August is National Breastfeeding Month, and Daily Nurse sat down withDr. Susan Crowe, an obstetrician/gynecologist and clinical professor of Obstetrics & Gynecology – Maternal Fetal Medicine at Stanford Medicine Children’s Health to answer some of the frequently asked questions about supporting moms on their breastfeeding journey.
Dr. Susan Crowe is an obstetrician/gynecologist and clinical professor of Obstetrics & Gynecology – Maternal Fetal Medicine at Stanford Medicine Children’s Health
How can nurses make breastfeeding/chestfeeding a safer practice?
Nurses are critically important to the safety of the delivery process and postpartum care. They play a pivotal role in assisting with skin-to-skin contact during a cesarean section delivery when the mother is unable to care for her baby. They can also help with skin-to-skin during hospital recovery. In addition, the World Health Organization recommends initiation of lactation one hour after giving birth. Nurses help facilitate this process to ensure it goes smoothly for the mother and child. Nurses can closely monitor vitals and help the newborn breastfeed for the first time, giving families the best start to life during critical hours post-birth.
How do weight loss drugs impact pregnant women and their babies?
Although dietary supplements can help support good health, they may also cause side effects and health problems, which is why the U.S. Food and Drug Administration recommends talking to your healthcare provider about what kind of prenatal vitamins and other supplements you should take.
Depending if the pregnant person needs to be on a weight gain program during pregnancy, it is usually okay for mothers to lose about 1-2 pounds per week postpartum. It’s important to note that this will happen naturally during the weeks after delivery. Even though lactation requires two-to-three times the caloric needs of a pregnancy, many women will find themselves hungry during lactation. If they choose to undergo medical treatment, it is always encouraged to follow the instructions and guidance from their healthcare provider. They can determine what is appropriate based on individual medical history and health condition.
Regarding weight loss drugs like Ozempic or Wegovy, there have not been enough research studies to determine their effectiveness or safety during lactation. As healthcare providers, we think about medication that would have to be absorbed by the newborn to have an impact.
What are the benefits of breastfeeding/ vs. formula feeding?
There are numerous benefits of breastfeeding/chestfeeding for both the infant or toddler and the mother. Babies often see decreased ear infections, lower respiratory infections, and even reduced hospitalization rates. Throughout the years, healthcare providers have seen positive correlations between nutrients in breast milk and a child’s brain development.
There are also health benefits to the lactating individual. For example, for patients with diabetes, I educate them about the limited opportunity that lactation offers as a “vaccine of sorts” against diabetes. It can lower the risk of diabetes when lactation continues to six months and even further reduces the lifetime risk when lactation is extended beyond a year. Lactation also brings about a long-term metabolic effect. Research shows a correlation between lactation and a decrease in breast and ovarian cancers – and the longer the lactation period, the greater the associated benefits. Emerging evidence also shows the potential cardiovascular benefits of lactating.
What diseases can spread through breast milk?
Some infants have rare metabolic diseases, meaning they cannot metabolize human milk (i.e., galactosemia). In these cases, newborns and infants require a special formula. Concerning these diseases, it’s important to screen every newborn for galactosemia (galactose in the blood) and other inherited metabolic diseases, which are, fortunately, very rare.
Pending a conversation with your health care provider, it is generally encouraged for people with infections such as hepatitis B and C to continue breastfeeding. There are excellent vaccines for these diseases, and we do not see an increase in hepatitis C for lactating infants compared with infants that do not lactate. Fortunately, we do not see these as widely transmitted through human milk. However, there are several diseases where recommendations may differ by country or region, and this is an evolving conversation as it relates to people living with HIV who have undetectable viral loads.
Do you have any advice for lactation consultants or clinicians?
My advice to advanced practice providers, nurse practitioners, and midwives is that we continue to talk about lactation. We must discuss it before pregnancy, during pregnancy, during a breast exam, and more. We must look to see if there are particular challenges someone might encounter, and we should prepare to address those challenges accordingly. Those conversations should address why we recommend breastfeeding, including many of the health benefits already discussed. Most importantly, we can use those discussions to reassure mothers and give them the confidence that they can successfully take on the breastfeeding journey. When I ask people if they plan to breastfeed, the most common answer I get is, “I’ll try.” There remains an underlying lack of confidence in the body’s ability to make enough milk, so anything we can do to educate, encourage and support the lactation journey goes a long way.
Why is keeping mothers breastfeeding so important?
I see it from my vantage point and the countless conversations I’ve had with expecting and new mothers that people want to breastfeed. We continue to see high initiation rates. Breastfeeding is a healthy way for pregnancy to transition to the postpartum phase. People are choosing to lactate. The entire healthcare community must ensure that we provide the societal and medical structure to support individuals in this choice.
How can nurses best support moms on their breastfeeding journey?
Nurses help patients postpartum for a much shorter time than they did in the past. Now, nurses are only with individuals 24-48 hours after birth, slightly longer after a cesarean or a delivery with complications. During this time, nurses must take the opportunity to instill confidence and educate mothers on the basics of lactation (and dispel any myths or misconceptions, which is a large part of the task at hand). For example, people come in thinking lactation only happens every three hours. That’s not true. It can be much more frequent. During these times, nurses can help with initial latches when the baby is learning to feed, help families notice the signs their infant is hungry, and show how important frequent lactation is to milk supply.
Additionally, nurses can teach patients about normal lactation volumes and what determines adequate feeding. Initially, normal feeding volumes might be close to a teaspoon, shocking many people. So, setting these expectations is vital.
Anything else to add?
I encourage everyone involved in birthing and postpartum to remember that each individual’s pregnancy journey is unique. Getting “back to normal” after giving birth looks different for everyone, and that doesn’t mean striving for unrealistic weight loss goals one might see on social media, for example. And I am grateful for all the work nurses do to bring attention to lactation and the positive health benefits it can provide both the parent and child.
Working with pregnant and breastfeeding families for 40 years, I’m passionate about women’s health and empowering women.
The woman’s body is amazing, providing the perfect recipe for milk for their babies. Humans produce milk for human babies, which makes it the best for feeding our little ones while providing benefits for both mom and baby.
Benefits of Mother’s Breast Milk
Our practice relies on evidence-based research that strongly supports the newborn health benefits of breastfeeding. Breastmilk is proven as the best for preterm infants and the prevention of necrotizing enterocolitis (NEC).
The benefits for moms include faster weight loss in the postpartum period since she burns 500 calories a day by producing milk for her baby. The risk for breast cancer, ovarian cancer, Type 2 diabetes, and high blood pressure decreases for a mom’s lifetime risk if she ever breastfeeds a child.
Breastfeeding creates a special bond between mom and baby for which a price tag cannot be placed. It is known that “happy” hormones are released during this bonding time.
Another benefit of breastfeeding is the cost savings and no need to warm breast milk-like formula at 3 am. The formula is also harder on the baby’s gastrointestinal tract. All the above reasons are why breast milk is often called “liquid gold.”
Breastfeeding sends immunities to babies, so during Covid, we encouraged all our moms to breastfeed. The American College of Pediatrics recommends breast milk through the first year of life for all these reasons.
Advise Caution with Weight Loss Drugs
I want to warn expecting and new moms about taking weight loss drugs, such as Ozempic, during pregnancy and breastfeeding.
We recommend that patients wait at least two months before becoming pregnant due to the limited studies done on these drugs based on some limited animal studies. Due to the molecular weight, the amount of drug that passes through the milk is likely low, so the risk of passing to the baby through milk may be lower.
Our recommendation to breastfeeding moms is to avoid these drugs while breastfeeding until more studies have been developed. Be sure to remind moms that breastfeeding burns 500 calories, equating to weight loss in the postpartum period.
Choosing a Breast Pump
Breast pumps can be overwhelming when it comes time to choose one. A mom’s and baby’s needs change throughout their breastfeeding journey, so I recommend a pump that can adapt to those changes. Luckily most insurance companies will cover a breast pump.
The best time for moms to start thinking about choosing a breast pump is around 32 weeks of pregnancy. Ideally, an appointment with a lactation consultant for a prenatal breastfeeding consult can help with those choices. I have a sample in my office to show moms what they are all about and help them make an informed choice.
Keep in mind moms returning to work or those who have busy schedules need to bring their pumps with them, so one that has a rechargeable battery is a great option. They don’t need to be attached to a plug if they want to pump.
Some pumps have a handle, making them easy to carry around. Some have night lights which may be a good option for some moms. There are single manual pumps and double electric. The double electric means both sides are pumped during a pumping session which is important since it stimulates both breasts. It has been shown to get 18% more milk by pumping both breasts simultaneously, with higher fat and calorie content.
Most pumps are designed with two modes of expression to mimic the baby’s natural sucking behavior. The first mode is the short, fast sucks to stimulate the let down reflex. The second mode is a slower, stronger sucking. Most pumps come with two flange sizes, and it would be helpful to see a lactation consultant to have a flange fitting after delivery since the nipple and breast change sizes at that time. The proper fitting flange is essential for comfort and efficient milk production. Different size flanges can be purchased with inserts that customize the flange to nipple size.
Consider recommending moms add a silicone hand pump to their shower wish list. Silicone pumps are handy and easy to use. The Haaka is a brand name, but any generic works the same. They can be used to put on one breast while feeding on the other side to collect the milk that drips while nursing. The amount can be over an ounce of “liquid gold’ collected and then saved and labeled in a freezer bag.
Another great wish list item is a hands-free pumping bra. They are comfortable and reasonable in price. The flange slides into the bra so moms can be hands-free with their double electric pump.
Benefits of Hands-Free Pumps
Hands-free pumps (Elvie Stride, Mom Cozy) have had mixed reviews from moms. They are costly but convenient. They are hands-free and go in the bra, so moms can do things while pumping. They are small, and each has a collection reservoir built into the pump. They are convenient if moms have a job where they work at a computer or desk and want to pump while they continue to work. Some moms say the suction is less effective than the double electric pumps, but they work well for their work environment.
Time and Space for Breastfeeding Journey
Encourage moms to check out the laws for having time and space (not a bathroom) to pump if they work for a company with 50 or more employees. The Fair Labor Standards Act (FLSA) states, “Most nursing employees have the right to reasonable break time and a place, other than a bathroom, that is shielded from view to express breast milk while at work.”
Remind new moms to stay calm during their breastfeeding journey. It’s an exciting time, and they can reach out for help. Moms should feel confident they are giving their baby an amazing gift. Most importantly, they must enjoy time with their baby because time goes quickly, and they will support their growing families before they know it.
The soaring fame of GLP-1 agonists, like Ozempic, developed to assist individuals in managing Type 2 diabetes and obesity, has garnered attention in the media due to its side effect of weight loss, catching the interest of celebrities and influencers. However, this surge in popularity has also led to questions concerning the potential impact of these medications on pregnancy and fertility.
Overview of Ozempic
Ozempic (semaglutide) is an injectable (subcutaneous) prescription medication that’s part of a drug class of medications known as GLP-1 (glucagon-like peptide-1) agonists. It mimics a hormone found naturally in your body, GLP-1 (produced in your gut and released when food is consumed), which regulates digestion, insulin, and blood sugar levels. GLP-1 agonists enhance glucose-dependent insulin production, reduce glucagon (which increases blood sugar levels) production, slow gastric emptying, and promote satiety, which can lead to weight loss.
In addition to managing blood sugar levels in individuals with type 2 diabetes, Ozempic is used to lower the risk of serious cardiovascular events in those with a history of heart diseases like heart attacks or strokes.
This medication is FDA-approved for managing type 2 diabetes when accompanied by an appropriate diet and exercise regimen. Although weight loss is a common side effect, it’s important to note that Ozempic is not FDA-approved for weight loss but may be prescribed off-label by healthcare providers.
There is currently no generic for Ozempic (Semaglutide), resulting in higher costs, even for individuals with insurance coverage. Ozempic can also be bought without insurance through online pharmacies like Marley Drug, which offer free home delivery via cold shipment.
Side Effects of Ozempic
Some common side effects of Ozempic may include the following:
Weight loss
Nausea
Vomiting
Diarrhea or constipation
Stomach pain or discomfort
Injection site reactions
Hypoglycemia
Some serious side effects of Ozempic may include the following:
A lump that may appear in your neck
Difficulty breathing and swallowing
Vision problems, including vision loss, spots or dark strings floating in your vision, and blurred vision
Feeling anxious, including shakiness
Confusion
Swelling that may occur in your legs, ankles, and feet
Rash or itching
Risks
Ozempic should be avoided if a patient has multiple endocrine neoplasia type 2, a history of medullary thyroid cancer, insulin-dependent diabetes, or diabetic ketoacidosis.
Black Box Warning
Ozempic may increase the risk of developing thyroid C-cell tumors.
This medication may cause pancreatitis.
Ozempic may also cause diabetic retinopathy complications.
Can Weight Loss Drugs Impact Fertility?
Healthcare providers may prescribe weight loss drugs, like Ozempic, to patients with specific conditions such as polycystic ovary syndrome (PCOS) or those undergoing in vitro fertilization (IVF). As you may already know, PCOS is characterized by irregular periods, elevated androgen levels, and obesity. And for those living with obesity or who are overweight, hormonal imbalances can disrupt ovulation.
Research suggests a connection between obesity and infertility, especially when ovulation disorders are present. However, even a modest amount of weight loss can help restore hormones essential for ovulation while lowering the risk of miscarriage and pregnancy-related complications.
Conversely, underweight individuals might experience a reduction in estrogen production, leading to a lack of ovulation and regular periods. Remember that ovulation is vital for the release of an egg, which needs to be fertilized by sperm for conception to occur.
According to the manufacturer of Ozempic, considering the drug’s half-life, it’s recommended that individuals taking Ozempic discontinue the medication at least two months before trying to conceive to minimize any potential impact on fertility during this period.
Is it Safe to Take Ozempic During Pregnancy?
The safety of using Ozempic during pregnancy remains uncertain due to limited data on its effects on pregnant women. While animal studies have indicated potential negative impacts on pregnancy outcomes, the direct implications for human pregnancies are still unclear.
Due to the lack of comprehensive human studies and the potential risks involved, it is generally advised to avoid taking Ozempic during pregnancy. Some animal studies have shown that pregnant rats exposed to Semaglutide experienced congenital disabilities and pregnancy losses. Although the effects observed in animal studies may not directly translate to humans, the potential risks of taking Ozempic while pregnant are considered significant unless there is a compelling medical reason to do so.
According to the recommendations from the manufacturers of Ozempic, taking this medication during pregnancy should only be considered if the benefits to the developing fetus significantly outweigh the potential risks involved. Although the importance of understanding that while it has its risks of severe side effects, uncontrolled diabetes during pregnancy can also have detrimental consequences. Poorly managed diabetes during pregnancy can increase the likelihood of congenital disabilities, preterm delivery, and pregnancy loss. Therefore, making decisions about using then product during pregnancy requires carefully evaluating the risks and benefits to ensure the best possible outcome for both the mother and the developing fetus.
Both weight loss and malnutrition during pregnancy can lead to complications and harm to the fetus. Therefore, the use of Ozempic during pregnancy should be carefully assessed for its potential risks and benefits by the patient’s healthcare provider.
Is it Safe to Take Ozempic While Breastfeeding?
Although the presence of Ozempic in breast milk has been observed in animal studies, its impact on human breast milk remains uncertain. Traces of Ozempic were detected in rat milk, but the transfer of medications into human milk may vary between species due to differences in lactation processes. While the extent of Ozempic transfer into human milk is not well-established, it is generally believed that if a drug passes into rat milk, it may also pass into human milk.
As a result, since the potential risks to nursing infants are not fully understood, healthcare professionals typically advise against using Ozempic while breastfeeding unless the benefits of the medication significantly outweigh the potential risks.
According to a new study, people giving birth report more positive experiences when cared for by midwives in both hospitals and community settings than physicians. Additionally, those receiving midwifery care at home or birth centers reported better experiences than those in hospital settings.
Physicians attend the majority of U.S. births (88%), while midwives attend 12% of births. Most births occur in the hospital, with less than 2% occurring in community settings, including homes and freestanding birth centers. Midwives attend most community births.
Measures of quality around maternity care often focus on clinical markers such as complications or rates of C-sections, leaving the lived experience of childbearing people unmeasured and neglected.
“In contrast to the standard obstetrical model, midwifery care is rooted in a philosophy that honors pregnancy and birth as a physiological, social and cultural process, not solely a clinical event,” write the authors, including lead author Mimi Niles, PhD, MPH, CNM, assistant professor at NYU Rory Meyers College of Nursing. “The care relationship between the client and the midwife serves as the primary vehicle through which values such as autonomy, respect, and informed decision-making are operationalized to preserve an overall satisfying experience of childbearing.”
To better understand people’s experiences during childbirth, the researchers examined 1,771 responses to the national Giving Voice to Mothers survey assessing four domains of the childbirth experience: communication and decision-making autonomy, respect, mistreatment, and time spent during visits. The researchers then analyzed differences between provider type and birth settings, breaking responses down into those cared for by a midwife at a community birth, a midwife at a hospital birth, and a physician at a hospital birth.
Compared to those cared for by physicians in hospitals, individuals cared for by midwives in community settings had more than five times the odds of experiencing higher autonomy and were five times more likely to report that their providers showed them high levels of respect. They also reported lower odds of mistreatment.
The researchers also found significant differences across birth settings: patients cared for by midwives at home or birth centers had significantly better experiences than those in the hospital settings across all four measures—autonomy, respect, mistreatment, and time spent. For instance, people cared for by midwives in the community were 14 times more likely to report having enough time in prenatal visits than those cared for by physicians, while people receiving midwifery care in hospital settings were nearly twice as likely to report having enough time during prenatal visits. Their findings generate more evidence that while the midwifery care model offers enhanced experiences of care, access to midwifery across all settings is needed to improve health outcomes for birthing people.
“Our findings add to evidence showing the model itself seems to be strongly influenced by the setting in which care is given—with community settings (home and freestanding birth centers) offering greater likelihood of support and the hospital settings being limited by the constraints of a medical approach to care which deprioritizes experiential outcomes,” Niles and her co-authors write.
American Association of Nurse Practitioners (AANP) and more than 235 organizations sent a letter to the leaders of the U.S. House of Representatives Committee on Ways and Means and the Committee on Energy and Commerce illustrating strong support for H.R. 2713, the Improving Care and Access to Nurses (ICAN) Act.
This bipartisan legislation, which was introduced in April in the House of Representatives, would authorize nurse practitioners (NPs) to order cardiac and pulmonary rehabilitation, certify when patients with diabetes need therapeutic shoes, ensure NPs’ patients are represented in the beneficiary attribution process for the Medicare Shared Savings Program, refer patients for medical nutrition therapy, certify and recertify a patient’s terminal illness for hospice eligibility, perform all mandatory examinations in skilled nursing facilities and more.
NPs provide high-quality healthcare to Medicare and Medicaid patients across all geographic areas and healthcare settings. Over 40% of Medicare beneficiaries receive care from NPs, the fastest-growing Medicare provider group. Yet, despite the high-quality healthcare NPs provide to Medicare and Medicaid beneficiaries, barriers still exist within the programs that prevent the effective and efficient delivery of care.
Daily Nurse spoke with former AANP President April Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, and FAAN, about this critical legislation and how it will remove outdated barriers to practice that delay access to care for patients and move healthcare delivery forward for patients, providers, and our nation.
Former AANP President April Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, and FAAN
Talk about the Improving Care and Access to Nurses (ICAN) Act, how it strengthens patients’ access to care, and why it’s so important.
The ICAN Act is improving care and access to nursing. It’s focused on Medicare and Medicaid beneficiaries and removing barriers so that they can have timely needed care. And there are just a few things I can mention that are in the act. Nurse practitioners and advanced practice registered nurses providing access to APRN care can order and supervise cardiac and pulmonary rehab to certify when patients need therapeutic shoes and include their patients in the Medicare Shared Savings Program. There are no costs, no delays, and immediate things that can be put into place where Medicare and Medicaid beneficiaries can immediately have that much-needed care. So we’re very excited about reopening of the ICAN Act. We feel it will reduce barriers to care for Medicaid and Medicare beneficiaries, giving them full indirect access to NP care.
Please talk about APRNs, who they are, why they’re essential to nursing, and their role in healthcare.
APRNs are healthcare providers. Advanced practice nurses include nurse practitioners, clinical nurse specialists, nurse anesthetists, and nurse midwives, and all play a pivotal role in the future of healthcare. They’ve been educated and clinically trained to care for patients in a particular field of practice. They can diagnose and treat and order and interpret tests. They’re great at coordinating care and educating. They provide a comprehensive but focused health promotion and chronic disease management approach. And you know, most of the people I’ve talked to either know an NP, or they see an NP and know precisely the type of high-quality care we provide.
APRNs are stepping up, and we’re meeting these huge needs that we see in healthcare today. According to the U.S. News and World Report, for the second year in a row are the number one job in healthcare. So people want to see nurse practitioners. There are over a billion visits to nurse practitioners every year 42% of Medicare Medicaid beneficiaries are seen by nurse practitioners. That’s why this piece of legislation is so important. It removes those outdated and unnecessary barriers to providing the care we’ve been providing so well.
Let’s talk about the history leading to the ICAN Act. In 2010, The Institute of Medicine (IOM) issued The Future of Nursing: Leading Change, Advancing Health and in 2021 The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity.
The Future of Nursing Report in 2021 is the Future of Nursing 2020-2030. It focuses on health equity, understanding social determinants of health, and nine key recommendations. Recommendation four is to remove unnecessary barriers to practice that all nurses should be able to practice to the full extent of their education and training. And that is just absolutely to provide access to care for everyone everywhere. Over 100 million Americans lack access to primary care, and nurses are catalysts for this care. So the Future of Nursing Report is very important and comes on the heels of that foundation. We must allow nurse practitioners to practice to the full extent of what they’ve been educated and trained to do. And this will enable more and more Americans to have access to care.
Despite recognizing the importance of APRNs to our healthcare workforce, some federal statutes and regulations and state practice acts limit APRN practice. How is this thinking detrimental to patient care?
We have over 100 million Americans that lack access to care. We have 163 million Americans that lack access to mental health services. It is very much a need that we’re all focused on as nurse practitioners. We’ve evolved over the last six decades. We provide very high-quality, safe care. We’re educated and have nationally accredited education, training, and standards of care. And so we need all of our states to update their laws. We have a workforce today that includes nurse practitioners. We have healthcare changes to absolutely demand nurse practitioners to be out there providing care. And so we need our states to update their laws so that we have the licensure authority to practice to the full extent of our education and training. Twenty-seven states and D.C. are full practice authority states. In those states, we’ve seen an improved workforce, increased access to care, and more nurse practitioners working in historically underserved areas.
How can we reach those states that have yet to allow full practice authority? What can nursing do to get things in motion?
We must get in front of the lawmakers, educate them, and provide evidence of our patient care outcomes. We have decades of evidence out there that show that we provide high-quality, very safe care. We get that information in front of the lawmakers and give examples of what’s happened to other states that have moved to full practice authority. So I’ll give you an example. Arizona moved to full practice authority in 2001. Five years later, they saw their workforce doubled. And they saw a 70% increase in nurse practitioners working in historically underserved areas. We see this in every state that moves to full practice authority. No state has gone back. They’ve only gone forward. The states associated with the best healthcare outcomes are full practice authority states. Those states at the low end of the list are restricted with outdated laws. If they can update those laws, it would be a no cost. As I said earlier, there is no cost, no delay solution to increasing access to care for the people in their state.
How can nurses and others support this legislation and have their voices heard?
We need to speak up. We need to advocate. We need to speak with our legislators. We need to send letters and emails. We need to contact our lawmakers as constituents in their area. They need to hear from us as nurses. From a professional association standpoint, many nurses are part of a professional association. The American Association of Nurse Practitioners is the largest NP association representing all specialties of nurse practitioners. And we have an excellent state and federal advocacy team that keep all of our members updated on what’s happening. And they keep us updated on the bill number so that we can immediately advocate for the legislator that legislation and we can immediately connect with our lawmakers. I think what’s important is we need to make that reach out to our lawmakers. They want to hear from us. They want to hear from nurses. There are over 4 million nurses in the U.S. There are over 355,000 nurse practitioners in the U.S., and they want to hear from us.
It’s no secret that nursing is a popular and highly respected profession with excellent potential for job growth. The American Association of Colleges of Nursing (AACN) reported in April of 2022 that a “strong interest in nursing careers” was readily apparent based on increasing enrollment in entry-level programs. However, examining the job growth projections published by the Bureau of Labor Statistics (BLS) may lead us to wonder what the future may hold during the remainder of the decade.
Let’s Do the Numbers
The Bureau of Labor Statistics (BLS) tracks every occupation you might think of, from airline pilots and postal workers to nurses and psychologists. While any statistic should be taken with at least a grain of salt due to the potential for error, miscalculation, bias, and other factors, we can generally feel confident in what the BLS says.
For the BLS grouping of nurse practitioners, midwives, and nurse anesthetists, job growth between 2021 and 2031 is projected to be 40 percent, “much faster than average.” In addition, they report, “About 30,200 openings for nurse anesthetists, nurse midwives, and nurse practitioners are projected each year, on average, over the decade. Many of those openings are expected to result from the need to replace workers who transfer to different occupations or exit the labor force, such as to retire.”
While we’re at it, let’s acknowledge the BLS median salary stats for this group of APRNs, which is $123,780 annually.
When it comes to the BLS statistics for registered nurses, it’s not quite the same, with job growth between 2021 and 2031 projected as six percent, which is deemed “as fast as average.” In terms of job numbers, the BLS reports, “About 203,200 openings for registered nurses are projected each year, on average, over the decade.” The median salary for RNs in 2021 was $77,600.
For comparison, let’s look at what the BLS says about physicians and surgeons, which is worse still. Projected job growth for this group during the same period is expected to be three percent, “slower than average.” On the other hand, physician assistants fair much better at 28 percent job growth and a median salary of $121,530, not far from NPs in terms of money, yet significantly behind for jobs.
According to a survey by Incredible Health, 34 percent of nurses were planning to leave their current role in 2022, and 32 percent were planning to leave the profession entirely or retire.
What Story Do the Numbers Tell?
The data mentioned above can be interpreted in various ways concerning registered nurses.
On the one hand, we can point to disappointing projected job growth for RNs in the coming decade despite the constant talk of an ongoing nursing shortage. On the other hand, one might also hypothesize that since many nurses are leaving their roles or retiring, those jobs that need to be filled may not be counted as “job growth” since those positions already exist.
Many nurses are seeking alternative career paths away from the traditional acute care bedside, perhaps to a large extent due to the rigors of the COVID-19 pandemic. As some seek ambulatory positions or entrepreneurship, their old jobs will be up for grabs.
Notwithstanding the numbers, demand for nurses should stay relatively consistent (six percent job growth is “as fast as average,” after all). We can also consider that changes in the economy or the healthcare industry may cause shifts in the nursing labor market of the coming decade. We may also encounter enacting legislative initiatives and other policies to counteract the nursing shortage, which could positively impact employment opportunities for nurses.
As for nurse practitioners, they are certainly in the ascendant and will likely stay there, especially as physicians abandon primary care and demand for NPs grows apace.
No Place for Fear
Nurses have always been, and always will be, in demand. As the very mitochondria of healthcare, the wheels of the system would grind to a halt in their absence.
For those who wish to remain in the profession in whatever capacity — be it acute care, research, case management, remote nursing, ambulatory care, or otherwise — there will assuredly be room at the inn for nurses seeking employment.
Creative approaches to one’s nursing career can yield interesting and unexpected opportunities (e.g., cruise nurse, a nurse script consultant for film and television). Still, those seeking something outside the box can find other unusual roles.
Nursing as a profession isn’t going anywhere, and nurses can rest assured that their skill, knowledge, expertise, and compassion will always have a place in a society that’s wholly dependent on them always being there whenever they’re needed.
Daily Nurse is thrilled to welcome Keith Carlson, “Nurse Keith,” a well-known nurse career coach and podcaster of The Nurse Keith Show as a guest columnist. Check back every other Thursday for Keith’s column.
