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April 23, 2002, by Ryan Alessi
The many sides of a nursing shortage
Amid the beeps and blips of medical machines, Kara Coullard calmly takes a needle and injects it into her elderly patient's vein. The fluid is supposed to rush through the woman's bloodstream to trace how swiftly her struggling heart is pumping.
The patient just had her chest opened for double-bypass surgery. A team of doctors had delivered her to Coullard in the George Washington University Hospital's intensive-care unit only a few hours before.
It was just the second heart patient Coullard had worked on, even though she has been in the intensive-care unit since she graduated from nursing school two years ago.
"I was very nervous," Coullard said, glancing over at the monitor of numbers and zigzagging vital signs. "I said, 'Oh no, I don't know if I can take it.' The doctors said, 'Oh, we'll be right there to get you started. You'll do fine.' "
Then they left the woman's life in Coullard's hands.
It's routine that once a procedure is finished, doctors rush off to the next. Their time is spread thin. It's the nurses who hold patients' hands, keep an eye on all those vital signs and rush to bedsides for special needs.
But the nation's aging nursing corps has faced its own needs in the last decade. Hospitals have been bound more closely to their bottom lines, largely because of managed-care organizations. And nursing schools haven't been churning out enough new nurses to replenish the work force.
As a result, some health officials fear that the decline in nurses over the last few years is only the beginning of what could be a 20-year shortage.
"We've had shortages before," says Rep. Lois Capps, a California Democrat who is a registered nurse. "But we could see the signs a few years ago that it was not a quick downturn - not part of a cycle. And it's becoming critical for many hospitals across the country."
Last summer, the American Hospital Association estimated that U.S. hospitals have a combined 126,000 nursing vacancies. Three out of every four open positions at a hospital is in nursing.
In addition, the average age of nurses has risen steadily over the last 15 years to more than 43 years old, meaning a higher percentage of nurses will begin retiring over the next decade. At the same time, the U.S. Department of Labor predicted in November that demand for nurses will rise 21 percent between 1998 and 2008, in large part because of the aging population's need for health care.
To stem the nationwide shortage, the government, a few schools and some health-care companies have begun campaigns to drum up more interest for the profession and offer incentives for people of all backgrounds to don scrubs.
Capps, who was a school nurse for 20 years before coming to Washington, is pushing Congress to pass her bill, which would provide federal funds to pay for nursing scholarships, training of more nursing instructors, public service announcements for the profession and programs in schools to nudge young students toward nursing.
Different versions of the bill, which was introduced last April, have passed in the House and Senate. Now a team of legislators is wrangling over which parts will become law. Among the biggest questions: whether to provide money for nursing faculty development, whether to pay other stipends for nursing students and whether to fund residencies for specialized nurses.
Corporate giant Johnson & Johnson sponsored television ads featuring nurses from around the country collectively explaining why they do what they do. The ads began airing in February. The company also hosts a Web site, http://www.discovernursing.com, which includes a database of grants and scholarships for prospective nursing students, as well as a listing of nursing programs across the country.
"That's a start," said company spokesman John McKeegan. "But the shortage of nursing (instructors) is just as severe."
It is one of many threads that has been unraveling from the tapestry of America's nursing corps.
Because nursing classes must be kept small - one instructor per 15 students at most - schools must hire more faculty members before admitting more students. As a result, many nursing programs have waiting lists one or two years deep.
On the other end of the spectrum, some nursing schools can't find enough students. Overall, the American Association of Colleges of Nursing reports enrollment in entry-level nursing programs dropped from 127,683 in 1995 to 106,557 last year.
Sue Dachenhaus, an administrator at San Marcos High School in Santa Barbara, Calif., knew nurses were in high demand. All she had to do was go down the street to Santa Barbara Cottage Hospital to see that.
In May 2000, she and other teachers from San Marcos trekked to Bakersfield to visit a health academy for high school students, which sits across the street from a Kaiser Permanente facility. "We decided we could do something like that in our school," Dachenhaus said.
Last fall, 10th- through 12th-graders became the first San Marcos students to parti
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Contact Ryan Alessi at AlessiR (at)
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