NEW YORK TIMES ON THE WEB
May 28, 2002
Shortage of Nurses Spurs Bidding War in Hospital Industry
By MICHAEL JANOFSKY
ENO, Nev.-After workers around the country were laid off last fall, Kaylene Opperman sensed an opportunity. As chief nursing recruiter for Washoe Medical System, Reno's largest hospital, she figured that some of those workers were married to nurses, who might be willing to move their families to Reno. So she placed newspaper want ads in Florida, Missouri, Ohio, Texas and Utah.
With the shortage of nurses growing worse by the year, hospitals are stepping up efforts to fill vacancies by selling themselves through advertisements, job fairs, even highway billboards. They are also trying to lure nurses with flexible hours, ever-larger signing bonuses and other financial incentives.
"It's getting aggressive out there, extremely aggressive, and it's not pretty," Ms. Opperman said. "It's become totally a buyer's market."
Ms. Opperman is, herself, a product of the new bidding wars. Until she was hired three years ago, she said, Washoe waited for prospective nurses to walk in the door. Now, she is one of three recruiters who scour the country for nurses. By July, she said, she will have attended five big job fairs this year and visited dozens of nursing schools.
Hospitals around the country have 126,000 nursing vacancies, or 12 percent of capacity, according to the American Hospital Association. Health industry experts predict the number could triple over the next decade as baby boomers age.
But the problem's roots go back a decade. As the health system shifted toward managed care, hospitals merged, and nurses were laid off to cut costs. Those who remained found themselves working longer hours and caring for more patients. When workloads became so heavy that hospitals had to hire again several years ago, many nurses had moved to work in other fields or to nursing jobs
in the calmer environs of doctors' offices, pharmaceutical companies and neighborhood clinics.
Nor has it helped that hospital nursing salaries have stayed relatively flat for a decade, according to the American Nurses Association. A recent survey by Allied Physicians, an industry employment service, found that the national average nursing salary was $45,500. Nurses with graduate degrees, those with specialties like cardiac care and those who work in big-city hospitals can make $60,000 and more, but entry-level salaries in many places remain low, $25,000 to $30,000.
The need for nurses has forced many states, especially those with fast-growing populations, like Nevada, Texas and Florida, to spend more for nursing schools and recruitment. In addition, Congress is completing legislation that would generate $136.7 million in new federal spending for scholarships, loan repayments and recruitment grants.
But stuck on the front lines with understaffed wards are hospitals that have now turned against one another in the biggest recruiting frenzy in more than a decade.
A popular tool is the sign-on bonus, given when a nurse accepts a job. Hospitals have used them in modest amounts before to shore up needs but not to the levels being offered now. In April, for example, the Health Alliance of Greater Cincinnati, which includes six hospitals, began offering bonuses of $30,000 over three years for nurses with specialized skills.
Patty Holiday, a spokeswoman, said dozens of candidates had been interviewed, three had been hired and an intensive promotion was continuing with job fairs, open houses and classified ads intended to hire nurses away from hospitals in Ohio, Indiana and Kentucky.
In St. Paul, Regions Hospital has been offering one-time bonuses of $10,000 since March, hiring more than 25 nurses under the program.
Other hospitals are offering large sums in other packages. Hospitals in Orange County, Fla., are offering $7,500 toward a down payment for a new home. Last year, the Jerry L. Pettis Memorial V.A. Medical Center in Loma Linda, Calif., began giving recruits enhanced benefits, with five weeks vacation and a $10,000 scholarship for continuing education.
Neither of Reno's largest hospitals, Washoe or St. Mary's Health Network, offers sign-on bonuses. But Washoe has begun giving current employees a finder's fee of $1,000 for referring nurses, another $1,000 if the nurse stays six months and $1,000 more if the recruit stays a year.
Many hospital administrators object to one-time bonuses, saying they encourage nurses to take the money, then quit months later to get another bonus somewhere else. They also say the awards do nothing to expand the pool of nurses, to improve working conditions or to attract more college graduates into nursing.
"We're recruiting these people into a profession that's broken," said Susan Bianchi-Sand, director of United American Nurses, the country's largest nurses' union. "The system needs to be fixed so people not only want to come in, they want to stay."
Nowhere is the need for nurses more urgent than in Nevada. The fastest-growing state, Nevada has the lowest nurse-per-person ratio, with 520 nurses for every 100,000 people, according to a recent survey by the federal Department Health and Human Services.
Doreen K. Begley, nurse executive with the Nevada Hospital Association, said studies had determined that Nevada would need 680 new nurses every year for the next eight years to keep pace with the population growth.
Those needs are unlikely to be met. Not only does Nevada face competition from other states, Ms. Begley said, but its six nursing schools are turning out only 300 new nurses a year from their four-year programs. One school, the Orvis School of Nursing, in Reno, can graduate only 48 students a year, said its director, Julie Johnson, because the school cannot afford to hire more instructors. Moreover, the state limits those instructors from overseeing more than eight students at a time in the part of their training at hospitals.
To help in the short term, the state licensing board is allowing 21 nursing school graduates from the Community College of Southern Nevada in North Las Vegas to take a licensing test, even though their program is still awaiting accreditation.
More broadly, Ms. Johnson and Ms. Begley helped develop a state plan that will allocate $27 million to double the number of nursing graduates from state schools. But even if these goals are met, Washoe and St. Mary's still have to compete fiercely for new nurses.
Washoe, a 529-bed hospital, where about 12 percent of the nursing jobs are unfilled, is trying to identify prospective nurses before they are ready for employment and to create internships to fit their interests. The recruiters focus mainly on Nevada but also offer assistance to prospects willing to move, like one recruit who responded to an advertisement Ms. Opperman placed in Cleveland.
St. Mary's, where 8 percent of the nursing jobs are open, focuses less on recruitment enticements than on retention. Norma E. Brown, an administrator, said the efforts included more frequent raises, a greater role in decision making and improved working conditions.
Helen Schwartz, who recently graduated from Orvis, said she chose Washoe because its recruiters courted her aggressively and promised what she wanted most, a fast track to a position in the cardiac care unit.
Ms. Schwartz said her classmates had become acutely aware of the bidding wars for nurses. As a resident of Truckee, Calif., 30 miles southwest of Reno, she did not want to leave the area, so she accepted the Washoe job, because it offered more to get her than either St. Mary's, or a third Reno hospital, the V.A. Sierra Nevada Healthcare System. "The other two didn't feel the need to do it that way," she said. "But they're going to find they may have to."