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Behind the Nursing Shortage

September 29, 2000
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When a nursing shortage hits the world-renowned Cedars-Sinai Health System,you know it's ugly.

Janice Buehler, recruitment manager at Los Angeles-based Cedars-Sinai, saysthat two-and-a-half years ago, 150 nurses showed up at an open house for women’shealth nurses. In August 2000, only 15 showed. "It’s a big indicator ofthe market," she says.

Big it is. The labor shortage in some cities is so bad that hurried andharried nurses are doing everything from sticking themselves with needles, toburning out, leaving for agency work, or quitting altogether. It affectspatients.

"We’ve had to cut down on the number of surgeries simply because wedon’t have the nurses to work them," says Justine Zeoli, of Children’sHealth Care of Atlanta. "That’s never a good thing." Zeoli says herhospital can’t just shuttle people to another hospital across town. "Alot of the hospitals aren’t equipped to do the level of [pediatric] surgery wedo here."

These hospitals are scrambling to find solutions to the problem.

"What we have -- at least presently -- is a geographic shortage ofnurses," says Cheryl Peterson, senior policy fellow at the American NursesAssociation. In the United States, the situation is especially bad inCalifornia, Texas, Florida, Missouri, Tennessee and Minnesota, as well as inurban areas such as Columbus, Ohio, Denver, Colorado, Atlanta, Georgia andelsewhere.

"We also have a shortage of specialists," says Peterson."Critical care nurses, ER, operating-room nurses. The prediction of whenthe demand will outstrip the supply is 2010," she says. "That’s whenthe numbers will show our supply is not going to meet the demand."

By 2008, there will need to be 450,000 more registered nurses and 136,000more licensed practical nurses in the United States, according to the U.S.Department of Labor. According to Vanderbilt University, by 2020, there will be20% vacancy rates for nursing jobs nationwide.

However you slice it, demand is high, and enrollment in nursing schools inmany areas is down.

Behind the Shortage

Among the factors contributing to the shortage are:

Demographics: "The compounding problem is that working a nurse’saverage age is 42 years, so we’re a graying, aging profession," saysPeterson. "The number of individuals going into nursing has droppedconsistently now for about five years."

Women’s migration from nursing: "I think a lot of it has to dowith a variety of opportunities available to women. They’re not automaticallychoosing what has historically been considered a female occupation," saysPeterson. Not all have bypassed the health care profession entirely -- some womenwho once would have gone into nursing have become doctors.

Zeoli says nurses in Atlanta are getting MBAs and heading to careers inmarketing, nursing information systems, or in combinations of clinical work andmanagement.

According to Gigi Garcia, nursing recruiting manager for health-care staffingfirm CompHealth, 43% of today’s medical students are women, as compared to 26%20 years ago. Garcia says that "new opportunities outside health care makenursing a hard sell," and that people are leaving for more money, lessstress, and flexible schedules. CompHealth estimates that as a company they’vehad a 45% increase in requests for healthcare professionals over the last 12months.

Legislation: In California, mandated staff ratios -- though well-intended-- may exacerbate the problem.

Medicare: Hospital nurses aren’t the only ones in hot demand. Recentchanges in Medicare funding took their toll on other sectors of the industry."It [funding changes] hit physical therapy really hard, but it also hithome health nurses," says Peterson.

They’re working faster and harder. It’s a classic, oldLucille-Ball-chocolate-factory-thing.

Global recruiting: American hospitals are scouring Canada for nurses inlarge numbers, but unfortunately in the global economy, that just shifts thenursing shortage to Canada, which is having its own problems. Canadian hospitalsthen recruit from the UK. Then UK hospitals go pecking, like Bedford Hospital inthe UK, which recruits from South Africa. South Africa recruits from Asia.Dominoes.

Overall employment trends: The health care industry isn’t exempt fromthe job-hopping, what-have-you-done-for-me-lately attitude of employees."It’s like in the 1970s with Information Systems," says Shirley A.Skinner, compensation manager at Cedars-Sinai. "People go from oneorganization to another and back, even if it’s across the street."

Managed care: Nursing advocates say that the intense pressure to reducecosts has resulted in higher-paid nurses being replaced with less-prepared ones.

The media: "In the 1990s when the health system reorganized,restructured itself there was a fair amount of negative press," saysPeterson. "Someone might have said, ‘why would I want to go work there?’What we saw were articles about the adequate or oversupply of nurses, articlesabout nurses being laid off in mergers. Cost-cutting."

Peterson also says that the media played up shorter hospital stays, which inturn could have meant a lower, long-term demand for nurses. "All of thosefactors created an impression that nurses were not needed, or hospitals were notplaces where individuals wanted to work."

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