Nursing staffs shrink

quality, availability of medical care suffer

Shortfalls cyclical, but current situation is worst in many years

March 19, 2000|By Diana K. Sugg | Diana K. Sugg,Sun Staff

As hospitals and nursing homes across Maryland cope with one of the worst nurse shortages in many years, they've been forced to close beds, turn patients away and scramble to find temporary nurses.

Some physicians and nurses at hospitals around the state say they believe the quality of care is eroding. They say some patients have to wait too long for pain medication, while others in intensive care units are not getting the close attention needed to monitor their condition or prevent infections.

While hospital officials disagree that quality is suffering, they acknowledge that there is no longer time for compassionate care -- like brushing the teeth of an incapacitated patient or calming an anxious one.

The shortage is forcing administrators to patch together solutions to their staffing problems.

"It's having a dramatic impact, and it's likely to get worse," said Dr. John Burton, director of geriatric medicine at Johns Hopkins Bayview Medical Center.

"We're headed for a crisis."

At a small hospital in Southern Maryland, nurses went on strike Thursday, complaining of chronic staffing shortages. While officials at Civista Medical Center in La Plata say understaffing occurs only rarely, nurses on medical-surgical floors have been taking care of 10 to 12 patients each, an unusually heavy load.

In the Baltimore area, Johns Hopkins Hospital has had to close as many as 10 of the 44 beds in its neurology and neurosciences area, because it doesn't have the nurses to safely staff them.

"People have come in for elective surgeries and been sent home," said Heidi Zhang, 31, a nurse at Hopkins for 13 years. "I've never seen anything like this."

In Maryland, as in other areas around the country, the deficit started a few years ago in more specialized units such as emergency rooms, critical care and operating rooms, but in the past several months, it has spread to general medical-surgical floors.

Nurse vacancy rates in hospitals are running about 10 percent to 12 percent, at some hospitals as high as 20 percent. According to the state Board of Nursing, from 1998 to 1999, the number of registered nurses available for work dropped by about 2,300.

Hospitals and nursing homes are paying overtime and higher salaries, adding extra benefits such as tuition or day care costs, or hiring nurses from overseas.

In some cases, managers are bringing in higher-skilled nurse practitioners or creating new "customer services" positions to ease the strain on nurses. Many specialized units that would never have considered new nursing graduates a few years ago are hiring them -- and having to train them.

'Make your own deal'

"You can make your own deal just about anywhere as a nurse," said Katherine McCullough, who oversees patient care services at University of Maryland Medical System.

Nurse shortages are cyclical, but because of a confluence of forces, this one is much worse than those in the past.

That's because as hospitals struggled with cost pressures in the 1990s, many RNs were laid off and replaced by lesser-trained personnel. Others have been leaving hospitals and nursing homes -- with their evening and weekend shifts and hard physical labor -- for new positions in schools, home health and managed-care plans.

Many prefer working for temporary agencies, where average hourly pay is about $35 or more, almost double what hospitals pay.

Many others will retire in the coming years. A Harvard study found that about half the country's nurses are in their 50s. There aren't nearly enough people to replace them, because enrollments at nursing schools are dropping as women pursue more lucrative careers.

But the demand for nurses is increasing because the population is aging, patients are sicker, and they need more complicated medical equipment. By 2015, federal statisticians estimate, 114,000 nursing positions will be unfilled nationwide.

Making matters worse, the good economy has contributed to a severe shortage of nursing assistants.

"We keep looking for the end of the tunnel," said Karen Haller, vice president for nursing and patient care services at Hopkins. Two years ago, she had to hire temporary nurses to help six units. Now, she needs them in 30 units.

To address the shortage, state Sen. Paula C. Hollinger, a Baltimore County Democrat, is pushing emergency legislation in the General Assembly that would establish a permanent nursing task force to develop solutions such as state-funded nursing scholarships.

"It's a crisis from every angle," declared Hollinger, a nurse, who, while not practicing now, has received a blizzard of mail from hospitals and other facilities promising $3,000 signing bonuses and other incentives.

Little public data exists on quality of care in hospitals, but officials from more than a dozen institutions across Maryland report that they are tracking such indicators as falls, hospital-acquired infections and medication errors, and that they have not seen any decline in quality.

Baltimore Sun Articles
Please note the green-lined linked article text has been applied commercially without any involvement from our newsroom editors, reporters or any other editorial staff.