What I like about this Congressional Research Service report is the statistical evidence that there are, indeed, enough nurses for the here and now. It forces the powers that be to look further than demographics as to the reason for the shortage.
Almost 1/2 million licensed RN's are NOT practicing nursing. This is equal to 18% of the work force and is really a huge number. That's what this report is saying. There ARE enough nurses, but they're choosing NOT to work in nursing. Therefore, it forces everyone to look at why and the only conclusion can be the working conditions.
This shortage needs CPR: Studies at odds on whether there are enough nurses to go around
By: Ed Lovern
The American Hospital Association has had to prop up an issue that it said could stand on its own. Last week, a study it released telling of huge shortfalls in hospital staffing served as prosthetic legs for this year's banner advocacy issue after a government study said a nursing shortage is years away.
Stakes are high for the AHA, which has made staffing relief a cornerstone of its lobbying campaign to pursue ``tens of billions of dollars'' in increased reimbursement and money from Congress this year to train and recruit workers.
Though the AHA found that its hospitals aren't able to fill about one-tenth of its registered nurse openings, a report released late last month by the Congressional Research Service said it couldn't state conclusively that an across-the-board shortage of registered nurses exists (June 4, p. 13). The CRS study has caused lawmakers to question hospitals' claims of a nursing shortage.
Rep. Nancy Johnson (R-Conn.), chair of the House Ways and Means health subcommittee, has asked the General Accounting Office to examine the existing research on the supply of nurses and report back to her subcommittee by the end of the month.
``It is not clear whether a nursing shortage exists nationwide,'' said Johnson in her May 22 letter to the GAO that cited the CRS study. ``If it does exist, the reasons and the cure are not evident.''
At last week's press conference on the AHA study, AHA President Richard Davidson said, ``I almost had to chuckle when I heard there wasn't a shortage. I said I don't know who all these people are who I've been talking to for the past year.''
Davidson said the new AHA staffing survey of 715 hospitals completed in May puts the question to rest: ``It shows an astounding shortfall of workers that the hospitals are coping with today.''
While the vacancy rate for nurses is 11%, those aren't the only jobs that the AHA said hospitals are having trouble filling. The study found that 21% of pharmacist positions were unfilled, as were 18% of radiological technologist vacancies and 12% of laboratory technologist posts (See chart). Rural facilities have higher vacancy rates than urban hospitals for most positions, except for RNs.
RNs represent the lion's share of hospital job openings around the country; 75% of the 168,000 unfilled hospital positions are for nurses. The survey measured vacancy rates, or the percentage of budgeted positions that go unfilled, but it did not track annual turnover rates, or the percentage of employees who leave their jobs during the year.
``We are having a tough time ensuring that we have an adequate supply of people to take care of people,'' Davidson said.
Shortage? What shortage?
The CRS report, which was distributed only to congressional offices, said there is no across-the-board nursing shortage in the country and that accounts of the scarcity of RNs are attributable, in part, to regional variation. Modern Healthcare disclosed the report's finding in its June 1 Daily Dose electronic newsletter.
Federal manpower studies bear this out. The number of employed nurses per 100,000 population ranges from 520 in Nevada to 1,675 in the District of Columbia.
``I hear all the time that there is going to be a big shortage of nursing, but as of right now we are sitting pretty good,'' said Sister Genevieve Karels, administrator of 35-bed St. Bernard's Providence Hospital in rural Milbank, S.D. Her state has 1,128 registered nurses per 100,000 population.
But at the five hospitals operated by Norfolk, Va.-based Sentara Healthcare, registered nurse vacancy rates range from 8% to 25%. Virginia has 711 registered nurses per 100,000 residents.
``We are probably reflective of a lot of other hospitals in the country,'' said Lois Kercher, vice president and nurse executive at 193-bed Sentara Virginia Beach (Va.) General Hospital. ``It is more of a problem for Sentara now than it was two or three years ago.''
The AHA's survey also found that the workforce shortage is getting worse and is affecting access to care.
Three of four hospitals reported more difficulty in recruiting RNs compared with a year ago.
More than one-quarter of respondents said they have had to divert patients from their emergency rooms as a result of the workforce shortage. Some 28% said they have reduced the number of beds staffed and 15% have canceled scheduled surgeries.
``We have an impending public health crisis sitting out there just waiting to happen over time,'' Davidson said.
Not a straightforward problem
Several issues are responsible for the staffing shortages, according to the AHA. Low unemployment in the general workforce has meant that hospitals have been competing with other businesses for all workers, from professional staff to unskilled workers. There are more opportunities for clinicians, especially nurses, in other work environments that are often more attractive than the high stress and limited flexibility of hospitals.
Yet the AHA's own statistics show that hospitals have been able to bring in more nurses in recent years. Hospital employment of full-time RNs increased 4.1% from 1995 to 1999, while employment of part-time RNs jumped 8.2%. This occurred at the same time admissions climbed 4.6%, ER visits rose 5%, but inpatient days fell 4%. Hospitals say the increasing utilization of outpatient medical services means that hospitals are caring for sicker patients, who demand more staff time.
Nursing and labor groups lay much of the blame for the shortfall of hospital nurses at the feet of administrators. A study conducted for the Service Employees International Union Nurse Alliance released in May said the industry created the shortage by cutting staffing levels to the point where nurses began to leave hospitals for less demanding and more rewarding jobs.
``Why are nurses burning out so quickly? The root cause of that is clearly the working conditions, the fact that nurses have, to the detriment of these facilities, been seen as its disposable labor pool,'' said Erin McKeon, the American Nurses Association's associate director of government affairs.
Diane Anderson, president of the American Organization of Nurse Executives and vice president of patient services at Boston's 589-bed Beth Israel Deaconess Medical Center, said hospitals are having more difficulty keeping and recruiting registered nurses. The AONE is a subsidiary of the AHA. Anderson said some hospitals need up to a year to fill critical-care nursing positions.
The proportion of RNs working in hospitals declined to 59% in 2000 from 68% in 1988. The percentage of licensed RNs opting to stay away from the nursing field has climbed to 18.3% in 2000 from 17.3% in 1996.
Davidson admitted that part of the fix is for hospitals to develop flexible schedules, education benefits and on-site child care for staff. ``To be employers of choice, which is clearly what we want to strive to be, it means we are going to have to be more innovative than we have ever been,'' Davidson said.
But the AHA is expected to spend close to the $10.4 million it recorded in federal lobbying expenses last year to bring home the bacon from Congress this year to fix the labor shortage (See story, p. 16). AHA Senior Vice President of Policy Carmela Coyle said the association will seek $9 billion more for hospitals by asking Congress to set a minimum wage adjustment in determining Medicare payment rates for inpatient care. Proposed legislation, also backed by the AHA, would increase Medicare hospital payment rates by the full amount of inflation, which would boost hospital pay by another $8 billion over five years.
Also, the AHA is calling for the creation of a $12 billion grant program to fund hospital partnerships with colleges to get more students in the healthcare profession pipeline.
The ANA said the lobbying effort misses the point. ``Unless you improve working conditions, scholarships, stipends and increased funding are all nice, but they aren't going to improve the overall situation,'' said Cindy Price, an ANA spokeswoman.
The AHA opposes a bill introduced in March that would prohibit hospitals from forcing nurses and other hospital staff to work overtime. The AHA said mandatory overtime is a ``safety valve'' that hospitals use as a last resort to meet unexpected jumps in patient volume.
The ANA's Price said overtime is a tool routinely used by hospitals to keep units staffed. ``It is issues like that that are causing nurses to leave the acute-care setting,'' Price said.
The AHA is also petitioning Congress to loosen immigration laws to allow foreign workers to staff hospitals. Last month, Bradley LeBaron, president and chief executive officer of 42-bed Uintah Basin Medical Center in Roosevelt, Utah, on behalf of the AHA testified before the U.S. Senate subcommittee on immigration and asked for changes to the visa program that would allow more foreign-born nurses into the country.
To develop additional strategies for reacting to the staff shortage, the AHA in January announced the creation of a blue-ribbon commission to study the issue. Davidson said last week that the commission is scheduled to report its findings in about one year.
At least one hospital system has managed some success in combating the nursing shortage without legislative help. Lehigh Valley Hospital and Health Network in Allentown, Pa., cut its RN vacancy rate to between 7% to 10% today from a high of 15% in 1999. The system also shrunk its RN turnover rate to 10% from 16.5% in 1999.
Lehigh Valley has done many of the things Davidson highlighted, creating flexible schedules and paying for professional development. The system also has created a registered nurse advisory group to give nurses more input on hospital administrative issues and a recognition program that hands out $41,000 annually to nurses for outstanding care.
Yet, Terry Capuano, Lehigh Valley's senior vice president of clinical services, said the improvement hasn't chiseled her RN vacancy rates down to the 3% or 4% she describes as ideal.
[Modern Healthcare Magazine]
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