This report really does not say anything new, however it does point to the reality that there are nurses out there, but unwilling to work in the conditions in existence today.
Nurses in Demand: A profession in turmoil
This time, experts say, shortage is for real
BY TAMMIE SMITH
When Capitol Medical Center closed, the nurses who lost their jobs didn't have to miss a day of work, administrators said.
The Virginia Hospital & Healthcare Association, with input from the Virginia Organization of Nurse Executives, the Virginia Partnership for Nursing and the Virginia Health Care Association, surveyed hospitals last year about the nursing work force.
The survey found there were 21,091 budgeted positions for registered nurses in Virginia hospitals. Of those, 13 percent (2,811) were vacant.
There were 2,419 positions for licensed pratical nurses in hosptials and 3,449 positions for clinical nurse aides.
Shortly after the closing was announced, Capitol human resources director Ralph G. Giannola arrived at work to find a stack of messages. The callers - human resources officials at other hospitals, nursing homes and health-care agencies - were after Capitol's kitchen and dietary staff, cleaning workers and unit managers, but especially the nurses.
A shortage of hospital nurses in the region has created almost a bidding war to get staff.
"I had HCA, Bon Secours, MCV, Southside Regional representatives calling me to find out when they could come in and talk to our associates about jobs," Giannola said.
Some longtimers were sad about the facility closing, he said, but none feared being out of work long.
"Nurses feel in demand," he said. "They know they can go out and get another job."
. . .
Every 10 years or so, there are reports of a nursing shortage. It has the ring of a broken record, of crying wolf. Nursing schools are not graduating enough nurses.
Nurses are leaving the profession faster than they can be replaced.
Hospitals are having to rely on expensive temporary help and costly signing bonuses to attract workers, while the regular nursing staff is overworked, which nurses say jeopardizes their ability to adequately care for patients.
And like clockwork, a few years into the crisis, with intensive recruiting, the situation is corrected.
But this time is different, say health-care work force experts. They see several factors converging to make the current problem of finding nurses to work in hospitals longer-lasting and more severe.
Among the factors:
An aging population. Many nurses are approaching retirement age, while the number of younger nurses is smaller and dwindling still.
At the same time, there are more older people, and with age comes illness. According to the U.S. Census Bureau, one in eight Americans is older than 65, 12 percent more than in 1990. And that number is expected to grow as baby boomers age.
Declining averages in how long patients stay in hospitals means those who are hospitalized are sicker, experts say. So a nurse will have fewer "walking and talking" patients, as one nurse described it, but more bedridden patients who need intensive nursing.
"We have had nursing shortages in the past," said Dr. P.J. Maddox, a nurse and former hospital administrator who now directs the Center for Health Policy, Research and Ethics at George Mason University.
"Before, there were always large numbers of nurses on the sidelines, employed part time or not employed," she said. "That means we had a cadre who could be enticed, through wage increases or other working conditions, to consider coming back."
The difference this time, Maddox said, is the aging nursing population.
Based on national work force data, the biggest group of working registered nurses is between the ages 40 and 49. In 10 years, many will begin retiring.
Twenty years ago, about 25 percent of the registered-nurse work force was younger than 30. Today, it is only 9 percent.
"By 2010 is when we will have this crucial gap where we believe we will have a significant national shortage of nurses," Maddox said.
Yet, at present there is some disagreement on whether there is actually a shortage of nurses. Earlier this year, a congressional report examining labor statistics suggested there are sufficient numbers of nurses and that the problem is a "maldistribution of labor."
For example, in some rural areas of Virginia, hospitals near bigger cities might have shortages, but isolated communities might not because there are fewer places to work other than hospitals.
"We are seeing more of a maldistribution at this point," said Dr. Barbara S. Brown, a registered nurse and vice president of the Virginia Hospital and Healthcare Association.
"Facilities are able to fill positions with traveler, float-pool and agency nurses. This would indicate that the number of licenses is there, but folks are choosing to work under different conditions of employment."
Dr. JoAnne Kirk Henry, co-chairwoman of the Virginia Partnership for Nursing, said reports conflict about whether there is a shortage partly because of the way data are collected.
"Some have looked at hospital nursing. Some have looked more broadly at nursing. Only 59 percent of nurses nationally are employed in hospitals. I have a friend who says nursing is a wonderful preparation for a variety of careers. Most nurses start in hospitals but have so many options for how they may practice."
The Virginia Hospital and Healthcare Association will present new survey data this fall, said Henry, who suspects based on what she hears that the situation has worsened since last fall for communities in central Virgina and the Hampton Roads area.
The Virginia Board of Nursing has undertaken a study of the nursing work force. Board records show 83,302 registered nurses licensed by the state. The work force study, due later this year, will provide answers to where these nurses work, information needed for planning.
In any event, although the federal report says no current numerical shortages can be documented, it does suggest a true shortage is looming if corrective measures are not taken.
Already there are glimpses of what a shortage could mean for patient care. Flu season is a busy time for hospitals, and some in the area periodically had to close their emergency rooms to noncritical ambulance traffic because they were full or did not have nursing staff to handle any additional patients. Ambulance patients were not necessarily taken to the nearest emergency room but to the closest one with room.
Hospital administrators say July and August are usually light months, but that has not been the case this year. One week in July, almost every in-patient bed was filled at Virginia Commonwealth University's Medical College of Virginia Hospitals.
"We have done everything we can to make sure whole units are not closed because of lack of staff," said Donna Katen-Bahensky, MCV Hospitals' chief operating officer. "We are doing everything we can to keep every bed open because the demand is so significant."
Physicians may figure out what is wrong with patients, but nursing care is what makes hospitals safe, said Dr. Sean P. Clarke, associate director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing.
"If the shortage continues, there are going to be real problems with availability of services," Clarke said. "In some hospitals, they are having to postpone or delay surgeries. Patients will notice waiting lists develop. When there is really no choice in the matter, such as with emergency admissions, there is really a difference . . . in how quickly people come to your aid."
The shortage of nurses is considered a factor in surveys that look at patient complaints about hospital experiences and reports of medical errors. By now, most everyone has heard the advice to have a family member act as an advocate during a hospital stay. It is not a bad idea, said one part-time nurse whose husband was hospitalized recently.
"Nurses have too many patients to give individual care," the woman said. "If I have too many patients, I cannot give the patient any quality of care. Sometimes you don't even know the patient's name. . . . The patient-nurse ratio is just way too high. Things are going to happen. It's a lawsuit looking for a place to happen, and it's not the nurses' fault."
Contact Tammie Smith at (804) 649-6572 or firstname.lastname@example.org