Hospitals Compete for Nurses

New Jersey Business, Feb 01, 2006 by Brice, Ann Roberts

Today, New Jersey's hospitals and medical centers find themselves competing among themselves and with other fields to attract enough high-quality nurses. The use of sign-on bonuses, pension enhancements, tuition reimbursement and higher salaries are not unusual - and not unlike practices of "blue-chip" corporations in strong economic cycles.

This year, the large wave of post-WWII baby boomers begins to turn age 60, which is likely to exacerbate the nursing shortages, which first surfaced in the late 1990s. The aging population brings with it increased needs for healthcare services - particularly for nurses who provide bedside care and carry out medical regimens.

Healthcare experts believe that 2006 could signal the beginning of a nursing shortage of unprecedented proportion over the next decades, despite the fact that in the past, nursing shortages - such as one in the early '80s - have proved to be cyclical. Some experts say that the nursing shortage will peak by 2020.

Besides adverse health consequences, the shortage will have an economic impact on the healthcare system. Registered nurses (RNs) comprise the largest healthcare occupation in the U.S., providing 2.4 million or more jobs. Some 60 percent of these are in hospitals.

"A reduction in negative patient outcomes is brought about by strong nursing structures, staffing and development," says Kathleen RussellBabin, RN, MSN, vice president of patient care services at St. Peter's University Hospital, New Brunswick.

A strong nursing capability prevents extra length-of-stay costs, promotes faster recovery and reduces complications costs. "This ultimately reduces the cost to the consumer," says Russell-Babin. St. Peter's, founded in 1906, is a 422-bed teaching hospital providing a broad range of services to the community from care of premature babies to specialized geriatric medicine.

In quantifying the financial impact of the shortage, Sharon Rainer, RN, deputy director of the New Jersey State Nurses Association (NJSNA), notes the $17 billion in costs associated with preventable medical errors each year. These are "one of the biggest costs related to not having enough nurses," she says.

Nurses, unfortunately, are looked at as a cost in healthcare, Rainer notes, although some of the more progressive thinking is that "it's more of an advantage to hospitals to provide better nursepatient ratios" and "it's a competitive advantage if you have the right skills mix and number of nurses."

"We're hearing of nurses taking care of far too many patients," notes Rainer, although the ratio of nurses to patients varies. "It's one to 10 on the medical-surgical floor, but with high acuity areas - with patients needing more care - such a ratio is worrisome." Overly high ratios lead to burnout and high turnover, she continues. The effect is also very costly.

Hospitals and other institutions including the University of Medicine and Dentistry of New Jersey (UMDNJ) are working to address nurse fatigue. Sara Torres, PhD, RN, dean and professor at UMDNJ - School of Nursing in Newark, says that nurse "burnout" is related to job satisfaction, which is in turn related to staffing levels and to nurse shortages.

UMDNJ partners with several hospitals in the state. Its nursing school graduated 167 nurses last year and offers advanced nursing certification in 12 specialty areas.

Torres notes that many current initiatives exist to address nurse shortages, ranging from local efforts to improve job satisfaction and retention to large-scale public campaigns to improve the image of the nursing profession and attract more men and women even from other fields.

UMDNJ has created accelerated programs for second career applicants [see sidebar on Page 38]. Second career nurses have more life experience, bringing something extra to the profession. Former business people, for example, tend to think along management lines as to how things in their units can work more smoothly.

Behind the Shortage

In the early 1990s, hospitals in New Jersey and other states hired reengineering consultants who advised them to reduce nursing staff to cut costs. As a result, some then recent graduates and even experienced nurses were unable to secure hospital jobs.

Towards the end of the 1990s, however, hospitals realized that more nurses were needed. Unfortunately, by that time enrollment in nursing schools had dropped with steady declines from 1995 to 2000. Some believe that nurse recruitment has never quite recovered.

Despite this, enrollments in fouryear baccalaureate programs in nursing have increased annually over the past five years. Enrollments across the U.S. rose by 13 percent from 2004 to 2005 alone in some 408 schools nationwide, reports the American Association of Colleges of Nursing (AACN).

However, some 32,000 applicants were turned away due primarily to a shortage of nurse educators. A common theme is that students graduate and go into staff nursing jobs earning as much as or more than their teachers, says Linda Parry Carney, president of the NJSNA and herself a full-time nurse educator.