Thursday, May 25, 2000

Nursing profession in critical condition

'Average citizen should be concerned'

By Tim Bonfield
The Cincinnati Enquirer

        Fresh from a graduation ceremony at St. Peter in Chains Cathedral, Matt Lowe can't wait to launch his nursing career.

        After 17 years on a critical-care unit, Annie Hamilton has decided to go back to school to become a teacher.

        The problem for those depending on quality health care in Greater Cincinnati and nationwide is that more and more Annie Hamiltons are leaving nursing and not enough Matt Lowes are entering.

        Several years of increased difficulty in recruiting and retaining nurses has reached what some health-care executives call crisis proportions. The concern is partly about today's health care but more about the years to come because few experts expect the factors driving the nursing shortage to change anytime soon.

        “The average citizen should be concerned, for now and into the future,” said Andrea Lindell, dean of the University of Cincinnati College of Nursing, who also recently completed a term as president of the American Association of Colleges of Nursing.

        “If we're unable to attract and graduate quality nurses, patients will not have quality nurses to give good care in hospitals or any other health-care facility,” Dr. Lindell said.

        Dr. Lindell said patients already have started feeling a triple-whammy of nursing trends — rising demand, more resignations and retirements, and fewer students. Quality of care remains high in general, but nurse-to-patient ratios are rising along with concerns about customer service and medical errors.

        If these trends continue, overall demand will outstrip supply of RNs by 2010, creating potentially serious service problems here and in other parts of the country, she said.

  • The average registered nurse is 44 years old, up from 40 in 1980. This aging of the profession will lead to high retirement rates in the next 10 to 15 years.
  • There is a rising demand for nurses, especially those trained in emergency, operating room and critical care, caused by rising numbers of elderly Americans who need health care.
  • There are more career options for women in general, who comprise 94 percent of RNs.
  • There are more career options for RNs outside of hospitals, such as HMO administration, home care, outpatient care, pharmaceutical and information technology jobs.
  • Enrollment in bachelor's degree nursing programs has dropped for five straight years.
        Several factors are contributing to the situation:

        • Rising numbers of elderly Americans who need health care are creating demand for nurses. Hospitals especially need people trained in emergency, operating room and critical care.

        • As baby boomers continue aging, nursing retirements will surge in the next 10 to 15 years. The average RN in 1999 was 44 years old, up from 40 in 1980.

        • Enrollment in bachelor's degree nursing programs (the most common category) has dropped for five straight years. In 337 schools studied from 1995 through 1999, enrollment dropped 19.2 percent while graduates dropped 11 percent.

        • More nurses are leaving high-stress jobs at cost-cutting hospitals for steady work at HMOs, home-care agencies, outpatient clinics and pharmaceutical companies.

        • Women, who comprise 94 percent of RNs, enjoy more career options than ever, especially in a high-employment economy.

        • While many nurses earn comfortable livings (average pay is about $40,000 a year), some say nurse pay often doesn't reflect the value of their jobs.

        Ms. Hamilton said she is leaving her job at University Hospital because of constant pressures to work overtime and the growing responsibility for more, sicker patients.

        She also got tired, she said, of having rookie physicians boss her around. And the pay raise she received? A part of it evaporated, she said, when the hospital raised parking fees.

        Most important, however, was the feeling that things won't get better anytime soon.

        “I don't think it's just burnout,” Ms. Hamilton said. “I've been living through the consequences of a situation that wasn't well thought out from the beginning. I don't think the situation is recoverable. If it is, it's going to be a long journey.”

        Hospitals have been struggling in recent years to attract and keep nurses. In February, the Greater Cincinnati Health Council launched a task force that includes hospital executives, nursing school administrators and nurses to come up with ways to attract nurses.

        Concerns about the health-care labor supply stretch beyond hospitals, said Warren Falberg, chief executive of the Visiting Nurse Association, a large home-nursing agency.

        “It's home care, nursing homes, physician offices. You name it. There is no facet of health care that hasn't been impacted,” Mr. Falberg said.

        Graduates say they want the work despite the complaints they hear.

        At a recent ceremony for the Good Samaritan Hospital School of Nursing, Matt Lowe was one of three men in the graduating class of 35.

        “I wouldn't change my mind for the world,” Mr. Lowe said. “I've always been a people person, and with nursing you really get to be hands-on with your patients.”

        Morris Cohen, director of the Good Samaritan nursing school, said it can be hard, nonetheless, to sell young people on working weekends, nights and holiday shifts.

        Sharon Harvey, 40, has been a neonatal intensive care nurse at University Hospital for 15 years. She went into nursing because she was impressed by the job her mother did as a nurse.

        “It's a very satisfying job, very fulfilling,” she said.

        Better pay, flexible hours and making nurses feel part of a team will help bring people back to the job, she said. But that's no easy task in today's health-care environment.

        “Insurance companies don't want to compensate hospitals for what they put out,” she said. “But you just have to tuck the politics aside and focus on care for the patient.”

        Greater Cincinnati's nurs ing schools offer various levels of training. Six offer bachelor's degree programs for nurses: UC, Xavier, Miami, College of Mount St. Joseph, Northern Kentucky University and Thomas More College.

        Among those schools, enrollment dropped 14 percent from 1998 to 1999, much like the national trends.

        As local enrollment continues to drop, local graduation figures will follow, Dr. Lindell said.

        Several non-bachelor's degree programs contacted by the Enquirer also have seen flat or declining enrollment rates.

        With rising demand and growing nurse retirements, holding steady won't be enough, Mr. Cohen said.

        At the University of Cincinnati, the largest of several area nursing schools, enrollment in programs that would increase the overall nursing supply have dipped in recent years, but graduation figures have grown.

        In 1995, UC had 346 students enrolled in bachelor's degree and accelerated master's degree programs. That year, 120 such students graduated.

        In 1999, UC had 332 students enrolled in those programs. But it had 146 graduates.

        Lori Greiser, 29, graduated from Good Sam's school with hopes of moving from a nursing home job into a hospital neonatal intensive care unit. She wants more nursing experience, but she said doing so could mean at least a short-term financial hit.

        “They don't want to pay nurses enough for what they have to do,” Ms. Greiser said. “I'll probably be taking a pay cut to work as an RN.”

        At some local nursing homes, a licensed practical nurse can earn $11 to $21 an hour, she said, plus $24 an hour for weekend shifts. But starting as a registered nurse at a neonatal intensive care unit (a job that requires much more training) she expects to make about $17 an hour.

        Meanwhile, an agency nurse with the same level of training for intensive care work can command up to $40 an hour, Ms. Greiser said.

        In the gilded halls of St. Peter in Chains, Dr. John Wolf, medical staff president for Good Samaritan Hospital, told graduates clad in traditional white uniforms that they were entering something more than a job, or even a career.

        “You have the opportunity to make a difference in the lives of your patients,” he said. “You will not be bored. You will not wonder what the purpose of your life is. And you will never be well-rested.”

        “It's the nurses who keep the care in health care,” Dr. Wolf said. “Go out and make a difference.”


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