NURSING SHORTAGE: Shortfall May Be Long Term
Hospitals around the country "are experiencing a shortage of registered nurses, especially the specialized, highly trained nurses who staff operating rooms, emergency rooms, intensive care units and pediatric wards for high-risk babies," and the shortage may have roots that will make it difficult to ameliorate. Today's New York Times profiles the crisis, which was highlighted last week by the announcement of St. John's Regional Medical Center, "the principle hospital serving Ventura County north of Los Angeles," that it would close part of its acute care ward because it didn't have enough nurses. The reason for the crisis is three-pronged: as a group, nurses are aging and moving into retirement; women today have "more and better-paying career choices" than nursing; and many have left the profession or taken administrative jobs due to managed care "belt tightening." Industry watchers warn that the shortage will continue because not enough nurses are being trained to take the place of those who retire or leave the profession. The American Association of Colleges of Nursing said enrollment at the nation's 500 or so nursing schools was down 5.5% in 1997, the fourth straight year enrollment has declined. A report by the American Organization of Nurse Executives, the American Nurses Association and HHS said the "shortage appears to be a new and different type. Previous shortages have been about sufficient numbers of nurses, while this shortage appears to be about an increased demand for nurses with competence, skills and experience to meet patient demand for care in a changing health care system" (Kilborn, 3/23).
While the national health care industry braces itself for an impending nursing shortage, officials in Arkansas "say the crisis has already arrived." Ten percent of nursing positions went vacant in Arkansas hospitals last fall, with some hospitals complaining of vacancies as high as 30%. Meanwhile, "the number of students enrolled in nursing programs has dropped 22% in the last five years." Linda Hodges, dean of the University of Arkansas for the Medical Sciences College of Nursing, said, "We've got a train coming down the railroad track, and the state's tied to the track. It's frightening. It really is." Susan Erickson, a nurse recruiter for UAMS, said that normal supply and demand cycles tend to create nursing shortages about every 10 to 15 years, with the last occurring between 1985 and 1991. But, the Arkansas Democrat-Gazette reports, "in about 1996, signs of a new shortage began to emerge." Alicia Mitchell, spokesperson for the American Hospital Association, said, "What we're seeing is the early warning signs of an impending nurse shortage. We don't want to alarm folks. There are variations across the country." While Arkansas has more registered nurses than ever before -- 22,317 in 1998 -- demand has outpaced supply. Moreover, "the work is getting harder" as hospitals rely more on outpatient care, and as a result, "nurses work with only the sickest people." Faith Fields, executive director of the state Board of Nursing, added that where educated women used to be steered to nursing, "[n]ow there are so many other things you can be, as well as so many more high-paying jobs you can get." The trend has forced hospitals to compete fiercely for nursing help, offering cash signing bonuses, child care, flexible hours or transportation reimbursement (Francis, 3/21).
Nursing Homes, Too
The Milwaukee Journal Sentinel reports that a shortage of nursing home workers in Wisconsin is "bringing patient neglect and frustration ... and is threatening access to home care for the elderly and disabled." Citations for short-staffing have tripled in recent months, a trend that may be related to complaints of missed medications, "panicky residents waiting an hour for help, overburdened aides forced to ignore basic needs and massive staff departures from facilities." At least 17 facilities froze admissions last year due to short staffing. Mary Ann Kehoe, a Wisconsin nursing home operator, said, "It's the biggest threat to our industry now." Since up to 70% of a nursing home's residents may be on Medicaid, the homes start entry-level workers at $8.32 an hour, a wage at which it is difficult to attract quality, long-term employees (Umhoefer, 3/21). Yesterday, "[n]ursing homes industry officials warned ... that staffing shortages were creating 'a looming crisis on the doorstep of virtually every nursing home in the state." Industry and nursing home union officials announced a "consumer advisory" warning that homes may start turning people away. The Coalition for Quality Nursing Home Care is lobbying the state Legislature for "a special 7% wage boost to alleviate staff shortages" (Umhoefer, Milwaukee Journal Sentinel, 3/23).
In response to the shortage, many facilities are "getting creative" to attract employees. A new movement called Wellspring -- in use at 11 nonprofit homes in the state -- "assigns front-line staff to a group of residents, lets nurse aides do their own scheduling and uses a team approach to caregiving," and also provides employees "big bucks on overtime pay, bonuses and pool help" (Umhoefer, Milwaukee Journal Sentinel, 3/21).