Dedicated nurses decry diminished ranks, image
Springfield News, Sunday, May 20, 2001, By RONNI GORDON

When Sarah A. King went to nursing school in the 1960s, she enthusiastically was pursuing a career choice that many intelligent women were expected to make.

"There was never any doubt in my mind what I wanted to be when I grew up. I wanted to take care of patients and help people," she said. "It was a very positive thing in my day. People kind of looked up to you, thought you were able to think critically. It's not portrayed as that today."

King, vice president of nursing at Holyoke Hospital, said the positive image of nurses has changed as fewer and fewer enroll in nursing school. And that is one reason for a national nursing shortage that is hurting patient care and employee morale from Western Massachusetts to the West Coast.

With the average age of nurses now 42, up from 37 in 1983, the shortage is looming much larger in the years to come. Factoring in declining nursing enrollments, the nation could be short 500,000 nurses, or 20 percent of the needed supply, by 2020, according to research recently reported in the Journal of the American Medical Association.

Nationwide, it is estimated one in 10 nursing positions are vacant.

Baystate Medical Center and Mercy Medical Center in Springfield have an 11 percent nursing vacancy rate, while Holyoke Hospital's vacancy rate is 8 percent to 9 percent. At Cooley Dickinson Hospital in Northampton, the vacancy rate is 3 percent.

The shortage is even worse for visiting nurse associations and nursing homes. A recent survey by the Massachusetts Extended Care Federation found a median vacancy rate of 26.6 percent for registered nurses, licensed practical nurses and certified nurse's assistants at Pioneer Valley nursing homes.

Maureen Skipper, president of the Visiting Nurse Association of Western New England, said the organization's vacancy rate is close to 20 percent. "The competition is quite fierce today, and we are almost cannibalizing each other to get appropriate staff members," Skipper said.

David J. Schildmeier, spokesman for the Massachusetts Nurses Association, said the groundwork for the current shortage was laid in the 1990s, when health-care facilities laid off nurses in a drive to cut costs due to managed care and decreased government and insurance
reimbursements. "Now we're trying to play catch up and recruit these nurses back to the fold," he said.

But at the same time, experts say, women increasingly are finding other opportunities in male-dominated careers such as medicine, business and law. And Schildmeier said it's no wonder that many prospective students find the field unattractive.

"Now nurses are breaking their backs to deliver the minimum care. To really monitor a patient's condition, to educate the patient, talk to the family — all those things that make nursing so important are going away."

He calls the shortage a public health crisis.

"If you look at any of the major problems that have been discussed, such as emergency room diversions, medication errors . . . any of these issues is directly related to the shortage of nurses," he said. "It's a question of the quality and safety of patient care."

He said that while the association recommends a ratio of one nurse for every five patients (and a 1-to-2 ratio in intensive care), "It's more common for nurses in Massachusetts to have seven, eight or nine patients. That's patently dangerous."

Those numbers vary from hospital to hospital, from day to day. For example, Nancy L. Hosta of East Longmeadow, a registered nurse at Northampton's Cooley Dickinson Hospital, said she is usually assigned to five patients, but sometimes cares for seven or eight if another nurse misses work.

She made her remarks in March at the Statehouse during the annual lobby day sponsored by the Massachusetts Nurses Association. Nurses urged politicians to approve legislation mandating minimum nursing staffing levels in hospitals and nursing homes.

Meanwhile, younger nurses are not replenishing the field; enrollment in nursing programs has steadily declined since 1995, according to an annual survey of 337 nursing schools by the American Association of Colleges of Nurses.

Unlike other nursing shortages of the past, which have come and gone, this one is expected to worsen as more nurses retire, and the aging baby boomers require increasing care.

In hospitals, where some 60 percent of registered nurses practice, the shortages are felt across the board, according to Sharon A. Smith, vice president of patient care services at Baystate Medical Center. She said shortages exist in critical care units, general in-patient units, pediatrics and cardiac units.

The field is at risk of further erosion as nurses, dissatisfied with the current conditions, look toward other fields, said Mary E. Foley, president of the American Nurses Association.

In a survey released in February, the association found that 75 percent of nurses believed the quality of nursing care at the facility in which they worked had declined over the past two years, and 56 percent of nurses surveyed said the time they had for patient care had decreased.

In addition, more than 54 percent of respondents said they would not recommend their profession to their children or their friends.

"Nurses love their work, but they hate their job," Foley said. But she said the decline can be reversed. "You fix the nursing conditions, you'll retain nurses, and you can recruit more nurses."

Nurses are pressing for changes. And hospitals also are trying to find solutions.

For example, at the former St. Vincent's Hospital in Worcester, nurses went on strike for six weeks last year over the issue of mandatory overtime. The nurses returned to work after reaching an agreement that included limits on overtime and the right to refuse it, guidelines on safe staffing levels, enhanced nursing rights and salary increases.

Meanwhile, members of the state nurses association have testified in support of a legislative package called the Clara Barton Program, named after the nurse educator and founder of the American Red Cross. It consists of two bills sponsored by state Sen. Richard Moore, D-Uxbridge, chairman of the Legislature's joint committee on health care.

One bill would provide for a student-loan repayment plan, a signing bonus, a mentoring bonus and grants to health-care institutions for establishing mentoring and internship programs. The other would provide students with nursing scholarships.

Baystate Medical Center's Smith said the crunch was eased somewhat at the hospital 18 months ago with implementation of a "flex team" of 45 nurses trained to step into core areas when needed. And, she said the board of trustees has allocated an additional $1.5 million to increase staffing.

With the hiring of 70 nurses, the vacancy rate has dropped from 13 percent this fall. She said administrators are studying ways of easing the workload and offering more flexible shift options, among other possibilities. "There is a sense of real improvement," she said.

Holyoke Hospital has developed in-house educational programs to help develop the experienced nurses who are increasingly in short supply, according to King.

Cooley Dickinson's vacancy rate is lower than the others, but Donna C. Bowles, senior nurse executive, said the rate is higher than in the past, and she expects it to increase. To help make the hospital a place where nurses want to stay, administrators and nurses have been meeting
monthly to review staffing issues.

In addition, Cooley Dickinson belongs to an alliance of eight New England hospitals that has hired a nurse specifically to look into retention and recruitment, she said.

"We're stepping back and looking at the bigger picture of the long-term shortage," she said. "Our main goal is to improve the image of nursing and to have more Western Massachusetts young people choose it as a profession."

© 2001 UNION-NEWS. Used with permission.