Situation critical
Boston Business Journal - March 25, 2002
From the March 22, 2002 print edition
Linda Goodspeed
Special To The Journal

Hospitals grapple with an increasing shortage of registered nurses

Not even the lure of a $10,000 signing bonus could entice Liz Joubert back into nursing. Joubert, a former registered nurse, left the profession in January 2001 after 37 years to take a job as safety officer at Siena Construction in Cambridge. Just a few months into her new job, another area hospital called with the promise of a signing bonus if she would come back.

"Money has nothing to do with it," said Joubert, who was making in the high 60s when she left nursing.

"(The hospital) couldn't guarantee staffing ratios, and that's the reason I left nursing," she said. "I had too many patients to care for. I felt I was putting them at risk. I brought it time and again to the administration, and they just said, 'Do the best you can.'"

Doing the best they can is no longer good enough for RNs who are leaving the nursing profession in droves, causing a nationwide shortage of nurses.

Locally, hospitals are so desperate to fill nursing vacancies they are offering signing bonuses to experienced nurses of as much as $10,000 -- and they're recruiting nurses from as far away as Canada, the Philippines and other countries.

"It's totally outrageous," said Keren Higgins, president of the Massachusetts Nurses Association in Canton and a 27-year practicing nurse at Boston Medical Center.

"They're just stealing nurses from one hospital to another. Many of the countries they're recruiting from have as bad a nursing shortage as we do. They're not fixing the problem. The reason for the nursing shortage is because of poor working conditions."

Judith Shindul-Rothschild, an associate professor at the Boston College School of Nursing, says it's important to put the current nursing shortage in historical perspective.

"There are always cyclical shortages of nursing personnel," Rothschild said.

"Shortages are not a new phenomenon, nor are the roots of the current crisis new. Quite simply, they have to do with poor working conditions and salaries and benefits that don't keep pace with the standard of living."

In fact, Rothschild said, the nursing shortage of the early '80s was much worse than the current shortage. But it was turned around within two years after hospitals dramatically raised salaries and reorganized nursing care. "Those two policies alone completely eradicated double-digit vacancy rates within a very narrow window and In the mid-1990s, the shortage returned. Hospitals, under severe cost-containment pressures from insurers, took aim at one of their biggest budget items: nursing.

Layoffs of RNs followed, patient-load increased, mandatory overtime was instituted and wages froze.

Six years ago, Rothschild predicted the current nursing shortage, based on the results of a nationwide survey of nurses she conducted.

"I was shocked to find that only 72 percent of nurses said they expected to remain in nursing longer than five years. In all previous studies, the number who said they expected to remain in nursing longer than five years was 80 (percent) to 90 percent."

Although nursing salaries are on the upswing, nurses say working conditions are not. In fact, they believe it will take government intervention to reduce patient loads and bring nurses back into the profession.

"We want staffing ratios and we want them in writing," Higgins said. "Once we get staffing ratios, I think we'll see a lot of the other issues disappear and nurses start coming back to the profession."

One state, California, has already enacted staffing ratios for nurses. Massachusetts has introduced similar legislation.

"The bill is really starting to pick up steam," said David Schildmeier, spokesman at the MNA. "It would set up a commission that would establish staffing ratios based on the severity of the patient." Schildmeier said that in the two years since Australia established mandatory staffing ratios, 2,100 nurses have returned to the profession.

"I think government regulation of nurse staffing ratios is inevitable," Rothschild said. Joubert, who was a nurse in the post-anesthesiology care unit at Carney, said she should have had a 1-1 ratio for children recovering from general anesthesiology.

"And for years I did," she said. "All of a sudden, I was asked to take one child and one adult or maybe two adults. I couldn't work according to nursing standards. ... Nurses are leaving the profession because they feel they're putting their licenses in jeopardy. They're putting their ability to sleep at night in jeopardy."

Richard Averbuch, senior director of communications for the Massachusetts Hospital Association, said there is a definite nurse shortage, but "we're also seeing shortages among pharmacist, radiological technicians, lab technicians, even physicians in some areas.

"Everyone in health care is feeling stressed right now. The system is underfunded, demand has increased and we have a crisis as a result."

The hospital association does not believe that mandated staffing levels will address the nurse-shortage issue, Averbuch said. He said staffing problems need to be addressed on a hospital-by-hospital basis.

"By doing that, we're imposing rigidity on the system just at a time when flexibility is needed," he said. "Mandated staffing levels could actually result in the closing of key beds in hospital units, which in turn could make the problem of emergency-room overcrowding even worse."

Unlike previous nursing shortages caused by working conditions and salary issues, Rothschild notes that the current shortage has a "third wrinkle"—demographics.

"There are fewer 18-year-olds in the population from which to recruit new nurses," she said.

While she said "supply-side" strategies, such as subsidizing nursing education and more scholarships, can help ease the current shortage and demographic problem, increasing the number of new nurses is not the sole answer to ending the shortage.

"Currently, we have more nurses in the U.S. than we've ever had," Rothschild said.

"The problem is, they don't want to practice nursing. It doesn't matter how many new recruits you dump out if you burn them out in two years. You have to get at the root causes of the shortage. You have to address working conditions and salaries."