WorkForce21   News Story: Philadelphia Inquirer 10/10/2000

Major nurse shortage feared in years ahead Many experts believe that what Philadelphia and much of the nation is undergoing now is the beginning of what is likely to be a long and serious shortage. By Stacey Burling, PHILADELPHIA INQUIRER STAFF WRITER Sandy Rivera, a registered nurse with Jefferson Home Help, measures Teofila Knysn's blood pressure. (Inquirer / Michael S. Wirtz) Michele Meehan, a staff recruiter for St. Joseph's Manor, held an open house last month that she hoped would lure registered nurses to the care facility for jobs. Meehan had advertised heavily in Meadowbrook, Montgomery County. She had lined up a speaker. She had ordered dinner for her guests. But, for the first time in Meehan's seven years as a recruiter, something remarkable happened: No one showed up. For Meehan, president of the Philadelphia Area Association of Health Care Recruiters, it was the starkest sign yet of the region's worsening nurse shortage. There is plenty of other evidence. Temple University Hospital offers signing bonuses of up to $10,000. The Hospital of the University of Pennsylvania had to close some critical-care beds this summer because it did not have enough nurses to staff them. One local agency touts pay of as much as $47 per hour for temporary nurses. To add to the competition, hospitals from the Carolinas, New York and Georgia have advertised for nurses in the Philadelphia area. Nursing has long been a cyclical occupation. Only five years ago, local hospitals were laying off nurses because of changes brought about by managed care. But many experts believe that what Philadelphia and much of the United States is undergoing now is the beginning of what is likely to be a long and serious shortage. Experts say that will have major implications for nursing pay and working conditions, patient safety, and the financial health of hospitals and other businesses that employ nurses. "It really is a career at the crossroads," said Rick Wade, a spokesman for the American Hospital Association. Hospitals, he said, see the shortage as "something that they may be dealing with for a decade or more." Peter Buerhaus, a registered nurse from Vanderbilt University and health economist who is considered an expert on the subject, predicts that by about 2009, demand for nurses will outstrip supply. By 2020, the United States could be 435,000 nurses short. The growing shortage, he said, will lead to higher pay and a restructuring of nursing jobs. Employers will have to figure out how to make the physical demands of nursing safer for older workers. And they might have to hire more foreign-trained nurses. Already, the first wave of the shortage - which is most pronounced among critical-care and operating-room nurses on both coasts - is heightening the politically charged relationship between nurses and their employers. Nurses are taking advantage of their growing desirability and public concerns about quality to lobby against mandatory overtime, lower nurse-to-patient ratios, and the use of lesser-trained employees to perform nursing duties. "Tired and overworked nurses are much more likely to make mistakes," said Jessie Rohner, executive administrator of the Pennsylvania State Nurses Association. "Hospitals cannot afford not to pay attention to nurses anymore." Hospitals, which got bad publicity earlier this decade for trying to save money by using more unlicensed employees, say the shortage might leave them little recourse but to use nurses more judiciously. They might have to assign nurses essential duties only, leaving everything else to other employees. They also might have to cut unprofitable services. And, they argue, they cannot pay enough to attract nurses without more money from insurance companies and the government. "Fundamentally, we may never have enough nurses and we may have to restructure the way care is delivered," said Andrew Wigglesworth, executive director of the Delaware Valley Healthcare Council. "If you look at the numbers, we're going to have to be doing something different," said Pamela Thompson, executive director of the American Organization of Nurse Executives, a part of the American Hospital Association. "There's clearly opportunism," Buerhaus, the Vanderbilt nurse and health economist, said of the lobbying efforts. "On the other hand, I think there are genuine problems." What's driving the tight nursing market? Baby boomers are approaching a time of life when they will be expected to need more health care. They also make up more than their share of nurses. About half of registered nurses will reach retirement age in the next 15 years. Women, who still make up 95 percent of the nursing force, have had more career options for years. Nursing - a physically demanding job that requires work at all hours - has been less attractive to younger workers. Nurses have more options within the field. Aside from hospitals, they are in demand at insurance, drug and home-care companies as well as outpatient surgi-centers. Nurses complain that managed-care cost-cutting has left them feeling overworked and scared of making mistakes. Layoffs have made the job look unstable. Hospital patients are sicker. They need more nursing attention. Nursing has not attracted enough men and minorities. But forecasting demand and supply is difficult. Just five years ago, the Pew Health Professions Commission predicted a nurse surplus. Linda Aiken, a nurse who directs the Center for Health Outcomes and Policy Research at the University of Pennsylvania, doesn't think what's happening is "different at all" from the nursing shortages that have hit every five years or so since World War II. She guesses that this will be the worst year of the current shortage. Then hospitals will improve pay and working conditions enough to clear things up until the bigger problems hit in a decade or so. Even then, she said, the market quickly responds to higher nursing pay, because many nurses get two-year degrees. Median pay for the nation's more than two million nurses is about $41,000. But many others side with Buerhaus, who thinks the shortage is here to stay. "I'm not confident that the market or the hospitals are going to react strongly enough to beat it back," he said. Pay and perks are improving, local recruiters said. Hospitals are filling gaps with temporary nurses from agencies. And nurses are caring for more patients and working longer hours, nurse leaders said. The Hospital of the University of Pennsylvania turned some critical-care patients away this summer - it won't say how many - because it did not want to overburden its staff, said Maureen McCausland, the Penn system's chief nursing executive. For a hospital trying to recover from major financial problems, operating below capacity "cannot be a long-term strategy," she said. But McCausland's philosophy, shared by many nurse researchers, is that nurses will be attracted to hospitals with the highest quality and best working conditions. "It's not just about money," McCausland said. "It's really about being able to have a manageable workload and really feel at the end of the day that you've done what's right for patients." Another strategy is coaxing more people into nurse-training programs, which range from two to four years. Graduations from all programs fell about 13 percent from their peak of 97,052 in 1995 to 84,847 in 1998. Enrollment in four-year programs has been falling even faster. Many local nursing schools report an increase in enrollment this year, but Buerhaus estimates that enrollment would have to rise 40 percent to prevent the shortage. In this region, the Jefferson Health System formed a coalition last year with about 20 nursing schools in an effort to generate interest. Jeanne Fisher, senior vice president of human resources for the Jefferson system, said the coalition hoped to change the attitudes of young people and school counselors. Some counselors, Fisher said, have "outdated ideas" and discourage bright students from nursing. The coalition started a Web site - www.tobeanurse.com - and sent information to 800 counselors, emphasizing the flexibility, intellectual challenges and emotional rewards of nursing. The coalition also has a speaker's bureau to tell middle and high school students about the field. Last month, a group of nurses met to hone their message for attracting recruits. Many had personal experience with the shortage - "I need help," one said. But it is a job they love, despite the long hours and hard work. "You save people's lives every day," said Pam Hathaway, an emergency-room nurse at Frankford Hospital-Torresdale. Sandy Rivera, a home-care nurse for Jefferson, originally planned to be a doctor but switched to nursing. "When I come home at the end of the day, I feel like I've done something," she said. "I'm a nurse because I make a difference in people's lives." © 2000 Philadelphia Inquirer