Situation Critical: Hospitals grapple with an increasing shortage of registered nurse

[NRSKarenRN, BSN, RN]

this reporter got it right. karen

hospitals grapple with an increasing shortage of registered nurses

linda goodspeed special to the boston business journal

from the march 22, 2002 print edition

http://www.bizjournals.com/industries/health_care/hospitals/2002/03/25/boston_focus1.html

not even the lure of a $10,000 signing bonus could entice liz joubert back into nursing. joubert, a former registered nurse, left the profession in january 2001 after 37 years to take a job as safety officer at siena construction in cambridge. just a few months into her new job, another area hospital called with the promise of a signing bonus if she would come back.

"money has nothing to do with it," said joubert, who was making in the high 60s when she left nursing.

"(the hospital) couldn't guarantee staffing ratios, and that's the reason i left nursing," she said. "i had too many patients to care for. i felt i was putting them at risk. i brought it time and again to the administration, and they just said, `do the best you can.' "

doing the best they can is no longer good enough for rns who are leaving the nursing profession in droves, causing a nationwide shortage of nurses.

locally, hospitals are so desperate to fill nursing vacancies they are offering signing bonuses to experienced nurses of as much as $10,000 -- and they're recruiting nurses from as far away as canada, the philippines and other countries.

"it's totally outrageous," said keren higgins, president of the massachusetts nurses association in canton and a 27-year practicing nurse at boston medical center. "they're just stealing nurses from one hospital to another. many of the countries they're recruiting from have as bad a nursing shortage as we do. they're not fixing the problem. the reason for the nursing shortage is because of poor working conditions."

judith shindul-rothschild, an associate professor at the boston college school of nursing, says it's important to put the current nursing shortage in historical perspective.

"there are always cyclical shortages of nursing personnel," rothschild said. "shortages are not a new phenomenon, nor are the roots of the current crisis new. quite simply, they have to do with poor working conditions and salaries and benefits that don't keep pace with the standard of living."

in fact, rothschild said, the nursing shortage of the early '80s was much worse than the current shortage. but it was turned around within two years after hospitals dramatically raised salaries and reorganized nursing care. "those two policies alone completely eradicated double-digit vacancy rates within a very narrow window and successfully contained vacancy rates in the single digits right up until the mid-90s."

in the mid-1990s, the shortage returned. hospitals, under severe cost-containment pressures from insurers, took aim at one of their biggest budget items: nursing. layoffs of rns followed, patient-load increased, mandatory overtime was instituted and wages froze.

six years ago, rothschild predicted the current nursing shortage, based on the results of a nationwide survey of nurses she conducted.

"i was shocked to find that only 72 percent of nurses said they expected to remain in nursing longer than five years. in all previous studies, the number who said they expected to remain in nursing longer than five years was 80 (percent) to 90 percent."

although nursing salaries are on the upswing, nurses say working conditions are not. in fact, they believe it will take government intervention to reduce patient loads and bring nurses back into the profession.

"we want staffing ratios and we want them in writing," higgins said. "once we get staffing ratios, i think we'll see a lot of the other issues disappear and nurses start coming back to the profession."

one state, california, has already enacted staffing ratios for nurses. massachusetts has introduced similar legislation.

"the bill is really starting to pick up steam," said david schildmeier, spokesman at the mna. "it would set up a commission that would establish staffing ratios based on the severity of the patient." schildmeier said that in the two years since australia established mandatory staffing ratios, 2,100 nurses have returned to the profession.

"i think government regulation of nurse staffing ratios is inevitable," rothschild said.

joubert, who was a nurse in the post-anesthesiology care unit at carney, said she should have had a 1-1 ratio for children recovering from general anesthesiology.

"and for years i did," she said. "all of a sudden, i was asked to take one child and one adult or maybe two adults. i couldn't work according to nursing standards. ... nurses are leaving the profession because they feel they're putting their licenses in jeopardy. they're putting their ability to sleep at night in jeopardy."

richard averbuch, senior director of communications for the massachusetts hospital association, said there is a definite nurse shortage, but "we're also seeing shortages among pharmacist, radiological technicians, lab technicians, even physicians in some areas.

"everyone in health care is feeling stressed right now. the system is underfunded, demand has increased and we have a crisis as a result."

the hospital association does not believe that mandated staffing levels will address the nurse-shortage issue, averbuch said. he said staffing problems need to be addressed on a hospital-by-hospital basis.

"by doing that, we're imposing rigidity on the system just at a time when flexibility is needed," he said. "mandated staffing levels could actually result in the closing of key beds in hospital units, which in turn could make the problem of emergency-room overcrowding even worse."

unlike previous nursing shortages caused by working conditions and salary issues, rothschild notes that the current shortage has a "third wrinkle" -- demographics.

"there are fewer 18-year-olds in the population from which to recruit new nurses," she said.

while she said "supply-side" strategies, such as subsidizing nursing education and more scholarships, can help ease the current shortage and demographic problem, increasing the number of new nurses is not the sole answer to ending the shortage.

"currently, we have more nurses in the u.s. than we've ever had," rothschild said.

"the problem is, they don't want to practice nursing. it doesn't matter how many new recruits you dump out if you burn them out in two years. you have to get at the root causes of the shortage. you have to address working conditions and salaries."

[Mijourney]

Hi. That's one of the pros of the health care industry today and nursing in particular. The knowledge and skill sets of a nurse can be used in almost any health-related business or setting. A nurse does not necessarily have to spend all his or her working days providing bedside care. The downside, of course, is that there's no one picking up the pieces right now. I do know that my recruitment mail has increased lately.

[lisadavis]

a nurse can fill the role of almost any other healthcare provider, and many have been asked to do so, but who can be the nurse but the nurse?

[oramar]

As for not mandating staffing levels and shortage being solved on hospital by hospital level, well I could say yes to that except for one thing. There are so many places not dealing with the situations as all. Of course we hear of innovative programs and that is great. But it is shocking to hear nurses coming here complaining of the same old problems. Example, the new grad who is charge for first time on large unit, she is worrying about not having enough experience and by the way she also has 10 patients. EXCUSE ME, when are they going to learn? That is the sort of thing that causes burn out and early retirement. If this sort of thing continues healthcare is going to get more and more regulated and it will be there own fault. But then I am just repeating what this very fine article has said.

[-jt]

thanks for the article, Karen. I just copied, pasted & sent it to my state legislators, senators & Congressman - after highlighting the important parts with bold type. That was a lot easier than writing my own letter. Thanks.

[oramar]

-jt has a good idea there.

[llivingston53]

Great idea -jt... We all need to do that very thing. That article said it beautifully, when are they going to realize that it's not about MONEY. I've been away from the bedside for almost three years now because of those very reasons, and when I left my position I told them exactly why I was leaving. They know the truth, they just don't care, and as long as there is another nurse waiting to take your job they will continue to not care. Looks like now they are finally being forced to look at the real issues. Of course I think nurses should be paid more as well, but they need to fix the other things as well. I miss patient care, but won't go back until they fix things, it's just too much of a sacrifice:o Take care all

[OC_An Khe]

The shortage is about MONEY. On many different levels. To get the rn/patient ratio to acceptable levels its going to take a huge amount of money. To get the Nursing professon competive with other career paths is going to take a huge amount of money. Hospitals used to supply greater than 80% of all nursing employment opportunities, it now provides barely over 50% of employment opportunities. Hospitals have to become competitive as employers of choice. Thats going to take a huge amount of money.

The largest contributor of money to the health care industry is the state and federal governments. We need to become politically aware and active. Without the infusion of large amounts of capital and the direction of this capital to the people giving the direct patient care this shortage will either never end or our profession will cease to exist as we know it.

[-jt]

I said the same thing in a meeting with my state assemblyman (a republican) & his response was that in private industry they use private money but hospitals use public funds - including the for profit hospitals. And when you opt to take a job in a place that is publicly funded, you do so with the understanding that you will not be compensated as well as you would in private industry. Nurses have a calling - and its not to make money.

Can you believe it? THATS a sample of the mentality that we're dealing with. These guys need to be educated. Work on the Republicans.

BTW, he didnt have a repsonse when I replied that the CEOs & other administrators in these publicly funded facilities are making hundreds of thousands and even millions of dollars to work there & have compensation that IS competitive with private industry in order to keep them, so obviously his premise is flawed.

[VickyRN, MSN, DNP, RN]

Just another example of how our noble profession lacks respect. AND IT'S NOT JUST REPUBLICANS. Clinton's infamous Medicaid cutbacks of 1997 nearly destroyed many small rural hospitals. And let's not forget HILLARY'S brillant comment (made back in the early '90's when she was trying to implement her version of universal health care) that nurses make too much money???? She better hope we nurses have short memories, but that's one comment I will never forget.

[llivingston53]

I stand corrected ocankhe:p . You are absolutely correct in that it is about money. The hospitals won't staff floors proportionately because it costs money and digs into their profits. We all know that and you're right that it will take huge amounts of money to straighten out the problems. What I meant is that nurses aren't leaving because of their paychecks, although we are grossly underpaid, that had very little to do with the reasons I left. I left because of the long hours, mandatory overtime, little appreciation, weekends, holidays, feeling that I couldn't give the quality of care that the patient deserved, and for fear that not eating everyday and not going to the bathroom regularly in a 12 hour shift would eventually make me a patient. And those 12 hours shifts were more like 14 hours by the time you travel etc. And no one cared. Yes it will take money at all levels to correct this serious problem, but I was responding to the article that stated that a veteran nurse refused a 10,000. bonus to return to work. It obviously wasn't about money for her. I wouldn't return for a bonus either, not unless they correct the problems.

[Hardknox]

There is another reason I won't be back at the bedside unless there are safe staffing ratios: lawsuits. In Massachusetts there is a "charitable cap" on hospitals. They can only be sued for $20,000 so who do you think the litigous patients of Massachusetts sue? The doctors and the nurses and other health care workers. A pharmacy tech and 2 pharmacists just lost a suit to the tune of $7.1 million at Children's Hospital. When you can't give safe care, you're going to make mistakes and when you make mistakes someone dies or suffers. Look at Dana Farber and the Chemo overdoses. Those nurses were cleared by the DPH and their hospital. The BORN turned around and penalized them. Why Catholic Priest Pedophiles get treated better in Boston than Nurses!