October 12, 2008, 9:10 pm

The Nursing Shortage: A Sticky Wicket

Cherry Ames, Podiatry Nurse?


The poor nurse in this photo can barely contain her true feelings.

Obviously, she doesn’t relish her job, but that poor doctor actually has to do the exam.

Without gloves! I hope he washes his hands between patients, especially since he is looking for athlete’s foot. Major yuck!

At least the nurse is wearing a decent cap.


And that’s why I became a nurse. I wanted the cap. And I got it!

And now there’s a nursing shortage.


Ask ten people why there is a nursing shortage and you’ll get ten different answers.

The best post I’ve ever read that addresses the real reasons for the nursing shortage was sent to me by Shane. Now, it isn’t unusual for me to give Shane information about nursing, but it is unusual for him to send me stuff.

The Mission-Critical Sticky Factors in Nursing is a provocative post (and on a site about online nursing degrees, of all places!) You need to read it before you finish this post. I’ll go grab my coffee while you do that…..

Basically, the nursing shortage is caused by a number of factors leading to one conclusion:

We quit.


Why do nurses quit?

Well, perhaps because the salary sucks in the majority of the country. A pittance of a check for one hell of a lot of responsibility. You know, accountability without any power.

Or maybe we feel stuck because there is nowhere to go once you are in the profession. Oh, you can climb a clinical ladder, if your hospital has one, and make one or two dollars more per hour. It’s not standardized between hospitals so if you change jobs, you lose that “Clinical Nurse” distinction and have to start all over trying to earn it at your new facility.

Or maybe you can obtain an advanced degree, your BSN or your MSN or even a doctorate.

It won’t mean any more responsibility in your position as a staff nurse. If you don’t want to be a nurse practitioner or a nurse anesthetist, you will have just spent a ton of money and a great deal of time for a few more letters in your personal alphabet soup and zero increase in your pocketbook.

You want to become a nurse educator? Good for you. You’ll be living on about one-third of your staff nurse salary and working many more hours, but hey! Weekends and holidays off, right?

You want to be a researcher? I hope it’s just for the love of learning because it isn’t going to profit you in any other way.


That brings us back the the “Mission-Critical Sticky Factors” post.

Nurses quit because there is little in the profession that causes them to “buy-in”, to be loyal to the profession. Oh, we all start out like that. We “buy-in” to the altruistic, self-sacrificial, “angel of mercy” persona for awhile.

But within a few years we find our altruism singed around the edges. We have increasing responsibility with very little power to control our work environments. There is little incentive to advance our education, as if we had the energy to actually do it. The patients are emotionally demanding. The work is physically demanding, especially for those of us (cough!) who are veterans of the profession.

Assuming we last that long. Too often, especially these days, when the younger, newer nurses realize the reality of the profession, when they experience what Marlene Kramer referred to as “reality shock” as far back as 1974, they don’t put up with it. They no longer have to; there are too many other opportunities.

They quit.

The revolving door of nurse-retention spits them out faster than new ones can be hired.


Sound depressing. It is. Is it how I feel right now about nursing?


Is it how you feel about nursing? Have you “bought-in” to the profession or are you biding your time until you can escape? Are you new and wondering “what the hell did I get myself into?” or are you a seasoned veteran counting the days to retirement?

If you are thinking of leaving the profession, what would keep you in? More money? A sense of being valued by your patients or hospital administration? More benefits? Tangible incentives for more education?


Maybe I’m rare, maybe I’m a dinosaur, but I “bought-in” to this profession long ago.

Oh, there were times it looked like the grass was greener outside of nursing and I thought about what it would be like to do something else. But nursing is in my blood at the genetic-molecular level; map my genome and you’ll find it. My chromosomes are shaped like tiny nursing caps.

Nursing isn’t something I do, it’s something I am.

I guess I “bought-in” to the caring aspect on that front porch in the summer of 1966 when it was just Cherry Ames and me.

And not just because I’d get a cap out of the deal.

That was just the icing on the cake.


  • Healthcare Today
    Healthcare Today

    October 12, 2008 at 9:12 pm

    The Nursing Shortage: A Sticky Wicket // Emergiblog…

    A look at the nursing shortage and why nurses leave the profession….

  • Mary Lu
    Mary Lu

    October 12, 2008 at 11:21 pm


    You may want to add pharmacists to your “we quit” problem in healthcare. Dr. D’s latest problem with a previous facility may have finally pushed him over the line. It’s time there are laws put on the books with real teeth to protect clinical practitioners and a board or enforcement group willing to back them up.

  • kira

    October 12, 2008 at 11:57 pm

    there is a shortage of nurses but its very ironic that there are lots of nurses who are unemployed.

  • dragonfly

    October 13, 2008 at 5:11 am

    PLEASE DON’T QUIT!! We need and appreciate you….

  • Strong One
    Strong One

    October 13, 2008 at 6:42 am

    We are losing more than we are replenishing and training. It’s a sad state of the nursing world, and it’s only getting worse.
    I for one ‘bought-in’ to the profession years ago, although I can’t say I wanted or received a cap. (Sorry Kim) 🙂

  • Candy

    October 13, 2008 at 8:36 am

    Very thought provoking… while the salaries earned by nurses in (parts) of California may sound high, when you take the cost of living in these areas into account, you find they’re about the same everywhere. I don’t think a lot of CEOs or CNOs consider this.

    The “sticky” post is indeed provocative, but I would love to know who wrote it…

  • Margaret

    October 13, 2008 at 9:07 am

    Hello Kim (sorry for the long comment),
    This was certainly a thought-provoking post. I am not an active nurse, although I maintain my active nursing license.
    The sticky factors post talked mainly about money and (understandably) education. It did not at all address the lack of support that nurses so frequently exhibit for each other. In my case, not entering the nursing profession was about being stabbed in the back once too often while in nursing school and shortly after graduating to even want to try to stay in, and I am not alone. Most of my classmates were not employed as nurses within a few years of graduating and a lot had similar reasons to my own.
    But about the education. Why should I bother with a higher degree than the ADN or BSN if my passion is in staff/floor nursing? I don’t want to be a Nurse Practitioner, and if I like my patients awake then Nurse Anestetist is not an option either.
    Certifications beyond the RN (ICU, CCU, etc.) are not taught in degree awarding institutions. Therefore I cannot get a student loan for it, nor any scholar ships. I’m not sure that the IRS even recognizes the expense as a valid one for tax purposes. I’m on my own to sharpen the generic Nursing School skills into career advancing resume bullets.
    If schools would offer career specific certifications, as certificate programs or part of the BSN degree, I bet that more nurses would go for it. Heck, make the ADN the entry level degree and the BSN programs can focus on advanced certifications. Accept all my prior course work so I don’t have to take anymore basic nursing courses and add a certification program. That way, a 4-year student would still get a ‘generic’ nursing degree, and a prior ADN could move on with life and get CCU certified at the same time as earning her BSN. something like that…. That would be useful to the nursing profession, so it probably won’t happen.

  • kikam yun
    kikam yun

    October 13, 2008 at 10:09 am

    Thank you for shaing the fact. I’m a brand new nurse and aleary hate my job. As you says “accountability without any power,” I totally agree with you.

  • Rosita

    October 13, 2008 at 2:37 pm

    I have been a CNA all my adult life, but I still want to become an RN. I have loved nursing for as long as I can remember and I always will. I have experienced some of the back-stabbing in the profession, but I learned early on to just do my job and make sure my patients get the care that they deserve and for what I’ve been paid to do. I’m not seeking a BSN for the money, but for the added knowledge so I can help others, especially homeless people and those without health coverage. I don’t want to be a doctor, nor will I try to act like one, but knowing what to do or say may help someone someday

  • JustCallMeJo

    October 13, 2008 at 4:04 pm

    I wouldn’t buy into any profession that isn’t going to pay reasonably well. I used to make insanely good money, and I became a nurse because it makes me happier.

    But I require that any job still pay me a good salary.

    My state pays worse than most because people come here for “the lifestyle.”

    It’s why I recently left the hospital to become a contract specialty nurse. There are ways to make good money at the bedside. I bumped my salary by 20% by leaving the hospital system and making them a client.

    And work smarter, for more money with less hours.

    Self-sacrifice? Yeah, right. I take excellent care of my patients and I don’t sacrifice myself to do it.

  • NurseExec

    October 13, 2008 at 5:14 pm

    Great post. I bought in, and still love what I do, although it’s the third iteration of my career. I spent 8 years in CVICU, 3 in OR, and am really enjoying rehab, and management. Who knew? I actually feel like I’m paid appropriately, amazingly. I worked on a BSN, almost to completion, and after spending 20K, realized I would never be paid for it. I haven’t finished, and more than likely won’t. I regret spending the 20K, but oh well.

  • JustCallMeJo

    October 13, 2008 at 5:16 pm

    spawned a rant:


    Thanks for pokin me in the brain.

  • Kim

    October 13, 2008 at 7:14 pm

    I don’t even get a cap (boo) but I can’t see myself doing anything else…I guess that means I “bought-in” and I am still in school.


  • […] Kim talks about the fact that nurses are leaving the profession. There’s a supposed nursing shortage (which I suspect is really “a shortage of nurses willing to do jobs where they get too many patients to take care of and are paid crap”). Kim’s entry linked to an excellent article about why nurses quit. An article that I recommend to anyone who is an RN, thinking about becoming an RN, or knows an RN. […]

  • DrunkBunny

    October 14, 2008 at 6:01 am

    Like with “Just Call Me Jo”, it spawned a rant from me too. And oh what a rant! You might not like what I have to say, dear. 🙁


  • Candy

    October 14, 2008 at 9:46 am

    Here’s another perspective. The Press Ganey report on nursing satisfaction just came out, and according to their research, nurses ARE NOT satisfied. In the list of things that might change that, salary is number one. More pressing, however, are concerns about their role in the organization. Read it here: http://www.marketwatch.com/news/story/report-reveals-registered-nurses-least/story.aspx?guid=%7B93AEEBD7-D0F7-41C8-BC7F-661C194DBF7A%7D&dist=hppr

  • greg focker
    greg focker

    October 14, 2008 at 11:24 am

    I don’t think the problem is that the pay is too low so much as it is that there is nothing I can do (short of working overtime or a second position) to earn more money. Every nurse in the hospital (of equal seniority) earns the same salary. Great nurses who work hard earn as much as lazy nurses. I take pride in my work and work hard, but for a lot of people, the only incentive is to work just enough to not get fired. We’ve all worked with those nurses.

    If I work hard and someone else slacks – and there is no reward for me working hard – eventually I’ll either a) leave to go somewhere I can be rewarded (i.e. leave bedside nursing) or b) begin to slack myself creating a viscious cycle. So far, I’ve avoided the temptation. But eventually it’s easy to give in.

    There needs to be a way for me to have some control over my income. Most other professions have this. Work more efficiently, do a better job, etc, get rewarded with more money. Every place I’ve ever worked as a nurse, merit and ability have little if anything to do with your salary as a nurse.

  • Trusted.MD Network
    Trusted.MD Network

    October 14, 2008 at 2:22 pm


    Kim wrote a recent post about why nurses leave the bedside. She referenced an article that talked about more of the same.

    Sinus arrhythmia then wrote a response post about nurses and salary. Both the posts and the article are a very intriguing read….

  • runningwildly

    October 14, 2008 at 8:09 pm

    And then there are those of us out there who are just beginning to dip our toes in the pond. We are on the verge of diving in, just on the outskirts, waiting for our time…..in just a few months. Waiting. Waiting. Waiting. To dig into our share after 4 years on the sidelines known as nursing school. Yes, there are many quitting, but there are those of us just ACHING to get in on the action. Granted, there aren’t enough of us to compensate for the great loss…..but if we are eager and waiting whilst having our wits about us, perhaps, just MAYBE we won’t get too burnt out before we even get going. Although I am beyond excited to begin my long awaited career in a matter of WEEKS, I am nearing 30 and I *try* to remain grounded in the fact that reality will kick in and the only way to wade through the ripples with any sort of dignity is to take one slow step into the pond while knowing my boundaries. It’s the only way to be safe. And yet, there are so many out there who jump into the ’empty’ pond of nursing with glee thinking it’s ALL theirs for the taking. Sigh. The pendulum always swings back. Always.

  • missbhavens

    October 16, 2008 at 12:18 pm

    Quitting. Yup. Seasoned nurses get burned-out and quit and then new younguns get trained and bail. And there just aren’t enough younguns to keep up! I love the nursing but cannot stand the daily grind of a poorly managed unit and all the crap politics that go with it.

    I bailed and became a travel nurse in order to pull up stakes whenever the politics of nursing got me down. You know what I learned? Nursing salaries are squat outside NYC! I had NO idea! Places I’d like to visit simply don’t pay!

    And my body? At 39 I’m far too young to be so physically broken. My back is a wreck and the night-shift-diet is starting to catch up to me. I’m not going to be able to be a floor nurse forever.

    But whatever shall I do?

    Doctorate? Methinks not.

  • Why I’ll Probably Quit Nursing » PixelRN
    Why I’ll Probably Quit Nursing » PixelRN

    October 17, 2008 at 3:21 am

    […] There’s been a lot of recent discussion about nursing salaries and the nursing shortage. […]

  • Php_RN

    October 17, 2008 at 6:48 am

    Hello, I’ve just read your article here. I’m still new here but anyways, yeah, I don’t understand Amercica’s shortage of nurses. I’ve just graduated and recieved my license as RN in my country Philippines last April and June 2007. But I got married to an American, we were 3 years relationship and blissfully bloomed to get married, but anyways, I am now residing in PA, U.S.A. and trying to get a job here. But I still need lots of exams to pass inorder to be an RN here. It seems like -forever-. So I try looking at the classified ads to see if I can work as a Medical assistant, C.N.A. or Nurse Aide but still tied up not to because it needs certification. Hay, it seems taking -forever- again. I’m bored staying at home now, I want to pursue what God wants me to be, even though just to be a Medical assistant, C.N.A. or Nurse Aide. I’m declining my knowledge and field skills because it’s not easy to just take practice test again (and again) in the NCLEX test books. It’s driving me more anxious because I really want to work and get paid. Hay, it’s not easy to be always behind of everything you wanted to be. You’re lucky to be an RN here in U.S., Kim.

  • Adrienne Zurub
    Adrienne Zurub

    October 18, 2008 at 4:37 pm


    Great post and comments. I just responded via email and post to a nursing shortage answer from the president of the American Nurses Association (ANA) which was in the October 13, 2008 issue of Newsweek (with Sarah Palin on the cover) to Newsweek magazine, entitled, “A Conversation with Nursing Expert Rebecca M. Patton.”

    The president of the ANA, stated that the nursing shortage is due in part to weight lifting demands!

    Gender pay disparities, sexism, feudal work environments, or any of the other pressing factors were not mentioned. Yet, weight lifting demands, to a NATIONAL audience of Newsweek readers was cited as a reason … a primary reason.

    With nursing “experts” and nursing leaders offering misguided commentary and distanced perspectives, the nursing shortage will continue unabated.

    BTW, there is a huge schism occurring in nursing right now with some state nursing groups dropping out of the ANA.


  • Kellyann Curnayn
    Kellyann Curnayn

    October 25, 2008 at 5:12 pm

    When the Nursing shortage is written about, article after article briefly mentions the environment. Recently attention has been brought to the long occuring event of lateral violence. (Nurses being mean to each other).
    I did not like my job but yet could not put into words the causes of my dissatisfaction. Having never had a problem effectively communicating, I found this phenomena baffling. When I asked other Nurses about their job dissatisfaction the answers were all over the board. Everyone is running for higher ground which means escaping the bedside. I wrote a book called “A Good Day in Hell. The Flatling of Nurses Across America.” which just stratches the surface of the current dysfunction and the lack of buy in. Increase salary would help me endure the pain but the job would remain grueling. To date no one is trying to change the work environment and this shortage rages on.
    Kellyann Curnayn RN

  • irene

    November 4, 2008 at 12:04 pm

    I became an LPN in 77 and an RN in 86.. I wish I had the money to retire.. and No there is no real nursing shortaage.. just a lot of jobs that nurses are quitting from or know enough not to apply for.. Yes the pay does suck. and you can’t get ahead.. Sure you can work your ass off doing overtime till your body gives out.. like mine is now. But I tried other careers.. Paralegal for one.. and I have always come back to nursing.. I have a hate/love relationship to it.. it is who I am. I just wish the profession loved us nurses back as much as we love the profession.

  • nursepod

    November 10, 2008 at 8:53 pm

    IT is probably the problem in many states there is really a nursing shortage.

  • Henry

    June 15, 2009 at 4:48 pm

    Dear Cherry,
    Well you hit it on the head – a little rough on the language, but everything you said is true. I blame alot of it on that most states do not have nurse-to-patient ratio law in place. We have lots of nurses not working, so if that law passed lot’s would come back into the hospitals etc. But, nurses don’t want to – I’m going for my Master’s and that’s what some of the students around me say. “Too much stress” they say. Another one of your readers commented on lots of nurses available but they’re not working. I am over 50, and a male nurse. In my case I was replaced by a 30 something nurse, and she never had done this job before, and I have done it for 3.5 years. So I am looking for a floor/staff RN job. After three weeks, nothing at this point in time. I’m being discriminated against, I’m middle aged and a male. I feel better now that I have vented some. Thanks. By the way, I TOTALLY love nursing. I enjoy talking to the patients and anything new that comes along I enjoy that too.
    ps I like the readers posting on Lateral Violence. Also, called Nurse-to-Nurse Violence. Can we just be nice to each other?

  • Beck

    June 14, 2010 at 4:02 pm

    I didn’t buy into any profession, but became a nurse because it was a calling. I don’t work in any organizations anymore, but am still a nurse to my family and neighbors on call, as needed. I am currently researching on issues and a way to deal with the current nursing shortage and, from what I see, will continue to be a shortage of supply to a growing demand. We need to find a way to expand nursing in a new way to include people in it, so they can know as much as possible to protect their health and use first aid/CPR so they are not dead by the time they get to the ER, if possible. Too many times, I’ve seen this happen.
    Developing a nurse’s forum on national television to educate the masses on first aid, diet, warnings about fads, include education herbs and what not to mix (like Ginko and coumadin) answer questions, and tell stories of famous nurses and its history to bring back pride and understanding of what this calling/profession is really about. Sadly, I’ve recently seen a comment by someone suggesting all we do is give an aspirin, have low IQ’s and don’t deserve respect or high pay.
    We need to recruit more men into this profession, too.
    I found the TV network, now I need the people.

  • Kellyann Curnayn
    Kellyann Curnayn

    June 15, 2010 at 6:04 am

    Good health is a choice and unfortunately making bad choices is easier. I like the idea of educating the masses on health but how do we get them to tune in????? Your ideas although honorable don’t touch on the subject of this shortage. We all know Nurses are very smart and must have a wealth of knowledge to take care of a patient. The profession has been micromanaged into paralysis and people are being trained to be automatons vs rapid congnitive thinking of professionals.

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    March 27, 2011 at 11:30 am

    […] by Beth There’s been a lot of recent discussion about nursing salaries and the nursing shortage. I wanted to chime in because (a) I love to over-simplify things, and (b) I am on the verge of […]

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  • Albert RN
    Albert RN

    August 17, 2011 at 7:10 pm

    all comments are facts! but only applies to the USA.. Canadians are doing very good! think moving to canada

About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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