Critical Care Plus
Critical Care Nursing Shortage is Nationwide
Amount Varies Geographically But Shortage Affects All Areas
By Julie Crawshaw
Factors that include an aging workforce and continuing emphasis on financial cutbacks are combining to seriously reduce the supply of critical care nurses, forcing the closing of some ICU beds, and requiring hospitals to become more inventive in finding candidates to fill openings.
Leslie A. Hoffman, RN, Ph.D., Professor of Nursing and Chair of the Department of Acute/Tertiary Care at the University of Pittsburgh School of Nursing, says that the critical care nursing shortage is generally worse in the western states. "In some areas, salaries have not kept pace with inflation," Hoffman says. "In fact, some hospitals in California are hiring nurses in New Mexico, flying them to California to work three 12-hour shifts and flying them home again."
Hoffman’s observation is but one example of the difficulties brought on in critical care nursing by an aging workforce, declining enrollment in U.S. nursing schools, and increasing market demand. According to the U.S. Bureau of Labor Statistics, jobs for registered nurses are expected to grow 23% in the next six years. Many hospitals are now offering signing bonuses and other incentives, such as relocation bonuses and tuition reimbursement programs, to recruit nurses.
Alexia Green, Ph.D., Dean of the Texas Tech University Health Sciences Center School of Nursing, says managed care has focused on a business model of operating hospitals and has trimmed a majority of costs by decreasing nurse staffing. "This has led to a decrease in quality, which in turn, increases costs because many patients have to return to the hospital," Greene says. "Now, because of public outcry, hospitals are increasing nursing staffs."
Declining enrollment in nursing schools poses a challenge in meeting the increasing demand for nurses. Figures from the Harvard Nursing Research Institute show enrollments across the United States dropped by 20.9% from 1995 to 1998.
Texas Tech’s School of Nursing is increasing enrollment in both its undergraduate and graduate education programs. A new specialty is being developed in geriatric nursing care and long-term care administration that includes training of geriatric nurse practitioners.
Karen L. Johnson Ph.D., RN, CCRN, and lecturer at the University of Arizona College of Nursing in Tucson, says the University Medical Center has closed a couple of its ICU beds for lack of staff. The Tucson center has used unlicensed personnel for at least the last six years. "There are only two-to-three patient care technicians per 16 beds," Johnson says. "They assist the RN in completing tasks—baths, linen changes, blood draws, etc."
Georgia Shortage Worse Than Ever
Figures from the Georgia Hospital Association show the shortage of registered nurses in Georgia’s hospitals is greater than ever and will get worse before it gets better. A recent GHA survey of 115 hospitals found a statewide vacancy rate of 13% for RNs—19% in the metro Atlanta area. The RN shortage is especially acute among experienced, specialized nurses such as those who work in critical care. Vacancy rates for other hospital professions ranging from medical technologists to pharmacists were 8% to 11%. The nursing shortages, especially in metro Atlanta, are causing bidding wars for RNs, producing signing bonuses of up to $5000.
High vacancy rates are dovetailing with strong financial pressures on their bottom lines, a result of cutbacks from government programs and private insurers. The GHA report said hospitals often must hire temporary staff through agencies at increased costs, and many take 30 to 60 days to fill most jobs. The report also notes that enrollment in four-year nursing programs dropped 20.9% from 1995 to 1998.
The state’s shortage of health professionals is the worst GHA President Joe Parker has seen. "We’re just not finding people coming into nursing or other health professions," Parker says.
A strong economy and more career opportunities are two factors that create nursing personnel shortage. Experts said there’s no quick fix, and any long-term solution will take the cooperation of government leaders, the private sector, and local communities. Every area in every region is experiencing some form of RN shortage, according to Pamela Thompson, Executive Director of the American Organization of Nurse Executives.
Thompson cites the average age of RNs—in Georgia, it’s about 45—in predicting the shortage will worsen.
"The nurses we have are getting older, and are retiring. There are not enough new ones coming into the profession," Thompson says.
Hospital downsizings during the 1990s made jobs harder to get for new nurses. Now hospitals are facing an influx of patients and a shortage of nurses as many mid-career nurses have found work with drug companies and managed-care firms.
The GHA report lists several proposals to ease the staffing crisis, including targeting HOPE scholarship funds for health professions, and assisting those interested in health faculty positions.
Incentives to Stay Must be Long-Term
Hoffman says that the University of Pittsburgh Medical Center has teamed up with the School of Nursing to encourage nursing graduates to remain at the center. She emphasizes that the long-term solution to the critical care nursing shortage is an overall improvement in working conditions and pay. "Flexible hours, reliable scheduling, childcare provision, and better pay are all important," Hoffman says.
Hoffman stresses that being full contributors to patient care is very important to critical care nurses. "They want to have input to the work situation and feel that they are important contributing members of the medical team," she says. "Unfortunately, many times when institutions don’t desperately need nurses, they don’t provide the rewards that make nurses feel they’re doing more than just putting in so many hours of work."
Hoffman speaks of changing the work environment in ways that make it more user-friendly.’ One important change is setting up hospital committees to include nurse representation so nurses have a voice. "I think we all know that most solutions today will be a compromise," Hoffman says. "No one is going to be 100% satisfied, but it’s important to have a voice and to be respected."
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