Nurse shortage turns critical
Graying of America increases need at time when interest is waning.
By Gregory Weaver
September 17, 2001
All the symptoms of a national nurse shortage are striking Indiana hospitals.
Urban facilities in Indianapolis, Fort Wayne and Lake County report that up to 12 percent of their critical-care nurse positions are vacant -- more than double the rate of five years ago.
Registered nurses across the state report they are being asked to work overtime and outside their medical specialties to pick up the slack.
And some hospitals are offering sign-on bonuses of up to $14,000 just to get more nurses on staff.
While local hospital executives acknowledge the situation is a challenge, they quickly note it's not nearly as bad as the 18 percent vacancy rates being reported in popular retirement areas in Arizona, California and Florida.
"The overall statewide vacancy rate for nursing is at 7 or 8 percent -- about the same level we were at during the last big shortage 13 or 14 years ago," said Bob Morr, vice president of the Indiana Hospital and Health Association.
"There are always cyclical shortages. But everyone is saying that this shortage is different. That it's going to be more difficult to solve."
The situation promises to worsen as America's aging population continues to swell, the number of nursing students shrinks and nearly a fifth of the nation's 2.7 million RNs prepare to retire by 2006.
One of the health care industry's biggest challenges is holding on to existing nurses.
Nationally, the average age of active registered nurses is 45. And some don't relish the possibility of retiring in high-stress critical-care units, where the frequent moving of patients can cause back injuries and other ailments.
Among them is Karla Monroe, a 46-year-old critical-care nurse at Union Hospital in Terre Haute.
She said she enjoys her work but is tired of the periodic requirements to work overtime to fill in vacancies on the night shift.
"I won't be able to retire from there because it is very demanding physically and emotionally," said Monroe, who is pursuing a master's degree in management at Oakland City College.
She may use the degree to land a better job in health care or business.
Likewise, Michelle Fouse of Shelbyville left full-time bedside nursing to become an advanced nurse practitioner in a clinical setting.
"Most hospitals are usually short-staffed, and there's always stress if you don't have enough people," Fouse said. "Now I can spend more time with the patients and maybe look at them from a more holistic view."
At the other end of the spectrum, fewer recent high school graduates are choosing nursing as a profession.
Nationally, total enrollment in programs leading to bachelor's degrees in nursing is down 4.6 percent -- the fifth consecutive yearly drop, according to the American Association of the Colleges of Nursing.
In all, collegiate nursing schools report more than 5,000 vacancies in their bachelor's programs.
At the University of Indianapolis, enrollment in the School of Nursing dropped to 78 this year after reaching a high of 350 in 1993.
Sharon Isaac, the nursing school's dean, attributed the drop to a decrease in America's college-age population and growing career opportunities.
"Women no longer have to look at just nursing or teaching as a career," she said. "There's law school or medical school. Lots of other opportunities are out there."
The decreased interest is worrisome at a time when the demand for nurses is expected to explode to serve the needs of a graying America. According to the Bureau of Labor Statistics, 450,000 additional registered nurses will be needed to fill the present demand through the year 2008.
Isaac said those numbers represent tremendous opportunities for nurses, who now earn an average of $46,781 a year. But the shortage also presents increased stress for new nurses entering the work force.
"It's hard right now because there aren't enough nurses to do the work," she noted.
Hospitals are doing what they can to lessen the load and bring more nurses on board.
In April, Wishard Hospital upped the ante, offering sign-on bonuses of $14,000 to experienced RNs willing to work in critical-care units. That's more than double what most area hospitals offer.
Clarian Health, which operates the Indianapolis hospitals of Methodist, IU and Riley, has chosen to give $5,000 bonuses to current staff numbers who successfully recruit new nurses to those facilities.
Karlene Kerfoot, Clarian's senior vice president for nursing, said the organization uses a variety of approaches to cover shift vacancies so nurses don't feel too put upon.
Sometimes nurses are asked to work an extra shift, Kerfoot said, but Clarian hospitals also use temporary and "traveling" nurses to help fill the void and ensure quality patient care.
Demand for such nurses is rising across the country. Nursefinder Inc., a staffing agency, reported that business increased 25 percent last year.
Still, mandatory overtime for staff nurses has become an increasing concern across the nation.
"Many places aren't calling it mandatory overtime. They are using more subtle techniques," said Ernest C. Klein Jr., director of the Indiana State Nurses Association. "But it's still burning people out."
Nation: About 18 percent of the 2.7 million registered nurses with current licenses no longer are working in the profession.
Indiana: Of the 76,727 registered nurses with current state licenses, about 23 percent are not actively employed in nursing.
Aging work force
Nation: Average age of a registered nurse is 45.2. In the past 20 years, the percentage of nurses under 30 decreased to 9 percent from 26 percent.
Indiana: About 42.7 percent of RNs are 45 or older.
Nation: Job growth in nursing will place it among 10 fastest-growing occupations by 2006. By 2020, the supply of RNs is expected to be 20 percent short of the demand.
Indiana: Total jobs for RNs are expected to grow 12.4 percent by 2006.
Nation: Women graduating from high school in the 1990s were 35 percent less likely to become RNs than women who graduated in the 1970s.
Indiana: A recent survey of high-achieving high school graduates shows they rarely express an interest in nursing.
Source: Nursing Workforce Summit
Seeking a solution
Dozens of health care executives, educators, lawmakers and nurses will gather in Indianapolis today to try to find solutions to the state's nursing shortage.
"We know the situation here is not like it is in California and Arizona," said Barb Mitchell, an organizer of the event. "But we want to get ahead of it before it reaches that point."
About 150 people from the health care industry have been invited to attend the Nursing Workforce Summit today in the Clarian Conference Center at Methodist Hospital.
Among the summit's goals are:
Devising ways to collect data that allow for accurate projections of the state's nursing needs.
Developing programs that project a positive image for nursing as a career.
Exploring ways to make health care facilities "employers of choice."
Contact Gregory Weaver at 1-317-444-6415 or via e-mail at firstname.lastname@example.org