Nurse shortage - Shorts

Townsend Letter for Doctors and Patients, April, 2003 by Jule Klotter

US medical facilities have been experiencing a nurse shortage since the mid-1990s. The shortage is expected to become increasingly severe as aging baby boomers require more care. The American Hospital Association estimates that the national vacancy rate for hospital nurses averaged 13% across the nation as of December 2001. An additional 450,000 registered nurses are expected to be needed over the next five years, according to the US Department of Labor. Meanwhile, enrollment in nursing programs has declined since the mid-90s.

One reason for the declining interest in nursing is the comparatively low pay ($35,000-45,000/year, according to a Sept. 2000 Financial Times article) and stressful conditions. Hospitals began cutting full-time nursing staff in the mid-90s in response to managed care organizations' demands to cut costs. Cutting staff increased patient-to-nurse ratios, affecting care quality and contributing to staff stress. A 2001 survey by the Federation of Nurses and Health Professionals of 700 current direct-care nurses and 207 former direct-care nurses found that "one in five nurses plans to leave the profession within the next five years...." Low pay and understaffing were the primary complaints. Individual plans to leave nursing may be thwarted, however, by the slowing economy as other jobs become less available, according to an article in The Cincinnati Enquirer (Jan. 11, 2003).

High patient-to-nurse ratios and double-shifts are believed to lead to more errors and fuel the rise in malpractice suits. Aravind Adiga for the Financial Times reported: "As more fulltime nurses leave, [those] left behind are finding their workloads increasing to unmanageable levels. A recent report by the Chicago Tribune claimed that as many as 1,720 hospital patients might have been accidentally killed and 9,584 others injured since 1995 because of nursing-related errors." In addition, patients unhappy with the quality of care provided by understaffed nurses may be more likely to sue doctors and hospitals, according to one malpractice insurer.

Various agencies are taking steps to meet the demand for more nurses. In 2000, the federal government issued 500 special visas for foreign nurses. The government also passed the Nurse Reinvestment Act, which encourages nursing through public advertising, need-based scholarships and grants for students, and supports nursing school expansion and the training of instructors (who are also in short supply).

HCA Inc., the largest hospital chain in the US, has committed $10 million to recruit students and laid-off workers to train as health-care workers, according to an article in The Tennessean (Dec. 27, 2002). HCA needs radiology technologists and other technical positions as well as nurses. Three-quarters of HCA's funding, however, provides nursing scholarships and financial support to nursing schools.

In Cincinnati, Ohio, the area's largest home nursing agency, Visiting Nurses Association (VNA), was offering a $2,000 sign on bonus or a year of free housekeeping services (two 4-hour sessions/month). The VNA provides housekeeping services to the elderly and medically needy so it already has the staff to provide the same service to nurses who find themselves having a hard time caring for their home while working full-time. When the Health Alliance of Greater Cincinnati sought nurses and technicians for special cardiac-care units in 2002, it offered $30,000 sign-on bonuses in exchange for a 3-year commitment. Interestingly, the Health Alliance received only a few more resumes from qualified persons than it had job openings, despite the significant bonus.

Adiga, Aravind. US hospitals' cost-cutting measures cause critical haemorrhage of nurses. Financial Times. 2000 September 20.

American Federation of Teachers and the Federation of Nurses and Health Professionals. Survey: Nurse Shortage Will Be Worse Than Current Estimates (Press Release) April 19, 2001. www.aft.org

Hurst, Jack. Hospitals prescribe incentives to head off staff shortages. The Tennessean 2002 December 27. www.tennessean.com/local/archives/02/12/26961745.shtml?Element_ID=269 617445

Bonfield, Tim. Nurses can clean up with signing bonuses. The Cincinnati Enquirer; 2003 January 11.