Richmond Times-Dispatch, Aug. 27, 2001
In search of Solutions
Nursing groups seek lasting remedies for shortage
ARTICLES BY TAMMIE SMITH PHOTOS BY BOB BROWN
TIMES-DISPATCH STAFF Aug 27, 2001
Mary Bentley, fifth-floor nursing clinical coordinator at CJW Medical Center (Chippenham), is still hard at work behind the computer (right) at the end of her shift. She was still doing paperwork long after her shift was over.
When one of the patient-care units at CJW Medical Center got backed up last winter, administrator Deborah Pasch grabbed nursing gear and got busy.
"I went out and gave care at Johnston-Willis over the winter months," said Pasch, chief nursing officer for the medical center.
"My staff was feeling stressed," Pasch recalled. "They said, 'We have so many patients coming in and out. We need a helping hand.' I went to show my support. It's not just getting on the telephone and looking for help. Directors of nursing units do this all the time."
Getting nurse managers to ditch their suits and roll up their sleeves for hands-on nursing is neither a permanent nor practical solution to the nursing shortage, but one that meets the need at the moment.
Longer term, the solutions are not so straightforward.
"Nursing has had a cyclical shortage for most of the last century," said Dr. JoAnne Kirk Henry, an associate professor of nursing at Virginia Commonwealth University.
"We have tried a lot of solutions in the past. We are recycling them. The worrisome piece is this is the tip of the iceberg. We anticipate the biggest impact to start in 2008, and what we are seeing now is only the very beginning. These old tried-and-true solutions may be Band-Aids. They will not ultimately solve the problem of 'who is going to take care of me?'"
Nationally, nursing groups such as the American Nurses Association and the Association of Nurse Executives are lobbying and planning strategies.
In the state, the Virginia Partnership for Nursing, of which Henry is co-chairwoman, is in the forefront of solution-seeking efforts. Made up of health-care, education and nursing experts, task forces have been meeting since a spring nursing summit to draft a comprehensive strategy for averting the all-out crisis that's predicted. Another meeting is planned for October.
"[The shortage] is being addressed in a lot of arenas. From the hospital board rooms to nursing organizations, all are involved," said Florence Jones-Clarke, president of the Virginia Nurses Association.
"The legislative branch is looking at what they can do. I think things are happening. People are listening. . . . We are trying to address school enrollments and how we can make the profession attractive once again to young people in middle school and junior high. That is where it needs to start."
Carol Crosby, vice president for patient care for the Virginia Commonwealth University Health System, is involved.
"One of the things we have recognized is that we basically have to advertise to very young people, in grade school," Crosby said. "We really need to tell people how wonderful a career in nursing is. High school is too late to start telling them."
Dr. Barbara Brown of the Virginia Hospital and Healthcare Association said many of the strategies being tried this time around have been in place for only a few months, so it's too early to say whether they are having an impact.
For instance, one health system in Southwest Virginia raised base salaries for certain nurses, and when raises were announced, some nurses actually saw significant salary increases.
"The program has not been in place long enough to evaluate its effect," Brown said.
Efforts also include developing a Nursing Workforce Data Center that would provide a truer picture of the nurse employment picture in the state.
Dr. P.J. Maddox, a George Mason University researcher working on the project, said, "There is no place to go to get really good, regionally, geographically specific, market-specific data. We need to answer if rural is different from urban, if hospitals have it better than long-term care, if the shortage is in pediatric nursing or operating rooms. We don't have good data that is community-specific."
Nurse managers don't need data to tell them they don't have a staff nurse to work a 3 to 11 p.m. shift. They need nurses now and are trying a little bit of everything to attract nurses and keep those they have.
Incentives. Sign-on bonuses worth thousands of dollars, in-house reward and recognition programs, and retention bonuses to keep existing staff happy.
Collaboration. Health-care facilities working more closely with schools.
Agency help. Facilities hire temporary agency nurses to come in for anything from a single shift to several months.
Working conditions. Offering flexible schedules and on-site day care, mentoring new graduates.
Overseas recruiting. Administrators have gone to Canada, the Philippines and Mexico looking for nurses.
At Virginia Commonwealth University's Medical College of Virginia Hospitals, Crosby said, three full-time nurse recruiters scour the international market, including the Philippines and the Middle East, as part of overall recruiting.
"We have several groups interested in coming here to work," Crosby said. The delay is the immigration process.
"We have made application for these nurses to come here. There is a 12- to 18-month wait via the green card. We have also been to Canada to recruit. They are about as short as we are."
Many facilities are trying to lure nurses before they even get in the market for a job. Bon Secours and MCV Hospitals have scholarships and loan payback programs in which they repay student loans for nurses who agree to work for them.
These incentives appear to be having an impact. Educators at area nursing schools say they are getting more applicants.
"We are at full capacity and even have people waiting, because we don't have enough faculty," said Barbara Laird, John Tyler Community College nursing program coordinator.
The program takes 40 new students a year in the weekday registered nurse program and 20 students a semester in a weekend program for licensed practical nurses pursuing registered nurse credentials.
Bon Secours had 50 students start its program last year but doubled that to 100 this year to accommodate the demand and the health system's needs.
The glitch for the community colleges is accommodating the demand. Getting additional faculty is a problem at J. Sargeant Reynolds Community College, which also has a waiting list of nursing candidates, said nursing program director Fran Stanley.
"We have not expanded capacity. We have not been able to do that because of faculty positions. Nursing is a very expensive program," Stanley said. "They don't throw faculty our way very often."
Another catch: Nurses with the required master's degree needed to teach at the college level can usually demand even higher salaries in clinical settings. Educators say this exacerbates the problem.
Maddox said the profession can also stand some image work. The message out now is that there are across-the-board shortages and that everyone is unhappy.
"I think we lack a unified, coherent message that breaks down the various aspects of this profession," she said. "There are different careers and different education and career tracks. We are not doing a good job of communicating with one voice or a consistent message."
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