The latest nationwide shortage in the field of nursing has seen vacancy rates exceeding 10 percent since 1986. Statistics like that make nurses, including those imported through travel agencies, hot commodities today.
In Maryland, the average vacancy rate for budgeted nursing positions in hospitals statewide at the close of 1990 was 11.9 percent, says Richard Wade of the Maryland Hospital Association. That's an improvement over the previous year, when the figure was 12.5 percent, he says.
"It's nothing dramatic," he adds, "but the figures are inching downward."
Indeed, the industry hasn't been sleeping through the latest crisis, says Joan Meehan of the American Nurses Association. Hospitals and other employers have dramatically improved salaries and other incentives, including improvements in tuition reimbursement, flexible scheduling, assistance with non-nursing
tasks and pension plans. But still the shortage exists.
For many hospitals around the country -- including Johns Hopkins, University and Sinai in Baltimore -- part of the answer lies in hiring temporary help in the form of "travelers." In fact, 20 percent of the hospitals in Maryland have used travelers at some point in the last year, says Wade.
"The reality of managing a work force of 1,200 people, particularly 1,200 younger people in their child-bearing years, is that we will have pockets of people relocating," says Sharon O'Keefe, vice president for nursing at the University of Maryland Medical System. "Hiring traveling nurses is a good way to access temporary personnel for a short period."
At University, where 15 travel nurses are currently on the payroll, the most recent crop was hired "to tide us over the summer," says O'Keefe. In addition, the hospital recently opened two new intermediate care units -- in general surgery and cardiac care -- that required a boost in staff.
The fact is, says Meehan, that changes in health care have increased the need for nurses, so that while the number of people going into the profession may be growing, the need for them is growing faster.
"This is a demand-driven shortage." And the demand, she says, is threefold: The population is growing more elderly; people who stay in hospitals today are sicker on the average than they used to be; and high technology is keeping very sick people alive longer, requiring more critical care.
At Sinai, travelers are used in two critical care units and two medical-surgical units, says Elizabeth Dougherty, an associate director of nursing. She says Sinai has been combating a nursing shortage about three years now, but that the situation is improving, thanks to some changes the hospital has initiated.
Among other things, Sinai has expanded opportunities for promotions while encouraging people to remain in bedside nursing. "There has also been more attention paid to other institutions, to keeping our salaries in a competitive range," she says.
The ANA reports that the average starting salary for a registered nurse nationwide in 1990 was $24,768. In Maryland, a survey completed in April 1991 showed that the average salary for all nurses working in Baltimore and the five surrounding counties was $32,500, says Wade.
In addition to travelers, most hospitals also rely on local agencies for temporary nursing help. These nurses, however, can be contracted for only a day or two at a time and are better at serving last-minute needs, says O'Keefe. Travelers, on the other hand, usually work a minimum of 13 weeks in one place, and often contract to extend their stays.
"They are experienced and committed to your organization for an extended period of time," she says. "They get to know your systems, procedures and personnel. Some even decide to stay."