In two years, hospital
employment grew by 243,000. That's a world record. That's astounding,"
he said. "People were coming in from all over. I mean, we've got nurses
coming down from Uranus, from Pluto, waiting to get clearance to come
down."

As one of the perks, many hospitals give nurses the
option of changing a standard full-time schedule to three 12-hour
shifts per week, which allows some nurses to pick up a second job on their
free days.

It's a life-preserving strategy for when their
spouses (70 percent of nurses have one) lose their jobs, as millions of
Americans have since the recession hit.

Retired and part-time
nurses all over the country have been returning to work full time when their
spouses' jobs were threatened, or eliminated. Faced with the option of
hiring an experienced nurse or a novice who needs training, the choice
for hospitals is clear.

Or as a Marina Del Rey hospital
representative said, "We are not hiring new grads at all. With the
employment market the way it is right now, we don't have to."

And nurses who were going to retire decided to stay put.

"The
turnover is almost nil," said UCLA nursing school Dean Suzette Cardin.
"They're just not leaving. Everyone's afraid to leave."

These
older, returning nurses have crowded out novice nurses who need
training. And they've done so in greater numbers in California, where
the economy has tanked harder and where there tends to be more workers
nearing retirement age.

"There may have been a bigger
reservoir of older nurses that weren't working in California," Buerhaus
said, "and you had a very strong reaction of nurses getting back in the
labor market."

Fewer implants, greater uncertainty

One
of the first casualties of the recession was disposable income and all
the luxury items - watches, cars, and errr...silicone - that it buys:
Allergen saw sales of Botox and breast implants plummet in 2009.  

And as job loss led to health insurance loss, people were re-thinking not just nose jobs, but knee surgeries.  

The
decline has led to less demand for nurse assistance during some
procedures. "Elective surgeries are down, so patient days are down,"
said Deloras Jones of the California Institute for Nursing and
Healthcare.  

On top of that, hospitals are reluctant to beef up
their staffs while the healthcare debate rages on. Hire too many nurses
now, and in a few months they might be stuck paying more in salaries
while getting reimbursed less by insurance companies.

"Hospitals
are uncertain about what their near-term future is," Buerhaus said.
"It's taxes one day, payment reductions the next. Given that
uncertainty, it's slowing their employment decisions."

Pumping a dry well

Taken
together, these factors have shattered the popular narrative of nursing
jobs that are easy to come by. Cedars-Sinai hospital cut their job
openings for new grads from 250 last year to 100 this year. UCLA's hospital typically has two new graduate intake sessions - one in the
spring and one in the fall. This year, the spring session has been
canceled.

"A lot of nurses have applied to the UCLA new grad
program in August," said Kathy Carder of the California Nurses
Association. "But in the meantime, they're wondering how they're going
to feed their families."

It took Cedric Lara seven months and
40 applications to find a job after he graduated with an associate's
degree in nursing from Whittier's Rio Hondo college in May 2009.

"When
I was in school, I was looking at jobs and seeing the well dry up,"
Lara said. "Even hospitals where I looked during clinical rotation -
Kaiser, Downey Regional, Presbyterian - by the time I graduated, they
had hiring freezes."

In Northern California, the prospects are
even worse. Jessica Martin graduated with a master's degree in nursing
from the University of San Francisco in December, and she said just six
of the 25 people in her cohort have gotten jobs so far. Those who have
relied mainly on personal connections.

"It was pretty
misleading," she said. "The people that graduated before me were
getting jobs easily, and people were recruiting them. But then I
graduated, and there's nothing."
 
Martin is hoping for an
operating-room job, but so far the only hospitals admitting new grads
are those like Stanford, where there are 600 applicants for three to
six open positions.  

"I'm sending my resume out into the ether, and nothing is coming of it," she said. "It's fairly hopeless right now."

For some, hope lies in less sought-after jobs outside of hospitals and doctors' offices.  

"Before,
a new grad had 20 offers, but this is forcing them to seek other
opportunities than what they thought," said Kathy Lopez of the National
Association of Hispanic Nurses. "Some students may have to start in a
convalescent home, or maybe doing flu clinics."

Some, like
Martin, are looking out of state. Her student loans are coming due, and
the alternative is moving back in with her parents.

"I'm 28
years old and I might be financially dependent again," she said. "I'm
trying not be be bitter and angry about it, it just takes time."

Ironically,
California is still projected to have a nursing shortage in 2020,
especially since the older nurses are likely to swiftly re-retire after
the economy rebounds.  

Until that time comes, however, a pool
of cash-strapped nursing school grads wait with increasing frustration.
Healthcare experts hope they don't give up before the recession
does.

"We've been working hard to build our capacity, and
we're worried that if new grads can't find jobs, we'll lose the gains
we've made," Jones said. "Because if they leave California, they may
not come back."