St. Vincent's Strike

Nursing schools see enrollment steadily shrink
Drop especially big in Northeast
By Gerard F. Russell, Worcester Telegram & Gazette, Friday, April 21, 2000

The outcome of the battle over mandatory overtime in the St. Vincent's Hospital nurses strike may well have long-term implications as the health care industry deals with a shortage of registered nurses.

Enrollment in the nation's nursing schools dropped last year, the fifthyear in a row. Some people in health care say the drop does not bode well for the profession.

The decline was in entry-level, bachelor degree nursing programs. The drop was 4.6 percent last fall in a sampling of schools surveyed by the American Association of Colleges of Nursing. 

Enrollment in master's degree nursing programs nationwide also dropped slightly, about 2 percent from the previous year.

The drop was especially steep -- 7.4 percent—in the Northeast, according to the association.

It is estimated the supply of registered nurses will not meet the demand by 2005. By then, a shortage of more than 6,000 registered nurses is projected for Massachusetts, according to Judy Shindul-Rothschild, an associate nursing professor at Boston College in the Center For Nursing Research. She researches trends in nursing.

The nursing shortage has been acute in the past six to nine months at the UMass Memorial Medical Center-University Campus in Worcester, according to spokesman Mark L. Shelton. The hospital had openings for 100 nurses this month.

That is a little less than it has been. We added about 30 RNs over the past quarter, some per diem, Mr. Shelton said.  The hospital has held a job fair and continues to recruit, he said. 

Some employers are offering hefty bonuses as a lure to fill jobs. The Visiting Nurse Association of Central Massachusetts entices registered nurses with bonuses of up to $2,000. 

Karen H. Green, president and CEO of the VNA Care Network, said not as many young people are entering the profession.  Young women and men are making other choices, Ms. Green said.  In today's robust economy, young people have many more employment opportunities. Many are more profitable and less demanding than caring for the sick. Nursing is a very difficult, demanding profession. It takes a lot of time, effort and giving, Ms. Green said.

While enrollment is down nationwide, Worcester State College's nursing program has had a stable number of graduates over the years, according to Mary Lou Lovering, chairman of school's Department of Nursing.  The school began its nursing program in 1986 during one of the many cyclical nursing shortages. It still consistently graduates 40 nurses a year with bachelor degrees, although the number of applications has dropped.

This school year there were 199 undergraduate applications to Worcester State's nursing program, compared to 247 last year, according to a school spokesman.  In the 1980s, Ms. Lovering noted, the college received up to 300 applications.

I think there is a decrease in applicants who are high school age. A lot apply, but change their mind, Ms. Lovering said. 

Years ago, career tracks for women were limited to being teachers, nurses or secretaries.  I just think there are more things open now (to women), Ms. Lovering said.

The projected nurses shortage is for those with bachelor of science degrees in nursing and advanced degrees, Ms. Lovering said.  There is already a shortage of nursing faculty, she said.  The growing shortage throughout the profession differs from cyclical shortages of the past, some say.

It is different from the others because of the aging of the work force.  People will be leaving in droves in 10 to 15 years. There will be a lot of retirements, Ms. Lovering said.

Karen A. Higgins, a spokesman for the Massachusetts Nurses Association,said the shortage is worrisome.  We are putting a task force together to look at the shortage of nurses.  It is only going to get worse, she said.

There was a surplus of nurses nationwide seven to eight years ago. Ms.  Higgins said she was in California at the time and some nursing schools closed because there were already too many nurses. Boy, are we seeing the results of that, she said.

Audrey M. Silveri, director of nursing programs at Anna Maria College in Paxton, suggested the profession has to reach out to high schools to present a positive image of nursing.

We don't even have candy stripers in hospitals anymore. It was a way of recruitment, Ms. Silveri said of the teen-age volunteers who wore striped uniforms.

Anna Maria nursing students are already registered nurses who are seeking advanced degrees and training. 

While most in the field are aware of the problem, there does not appear to be a concerted effort to do anything about it, she said. 
Recently, Ms. Silveri said she has been most surprised to get calls
from nurses who have come from South Africa, Zaire and Kenya to the United States to work.

Nursing shortages are nothing new, according to Ms. Shindul- Rothschild, the Boston College professor, who has been researching trends in the profession since the 1980s.

Shortages were a chronic problem because salaries were low, working conditions were difficult and productivity demands were high.  By 1989, the U.S. nursing shortage was eradicated, and hospitals concentrated on using a majority of registered nurses for patient care, instead of less skilled, unlicensed workers, Ms. Shindul-Rothschild said.

Health care trends shifted in the early 1990s in Massachusetts and other states that cut regulations on health care to create more competition, she said.

She said she warned at the time that the effect of managed care on nursing would be costly.  With more competition, coupled with no limits on the discounts that insurers could negotiate with hospitals, quick fixes led to cutting labor costs and then to more drastic measures, such as hospital closings.

In Massachusetts, 15 hospitals closed, about one or two a year, with a slow squeeze on the health care system. In the first 18 months of deregulating the hospital industry in 1992 and 1993, the number of lost beds equaled what was lost in the entire decade of the 1980s, Ms. Shindul-Rothschild said.

Labor is a huge chunk of hospital costs, and hospital managers looked there to cut.  More unlicensed health care workers were used and many registered nurses were driven out of the work force, she said. 

They went back to the failed models of nursing care, she said.
We are back to where we were in the mid-‘80s, now that nurses are driven out of the system because they could not, or would not, put themselves in the position to jeopardize their own license, she said.  As seasoned nurses, some of them in special care units, leave, there are fewer mentors for new nurses. 
 

From a nursing standpoint, the solution is to go back to the basics.

You go back to what we know works, Ms. Shindul-Rothschild said. You treat nurses with dignity and respect. Yes, that might mean you staff more than you want to, but not more than you need to.

© 2000 Worcester Telegram & Gazette

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