U.S. Hospitals Hurting as Nursing Shortage Grows

Throughout the country, hospitals are searching frantically for registered nurses, including from abroad, to fill thousands of vacancies in what is becoming the most serious hospital staffing shortage in U.S. history.

The shortage increasingly is forcing hospitals to schedule nurses to work double shifts and to require many of them to perform duties ordinarily reserved for those with more specialized training. As a result, many nurses say, nerves are becoming frayed and tempers are getting short--and patients may be receiving less than ideal care.

In hard-pressed states such as California, Texas and New York, the dearth of nurses has become serious enough to force some hospitals to temporarily shut down beds in intensive care units and in general medical and surgical wards.

“Stress,” said Greg Graze, a vice president of Parkland Memorial Hospital in Dallas, “is a very serious problem that we try to avoid by closing beds rather than creating burnout among our nurses. You can’t have quality without happy nurses.”

But for the nurses, the current shortage has its silver lining. The unprecedented demand for their services is driving up overtime pay sharply at some hospitals. Many such institutions also are offering prospects bonuses and free housing. Too, the “crisis” also may eventually lead to greater professional responsibilities for all nurses.

The nursing shortage has many contributing factors. Nurses themselves often cite what they regard as increasingly adverse working conditions and the lack of recognition of their professionalism by the hospitals. Another factor has been the growing career alternatives for women, who long have dominated the nursing profession. At the same time, more and more nurses are opting to work in medical clinics and outpatient surgical clinics where the environment is far less stressful or demanding than in hospitals.

In any case, the shortage has become dire in many regions of the country, including in California, where nurses up and down the state are threatening to strike and are resorting to other job actions to draw attention to their demands.

Strike Threat

In Fresno, a strike in July by 400 registered nurses at Valley Medical Center over the issue of understaffing was averted only by a court order.

In Oakland, 300 nurses earlier this week struck Providence Hospital for higher pay.

In Berkeley, 800 nurses threatened to strike Alta Bates and Herrick hospitals. Officials there put emergency rooms on standby and reduced the number of patients being admitted.

A California Nurses Assn. official predicted that “this summer will be fraught with strikes.”

And in Los Angeles on Wednesday, nurses at County-Martin Luther King/Drew Medical Center picketed the hospital, protesting that it is “understaffed, underequipped and underbudgeted.” Administrator William Delgardo said that, while he has authorization to hire more nurses, “the problem is one of recruitment.”

Earlier this year, the shortage reached a critical stage at San Jose’s Santa Clara Valley Medical Center. Between January and March, hospital officials had to divert to other hospitals about one out of every three patient-carrying ambulance that was rushing to Valley Medical Center because the hospital did not have enough nurses to staff the intensive care unit.

Said Robert Sillen, Valley’s executive director: “Despite the fact that we are a designated trauma center, we had to divert heart attacks, trauma cases and other severely ill patients to other hospitals because of the lack of adequate staffing.”

Such diversions, said Michael Heil, a vice president of San Jose Hospital, the city’s only other trauma center, “puts a great stress and strain” on his facility and potentially on patients.

In New York state, according to Patty Montone, a spokeswoman for the hospital association, hospitals have managed to keep intensive care beds staffed but have had to shut down medical and surgical beds in some places.

In recruiting nurses, one widely used enticement is to pay nurses for 36 hours of work, with full fringe benefits, even if they only work 24 hours, as long as it is on Saturday and Sunday. Some hospitals also are allowing nurses who have small children to work partial shifts so they can spend more time at home.

At last month’s American Hospital Assn. convention in Atlanta, hospital administrators declared the nursing shortage to be the No. 1 problem facing hospitals.

The shortage is chiefly among registered nurses. Vacancies for nurses’ aides, licensed vocational nurses (LVNs) and orderlies also exist but to a lesser extent, according to national nursing officials. A registered nurse receives longer and more intensive training than does an LVN.

The most recent national poll of vacancies for registered nurses, reported last December, showed that 83% of hospitals had an average of nearly 14% vacancies each--up from 6.3% the previous December. Hardest hit, the surveys show, are the northeastern and north-central states and California.

In California, the latest survey found 91% of hospitals reporting vacancies that, according to the state hospital association, averaged 21% per hospital.

The shortage, hospital associations say, is worse than previous ones that occurred in the 1960s and 1970s. One big reason, they say, is the sharp drop in the number of women enrolled in nursing schools. Enrollments have plunged from 250,000 in 1983--the all-time high--to less than 200,000 this year, according to the National League for Nursing.

Part of the reason for declining interest in the profession, according to the American Nurses Assn., is the negative image it has acquired.

“Nurses in the media are seen as gofers for doctors . . . but not as the caring, responsible professionals they really are,” said Connie Curran of the nurses association.

Other Careers

Another reason is the growing number of career options for young women.

A recent UCLA study reported that the number of first-year women in four-year colleges interested in nursing careers dropped from 42,200 in 1983 to 19,800 last year. The study indicated that by 1990 more women will be earning medical doctor degrees than will be earning bachelor degrees in nursing.

In attempting to attract more nurses, hospitals from coast to coast are offering bonuses of thousands of dollars, a beginning salary of $24,300 a year in Los Angeles, free housing of up to several months, plenty of overtime and benefits galore.

Yet it remains an uphill battle. That is why many hospitals have embarked on energetic--and expensive--recruitment programs to fill a never-ending string of new openings.

In Grants, N.M., 70 miles west of Albuquerque, Cibola Hospital has narrowly escaped having to close its intensive care unit only by paying nurses $17 an hour instead of the $10 or $11 an hour that had been the going rate in the community. Even so, nursing director Ruth Rupe complained, the new recruits often move on to bigger cities--and higher salaries--after “only about six weeks.”

In Dallas, Parkland Memorial Hospital last winter sent three nurses on a $15,000 three-week recruitment sweep of Great Britain, offering sign-up bonuses of $1,000. The trip netted 36 contracts and 56 prospects.

But still, Parkland has 225 nursing vacancies among its 1,200 budgeted nurse slots, according to Beth Mancini, the hospital’s vice president for nursing.

In Los Angeles, Hollywood Presbyterian Hospital capitalizes on its sunny Southern California location and offers free room and board for three months to lure student nurses from the East and Midwest to spend summers working there. This way, said Dennis Anderson, director of nursing, “we have a real good chance they will come to us when they graduate.” England, Ireland, Scotland, Australia and Canada are favorite hunting grounds for U.S. recruiters. Nurses from those countries are highly desirable because they speak English and have had training similar to that in this country. For California hospitals, the Philippines has been a plentiful source of nurses. According to the California Board of Nursing Examiners, of the 8,279 foreign trained nurses who took the licensing exam here last year, about 70% of them were from the Philippines.

Most nursing professionals seem to agree that nursing can be a rewarding career to many women--and men, although 97% of nurses are female--if they are allowed to exercise the skills they were trained to perform. But too often, they say, the system forces nurses into roles of paper shufflers rather than bedside care-givers.

One way to solve this problem, said Linda Aiken, vice president of the Robert Wood Johnson Foundation, might be for hospitals to hire fewer registered nurses but to pay them more. This, she said, might improve nursing’s image and keep nurses on the job.

In Boston, Beth Israel Hospital is giving nurses more decision-making power in the care of patients, something that all nurses say they yearn.

Instead of requiring a head nurse to plan and coordinate each patient’s care, a staff nurse now has that responsibility from the time the patient is admitted until he or she leaves, according to Susan Chamberlain, director of Beth Israel’s surgical and psychiatric nursing.

She noted that just as patients have their own doctor they also have their own nurse. When the nurse is off duty, the responsibility goes to an associate primary nurse.

“Patients come to know who their nurses are,” Chamberlain said. “They feel cared for and the nurses feel trusted and respected as professionals. We try to keep nurses at the bedside rather than doing non-nursing things.”

It seems to be paying off, she said. The hospital’s nursing vacancy rate is now 3%.