Budget crisis a setback for industry on the mend

Nursing: As student enrollment picks up, the shortage shifts to nursing instruction, which is being squeezed by a lack of funding.

March 01, 2003|By Timothy B. Wheeler | Timothy B. Wheeler,SUN STAFF

It's the best of times -- and one of the most frustrating -- for Maryland's largest nursing school.

Once-lagging enrollment is climbing again at the University of Maryland School of Nursing, offering a glimmer of hope for addressing the shortage of nurses here and nationwide.

But the state budget crisis has handcuffed the school because it can't hire enough faculty to keep up with the demand, says Janet D. Allan, the school's new dean.

This semester, with midyear applications jumping 10 percent over the fall term, the school was forced to limit its undergraduate classes to 749 and turn away 101 qualified applicants.

There just aren't enough teachers to handle the influx, Allan says, and if state funding is cut further, instructors may have to be laid off, forcing a reduction in enrollment.

"What's kind of frustrating is we've really seen enrollments in our undergraduate program turn around," she says. "We're caught in the squeeze of not being able to admit qualified students."

The fiscal pinch on Maryland's pipeline for new nurses couldn't come at a worse time. Nationwide, as many as 125,000 nursing jobs are unfilled, with hospitals reporting nursing staff shortfalls of 12 percent to 14 percent. By the year 2020, experts predict, the shortage could grow to 800,000 nurses.

In Maryland, 2,000 positions representing 15.6 percent of all registered nursing jobs went unfilled in 2001, up from single digits just a few years earlier. State lawmakers took note of the problem three years ago by forming a commission to seek solutions to what it deemed a "crisis." But its report isn't due until 2005.

Meanwhile, hospitals are stepping up efforts to attract nurses by offering signing bonuses, flexible work schedules, scholarships and recruitment overseas. Advertising campaigns -- including a $20 million nationwide campaign paid for by Johnson & Johnson -- are inviting women and men to investigate the profession.

The federal government has also offered help. Congress last month approved $15 million to provide scholarships, loan repayments and grants to train nurses and nursing instructors.

But UM's nursing dean -- who arrived in Baltimore in August after a career on the West Coast and in Texas -- says new approaches may be needed. Nursing isn't the only health-care profession with staffing problems, Allan notes, pointing to a severe decline in pharmacists.

"We've had nursing shortages in the past," she says, "but this is a very different kind of problem. ... This is not a nursing issue; this is a public health problem."

The consequences for the public were emphasized in two recent studies that linked hospital infection rates, health complications and even patient deaths to staffing levels.

Staffing has been slashed so badly in some hospitals, Allan says, that "I've had students say, `I'm afraid to go to work.'"

While Allan hopes Maryland's budget squeeze will ease in a year or two, and that federal funding will help, she warns that nursing schools may never be able to provide enough graduates to fill the need.

"We're not going to catch up in terms of having the number of nurses for our population. We've lost that battle. We really have to look at how we deliver care," she says. "We have to revolutionize how we utilize nurses."

One approach may be to reinvent the nurse's role in health care, reducing the amount of paperwork and "fetching" they do in favor of direct patient care. She hopes to keep the University of Maryland, which produces 41 percent of the state's nurses, in the vanguard of that revolution.

Founded in 1889 by a student of the legendary Florence Nightingale, UM is ranked among the top nursing schools in the country by U.S. News & World Report. (UM comes in 10th and Johns Hopkins fifth in the largely subjective ratings by health professionals and educators.)

The school offers bachelor's, master's and doctoral degrees and boasts pioneering programs in environmental health and "informatics," using computers to improve patient care.

"They've expanded my horizons," said Beverly Meadows, 55, of Rockville who works full time at the National Cancer Institute while studying for her doctorate in nursing. She earned her bachelor's degree from UM in 1969, then returned in 1984 for a master's. UM also offers online classes, giving 97 nurses working elsewhere a chance to advance their education.

Allan, who came here after five years as nursing dean of University of Texas Health Science Center at San Antonio, wants to recruit more senior researchers and instructors.

But one of her underlying challenges is a shortage of students seeking graduate degrees that would qualify them to teach. The current market pays clinical nurses with master's degrees $16,000 to $36,000 more than they can make in the classroom. Partly as a result, the average age of UM's 94 full-time and 43 part-time faculty is 55.

"I think the faculty shortage is more acute than the nursing shortage," Allan says. "If there are not faculty to teach the students, there won't be nurses."

Like other schools, UM is trying to turn the tide by offering "fast-track" degrees and honors programs to encourage top undergraduates to consider graduate work and teaching rather than entering the work force.

But Allan says the ultimate sales tool may be the same one that got her hooked when she was growing up on Long Island in New York -- word of mouth.

Her former baby sitter and longtime family friend became a nurse and told her of her love for "the challenges of helping someone get well."

Now, at 60, Allan's job is to spread the word even further.

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