Barbara Elwell wanted a midlife career switch from medical billing to nursing. Since graduating in May, the Marin County resident has applied as far away as Georgia and interviewed as far away as Texas.
That's because Elwell has had no luck with hospitals in Sacramento, Stockton, Modesto or the Bay Area. Now she's almost ready to throw up the white flag in her job search.
"We're stuck between a rock and a hard place," said Elwell, who has been tutoring high school students in math and science since she earned her two-year associate degree from the College of Marin. "We've gone through all these classes and this training, and yet, I'm a licensed RN in this country, and I can't find a job."
California has spent at least $95 million in federal, state and private funds in the past decade to double the number of nursing graduates by expanding college programs and grants. As recently as three years ago, hospitals were offering moving expenses, housing allowances and signing bonuses to recent graduates of nursing schools.
But today, some new grads are happy to be offered an unpaid internship. That's because fewer nurses are retiring during the recession, and hospitals are saving money by turning to veteran or temporary nurses who don't need expensive training.
This leaves many new graduates in a Catch-22: They can't get hired without at least one to two years of experience, and they are hard-pressed to gain experience unless they volunteer or take part-time jobs that might not fit their skills.
Hospitals "see this very, very large idle pool of labor," said Timothy Bates, a program analyst at the Center for the Health Professions at the University of California, San Francisco. "They don't see the incentives to reach that point yet where they take them on in anticipation of an expected increased demand."
The nursing shortage will return during the next decade as the economy picks up, boomers begin to retire and California's insured population grows, Bates said. The current oversupply of nurses could eventually worsen that shortage if nursing winds up looking less attractive as a profession.
"We're still going to need those nurses long-term," said Cathy Martin, workforce director for the California Hospital Association.
Registered nurses are the largest class of employees at hospitals, though the federal health care reform law might shift many nurses into other facilities as they follow patients pushed to seek more appropriate care.
In the past, nurses often switched hospitals for better pay. But turnover rates have dropped by half since the recession began, according to human resources officers at several California hospitals.
A growing number of nursing school graduates are frustrated, though, because hospitals still need some nurses but are relying on outside sources to meet state-mandated nurse-to-patient ratios.
The Conference Board's October report about job postings nationwide on 1,200 major websites said there were 2.6 jobs available for every job-seeker in the "health care practitioners and technical occupations" category.
The problem for recent graduates is that a facility might hire one new nurse for every two veterans it recruits from retirement, other hospitals, temp agencies or within.
"What's disturbing is that there's an obvious need for health care providers, but the industry is not interested in spending more money on new graduate nurses," said Liz Jacobs, a spokeswoman for the California Nurses Association.
Jordan Stephens received her nursing license last summer. Her master's degree program to become a nurse practitioner doesn't start full-time until January, so she wanted to find a nursing position in between.
But her applications to UC Davis Medical Center, Sutter Health facilities and dozens of other hospitals haven't led to offers, Stephens said. She decided instead to volunteer at community clinics, recently settling into one in Woodland.
"I'm hoping if I can make some good connections, it might lead to something," Stephens said. "You adapt where you can."
Cedars-Sinai Los Angeles recruiter Thea Bruzdzinski said many of the recently added nursing jobs are leadership roles, which can take six to 10 months to fill because of the mix of skills and experience sought. "If you bring in a novice nurse, you have to pair them with an experienced nurse, and you start burning the experienced ones out," Bruzdzinski said.
Rookie nurses hired by hospitals tend to have either advanced degrees or experience with the hospital, according to a 2010 survey by the California Institute for Nursing and Health Care.
Jennifer Trujillo interned at Citrus Valley Health Partners' Queen of the Valley Hospital in Southern California while taking prerequisite courses for nursing school. Trujillo's performance in the internship led CVHP to pay for her nursing school tuition and expenses. Once she had her two-year associate degree, the hospital brought her on board as a night-shift nurse because she knew the hospital's unique system and its employees knew her.
Interning hasn't worked out for everyone, though.
Angela Lyman worked as an intern during the first half of this year with Kaiser Permanente Vallejo. She received a one-time stipend of $1,000 plus months of positive feedback, but no job offer.
She says recruiters at other hospitals ask her why Kaiser didn't hire her. "It hurt me instead of helping me," Lyman said. "It's all very frustrating."