Hospitals face nurse shortage

With enrollment down in nursing schools, hospitals are looking for ways to recruit and keep nurses.

By WES ALLISON

© St. Petersburg Times, published July 9, 2000

Eileen Forsythe's charge on Friday was 16 days old and weighed just 3 pounds, 14 ounces, but already she was recovering from heart surgery. Forsythe tried to calm the infant with a pacifier as she held a stethoscope to her tiny chest to check her heart rate.

A baby like this, whose name is Christina Yaemsang, needs intensive care and an ample supply of well-trained nurses to provide it. On Friday, Forsythe was one of four registered nurses from a pool of part-timers, called the resource team, who were helping to staff the neonatal ward at All Children's Hospital in St. Petersburg.

Such nurses work flexible hours, and often more than 40 hours per week. They get no benefits but earn a higher hourly rate and are well-trained in their specialties.

"They plug our holes," said Margie Baldwin, a family nurse in the neonatal unit. "When your workload gets heavy, the resource team relieves it. We do have (staffing) standards that we have to maintain."

Faced with a shortage of nurses that shows no sign of improving soon, hospitals across Florida and Tampa Bay increasingly are counting on nurses like Forsythe to fill gaps in scheduling and give staff nurses a break from the grueling pace of overtime.

Hospitals also are looking for creative ways to recruit and keep staff, and to get young people interested in careers in nursing that will reverse the trend for the long-term.

According to a new study by the Florida Hospital Association, nearly 40 percent of hospitals consider the shortage of registered nurses to be "severe" in critical care wards. Twenty percent say the shortage is severe for bedside and surgical nurses.

Overall, the association estimates Florida hospitals are looking to hire at least 5,100 registered nurses immediately.

Nursing shortages have plagued hospitals before, most recently in the late 1980s, but supply has always risen to meet the demand. That doesn't seem to be happening this time, despite aggressive recruiting by some hospitals, and the hospital association is forming a committee to attack the problem.

"Individual hospitals can do things in terms of the bonuses" and working conditions to lure nurses, but the industry as a whole needs to find ways to address the shortage, said Kim Streit, vice president of health care research and information for the Florida Hospital Association, who organized the study.

"This is different than what we've experienced in the past, with an aging nursing population, with people not interested in going into the field. It's going to take a lot of work," Streit said.

Many hospitals are reluctant to discuss staffing shortages, because they worry that acknowledging a shortage may suggest they're having trouble caring for patients. The hospital association's survey did not specifically address that, but officials there do not yet believe the shortage has hurt care, Streit said.

"But we know that if it continues, and they don't have enough staff to serve the patient, then it will," she said.

The Florida Department of Labor and Employment Security predicts the demand for nurses will rise in the next decade by 29 percent. That's 39,000 more nurses needed in Florida.

The employment pool, however, has been going the other way, nationally and in Florida, for the past several years. Consider:

11.7 percent of RN positions in Florida are open. For western Florida, including Hillsborough, Pinellas, Pasco and Polk counties, the vacancy rate is 14.7 percent. And often it takes months to fill new openings, the association survey showed.

"If it takes more than 60 days or 90 days to fill a position, you know that people aren't out there to pull in," Streit said.

The annual turnover rate for nurses at Florida hospitals is 18.2 percent. That means almost one in five quit in the past year.

Newly licensed RNs dropped by 50 percent from 1994 to 1999, from about 8,000 to 4,000. Meanwhile, the average age of RNs increased from 39 in 1989 to 46 last year.

Despite the wide-open job market, enrollment at U.S. nursing colleges fell 4.6 percent last year, the fifth consecutive drop, according to the American Academy of Nursing Colleges.

Experts say layoffs at many hospitals in the early and mid '90s scared many potential nurses away. The booming job market and vanishing gender barriers mean that women -- who still represent nine of every 10 nursing students -- have more career options than ever. And, nurses complain, their profession doesn't enjoy the same glowing image it once did.

When Diane Yates, a nurse at St. Joseph's Hospital in Tampa for 29 years, was younger, kids read about the adventures of Cherry Ames, student nurse, the Nancy Drew of nursing.

"We don't have those kind of stories about the nurse any more. When they read their books, they read about computers," said Yates, who now is interim vice president of patient services for St. Joseph's-Baptist Health Care.

"When we talk about hospitals, we talk about the balanced budget act, we talk about managed care . . . We need to focus on how great it is to be a nurse."

She and Deana Nelson, the senior vice president for patient services at Tampa General Hospital, say their recruiters have begun visiting middle and high schools as well as colleges. Tampa General is also preparing to offer scholarships to nursing students who promise to work there after graduation.

According to the Florida Hospital Association survey, more than half of all hospitals now are paying signing bonuses -- some up to $5,000 -- to new nurses. They're also paying employees up to $1,000 for referring nurses who get hired and stay at least a year.

Other incentives include flexible work schedules, tuition reimbursement and child care, plus so-called "retention bonuses" for sticking around, the hospital association reports. The average starting salary for most nurses has risen from about $27,000 in 1995 to more than $30,000.

St. Joseph's-Baptist Health Care and Tampa General Hospital have instituted programs called ladders, in which nurses can earn promotions and pay raises but still continue to work directly with patients. Traditionally, nurses have had to become administrators to advance.

"You can stay at the bedside, and that's a great career field, it's very fulfilling," said Jeanette Stevens, a nurse in the intensive care unit at TGH who earned a pay raise Thursday for advancing within her ladder. She's been at the hospital for nearly 18 years and has worked in operating rooms and the pediatric emergency room, too.

"You really have a chance to help everybody through really difficult times," she said. "And if you get tired of one area or get burned out . . . you can transfer to another."

To deal with the shortage, some hospitals now expect patients' relatives to help care for them. Nursing pools, like the resource team at All Children's that typically provides Forsythe three or four 12-hour shifts each week, are common. And hospitals often also use nurses from temporary agencies or so-called traveling nurses, who work for several months until a position can be filled permanently.

But most hospitals also are relying heavily on overtime, Streit said.

"After a while it gets old. It also leads to eventual burnout, but at this point there's nothing that can be done," she said.

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