Nurse shortage hampers hospitals and home care

One executive calls situation the problem of the next 10 years

March 21, 2001|By Roni Rabin And Carol Eisenberg | Roni Rabin And Carol Eisenberg,NEWSDAY

ATLANTIC BEACH, N.Y. - Missy Miller's fear is that she'll sleep through an alarm, one of the beeping, buzzing alarms signaling that her baby boy's blood pressure dropped, or his heart rate slowed, or that, in his sleep, he forgot to breathe.

So at night, after caring for him all day, Miller drags a pillow and a blanket into 14-month-old Oliver's room and camps out by his crib.

She cannot find a night nurse, not for love and not for money. And not for lack of trying.

"I called six or seven agencies," said Miller, 36, of Atlantic Beach, who quit working to care for Oliver, who was born without the ability to regulate his autonomous nervous system. "One actually did take my name and number. ... The others said, `Check back in a few months, but right now we don't have any, and we don't foresee having any.'"

Miller has run up against a crisis that is emerging as one of the most confounding health care problems to hit the nation: a profound shortage of registered nurses that comes as the aging population's demand for nursing services soars. With a broader range of opportunities available to young women, and experienced nurses inching closer to retirement, hospitals, nursing homes and home care agencies that serve families such as Miller's face huge difficulties recruiting and retaining registered nurses, and to a lesser extent, licensed practical nurses and nurses' aides.

And unlike previous nursing shortages that tended to be cyclical in nature, remedied through quick fixes like higher salaries, most experts say this shortage will get worse before it gets better - and that dire consequences will follow unless changes are made.

"I believe this is the issue in health care for the next 10 years," said Daniel Sisto, president of the Healthcare Association of New York State, a trade group of more than 500 health care facilities. "It will supersede other issues, as more and more of the public find themselves unable to access care when they need it."

That is happening already. The impact is being felt in settings as diverse as hospitals, nursing homes, home health care agencies and hospices.

Difficult to quantify

The extent of the nursing shortage is hard to quantify, but many hospital officials say vacancy rates of 10 percent for registered nurses are not unusual, and that it can take three months to fill specialized positions in surgical or intensive care units.

The shortage has driven some employers to desperate measures, including recruiting abroad. Others are beefing up salaries and offering in-house training.

Home care agencies have been using telemarketing techniques to drum up registered nurses, targeting nurses who live within the vicinity of a patient who needs care and trying to persuade them to take the case.

The root causes of the crisis are complex, but researchers point to two ominous and converging trends: a nursing work force that is aging at more than twice the rate of other occupations in the United States, and a plummeting number of new nursing school graduates.

In 1983, the average nurse's age was 37; By 1998, it was 41, according to a study published in the Journal of the American Medical Association last year. (The average age of other workers increased by less than two years during the same time.) The number of working nurses under age 30 dropped from 419,000 to 246,000 - by 1998, only 12 percent of nurses were under 30, compared with one-third of nurses in 1983.

Pressures on profession

Several developments have encouraged nurses to flee the profession, said Peter Buerhaus, author of the JAMA study and senior associate dean for research at Vanderbilt University's School for Nursing. In the 1990s, hospitals laid off thousands of nurses in response to market pressures, hoping to replace them with cheaper aides. They soon abandoned those plans, realizing that hospital patients were growing sicker and older than before, and that registered nurses were essential.

By then, however, the economy was booming. Married nurses whose spouses were doing well found it easy to leave their jobs. Others, embittered by changes that increased their workload and seemed to disparage their skills, looked elsewhere for opportunities. Some left the bedside to work for managed care companies; others left to become massage therapists, financial consultants, Web page designers.

The exodus took on a life of its own: As more and more nurses abandoned bedside care, those who remained behind saw their patient loads increase and their stress level and burden of paperwork mount.

By 2020, if current trends continue, the nation will be short some 400,000 nurses, Buerhaus said.

"There are potential problems regarding access to care and quality of care," Buerhaus said. "We're just not going to have nurses around, and there just aren't good substitutes for nurses."

And throwing money at it is unlikely to solve the problem this time around, experts say, both because there are no nurses being trained and because financially strapped hospitals cannot afford to raise salaries to the dominant labor force in their facilities.

Instead, hospitals and other providers are trying to reach out to young people in high school to nurture interest in nursing careers, burnish the image of nursing and develop scholarship and grant programs to entice young people.

But these types of programs will take years to bear fruit. In the meantime, greater shortages loom.

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