Nursing in Dallas

[EricTAMUCC-BSN, BSN, RN]

From The Dallas Morning News archives http://www.dallasmorningnews.com

Diane Barnet: Nursing 'shortage' is created by working conditions

04/19/2002

By DIANE BARNET

Judging by all of the stories about desperately understaffed hospitals, one would think there aren't enough nurses. The health care industry claims the average hospital falls short of the nursing staff it needs by at least 10 percent.

In an effort to attract nurses, many facilities now offer signing bonuses, attempt to coax nurses out of retirement and recruit them from abroad. The public is led to believe nurses are in short supply.

Wrong! Or, at most, only half-true. There are plenty of registered nurses in this country - they just aren't working in hospitals. They work for insurance companies, become malpractice paralegals or sell real estate.

According to the State Board of Nurse Examiners, of almost 169,000 registered nurses in Texas, only 83,000 work in hospitals. The same is true of the state's 75,000 licensed vocational nurses, who supplement registered nursing staffs.

Nurses are distancing themselves from hospitals. They have their reasons. They have heard the stories. They know the "shortage" is in part an artificially created one caused by deteriorating working conditions. Those conditions result from management goals that include maximizing profits for shareholders. Fair enough!

But business school management techniques that work in the average "widget" factory are less easily applied to health care facilities. For-profit health care corporations have created a vicious circle. By freezing salaries, keeping staff numbers low and hiring foreign nurses, hospitals can better meet their financial goals. The average registered nurse in Texas earns $32,000 to $35,000. But when underpaid, overworked and disillusioned nurses desert hospitals, conditions spiral further downward.

The public often is unaware of the factors behind the "shortage" and how valuable nurses are. Nurses are the frontline of defense for patients. They administer potentially lethal medications, detect subtle changes in patients' conditions that signal complications and determine whether doctors' (often illegible) orders are appropriate.

The work is physically hard and fraught with risks and employer abuses. For instance, some hospitals now require mandatory overtime of their nurses. Cost cutting means each nurse has to do more for a larger number of patients in less time. Yes, a nurse can deliver a high standard of care to five patients. But when he or she cares for eight or 10 patients, the amount of time and the level of care are limited and the risk of adverse results increases. An exhausted nurse could inadvertently become a murderer. As a result of such challenging working conditions, nurses jump ship to nonhospital work and other professions.

Recent measures taken to attract more students to nursing school programs are only part of the solution. Many graduates will leave hospitals once reality hits them. Nor are young people as interested in nursing careers as they once were, given today's many other options. Nursing schools also lack enough teachers to graduate a healthy supply of nurses.

The aging boomer generation will create a huge demand for qualified nurses. Where will they come from? Greater respect and recognition from management and the public might help to recruit and retain nurses. Such help includes better salaries, adequate staffing and a change in the sitcom image of nurses. In the meantime - if at all possible - I plan to stay out of hospitals, both as a nurse and as a patient.

Diane Barnet is a former nurse who lives in Austin.

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Hospital boom intensifies need for more nurses

Collin County growth means the scramble to fill jobs will increase

11:52 AM CST on Monday, December 1, 2003

By ED HOUSEWRIGHT / The Dallas Morning News

Carrie Wood has the kind of job security many people would envy.

She's a nurse, at a time when hospital administrators nationwide are scrambling to find and retain nurses.

"One of the luxuries of the nursing shortage is, you get a pick of what you want," said Ms. Wood, 30, who has been a nurse almost three years, all at Presbyterian Hospital of Plano.

In booming Collin County, the nurse shortage is likely to get even worse. Several hundred hospital beds will be added when new facilities open as major health-care firms scurry to keep up with the exploding population.

"We have some concerns that there will be adequate staff available," said Mary Jo Dean, vice president for marketing and strategic planning at Medical Center of Plano, the city's oldest and largest hospital. "We're going to do everything we can to maintain the staff we have."

Plano is the epicenter of the hospital growth.

For instance, Baylor Health Care System is building a 128-bed hospital and adjoining medical office building off Preston Road that's scheduled to open late next year. Presbyterian Hospital of Plano, the city's second-largest hospital, is adding 160 beds. Richardson Regional Medical Center recently broke ground on a Richardson complex that could eventually have 500 beds. And Children's Medical Center plans to start on a Plano hospital next year with up to 96 beds.

Elsewhere in Collin County, a 182-bed hospital is slated to open in June in Frisco, the county's fastest-growing city. Presbyterian Hospital of Allen and North Central Medical Center in McKinney also have begun expansions.

"The more hospitals that open, the more need there will be for nurses," said Dr. Nell Ard, director of nursing at Collin County Community College District, which received 265 applications for 60 student slots this fall. "It will be good for students."

Good fortune for nurses, however, means staffing headaches for hospital administrators. In the next few years, more than 1,000 nurses will be needed to staff the new facilities, said Jerry McMorrough, vice president for human resources at Medical Center of Plano.

The 427-bed hospital has a nurse vacancy rate of about 10 percent, down from as high as 25 percent, he said.

"When you bring a new facility into an area, you're looking at new equipment and a brand new environment," Mr. McMorrough said. "That's always appealing to people. It's not just clinical people. New hospitals will require management teams, housekeeping services, food services people, nursing assistants - it just goes on and on."

Children's Medical Center of Dallas has eyed Plano for several years as a site for a pediatric hospital, said Christopher J. Durovich, president and chief executive officer. The new hospital, which is expected to draw from Collin and six surrounding counties, is scheduled to open in 2006.

This year, almost 30,000 children from that region will receive services at Children's in Dallas, Mr. Durovich said.

Hospitals must "balance the need for more beds with how well you can staff them," he said.

"Quality of patient care is not exclusively about the bed," Mr. Durovich said. "It's about the caliber of people that provide the care. All health-care organizations are continuing to seek to identify creative ways they can attract and retain nursing talent."

Mr. Durovich said the new Plano hospital, to be called Children's Medical Center Legacy, won't compete directly with other hospitals for nurses.

"We know from experience that people specifically choose a pediatric hospital to work in," he said. "Children's health care is unique. You have pediatricians and pediatric subspecialists who are specially trained to treat children."

Presbyterian Hospital of Plano, with 231 beds, has few nursing vacancies now, said Eileen Hoffman, director of nursing.

"There's always need based on turnover," she said. "We will have greater need when we add 160 beds. We need to keep focusing on creating a culture to retain our employees. There will be a challenge of them going to the new facilities."

Health-care officials agree that more hospital beds are needed in Collin County, one of the state's fastest-growing counties. From 1990 to 2000, the population grew 86.2 percent to 491,675, according to the U.S. census. Since 2000, the county population has risen an additional 17.4 percent to 577,100, estimates show.

The need for more hospitals is occurring simultaneously with one of the country's most severe nursing shortages, officials say. The current downturn in supply began around 2000 and is expected to linger for the foreseeable future.

The nurse shortage is fueled by an aging population that has more health-care needs, older nurses who are nearing retirement and a drop in nursing school enrollment, experts say.

"The current nursing drought is not like previous shortages," according to a report last year by the Robert Wood Johnson Foundation, which funds health-care research. "It is about to get worse, and the tried-and-true solutions of the past are unlikely to solve it."

The nursing shortage is a "major factor in emergency department overcrowding, cancellation of elective surgeries, discontinuation of clinical services and the limited ability of the health system to respond to any mass casualty incident," says a study last year by the Joint Commission on Accreditation of Healthcare Organizations, which monitors hospitals.

Some hospital firms are stepping up recruitment efforts nationally and overseas, giving sign-on bonuses to nurses, offering part-time and flexible shifts, and providing scholarships to nursing students.

"In both nursing and the other health sciences, we have established pipelines on a national basis," said Jean Francis, senior vice president for patient care services at Children's Medical Center of Dallas. "We're not just relying on the Texas schools."

Hospitals expect to occasionally lose nurses to rival facilities, said Fiona Macleod Butts, director of employment for Baylor Health Care Systems.

"We hire from existing hospitals all the time," she said. "Each hospital works very hard to retain nurses, but for various reasons nurses will move around. We don't sit in the parking lot and lure nurses. Through advertising, career fairs, open houses and that kind of thing, we advertise what the opportunities are. If a nurse is interested, they would come over."

Hospital executives say they are working hard to increase the supply of nurses.

"In this last year, we invested in a program for clinical professionals ... to go to local schools to talk about the excitement of a career in health care," Ms. Butts said. "There's a lot of scholarship money available through the government. We work extremely hard to get as much of that money as possible. Last year, we managed to get a ... grant to provide to our current employees to become nurses."

Julia Lankes of McKinney picked a good time to go into nursing. She's in her second year at Collin County Community College District and will graduate in May with an associate's degree in nursing. She has heard of all the new hospitals being built in the area.

"I feel like the doors are wide open to about anywhere we want to go," said Ms. Lankes, 39, president of the Collin Nurses Student Association. "I love knowing I can go anywhere in the country and get a job."

E-mail [email protected]

[Hellllllo Nurse, BSN, RN]

Everyone needs to read this article!

The second article, however, (by Mr Housewright) is a big steaming pile of BS.

[mattsmom81]

I agree Helllo...Barnet's article is right one.....think I'll write her and encourage her to keep up the good reporting!!Sorry I missed it the first time around.

Thanks for posting this!

I have 'heard' there is no nursing shortage in Austin so I voted for Austin with that in mind...although I have zero firsthand knowledge.

[JuicyJem]

I agree that the article about the shortage in Collin County is a huge pile of BS. I applied to every hospital in Collin County, where I am originally from, to work as a GN. I applied on line, called, faxed, and was not given the time of day.

I have been told by others who went to school there that you have to be a student and doing clinicals in the hospitals there to get a job, and you have to know people. I did have interviews in Dallas county but they did not turn out any offers. Just my opinion, I know I don't know a lot because I am a new grad, and I went to school in Lubbock. But I did give every effort to finding a job in that area because when I started nursing school, everyone said "Oh, you can work ANYwhere you want to." Now isn't that the overstatement of the century. There are options, I guess you just have to have more experience.