Medical — Nursing Shortages Economic Ills Replenish Ranks of Nurses, But Experts Say Cure Only Temporary by Gina Shaw For years, there has been concern nationwide about a shortage of nurses. As many nurses retire and the baby boomers age — boosting demand for health care — the national nursing shortage has been predicted to reach 500,000 by 2025. That’s half a million nursing positions going unfilled. And that’s not even mentioning a possible flu pandemic breaking out in the future — a nightmare scenario that would expose just how vital nurses are to the health care system. But now, in the Washington area at least, it appears that that declining trend may have reversed itself — perhaps another result of the shaky economy. According to an April report from the Associated Press, there are only a few nursing fields in the area that need applicants (those fields are acute care and emergency room nursing) in part because of fewer people being treated at hospitals, nurses working longer to avoid retirement, and nurses re-entering the work force. Shady Grove Adventist Hospital in Rockville, Md., and Virginia’s Inova Health System both told the AP that they had few openings for nurses — Inova’s being all in critical care, with none in medical/surgical nursing. Other areas are seeing similar trends: News reports from Florida, Wisconsin and North Carolina in recent months all say there are more applicants than nursing positions. This seems like a radical shift. In August 2008 — less than a year ago — WTOP Radio reported that the nursing shortage in Maryland had reached 10 percent, or a total of 2,603 full-time nurses needed. Government studies had projected that, nationally, we would reach a sort of tipping point in 2010, when there would be just enough nurses to take care of the normal patient load. After that, things would begin to go downhill. “At that point demand will begin to exceed supply at an accelerated rate and by 2015 the shortage, a relatively modest 6 percent in the year 2000, will have almost quadrupled to 20 percent,” according to a report from the Health Resources and Services Administration. So has a bad economy saved us from the nursing shortage? (It doesn’t seem like a very good tradeoff, does it?) Probably not, say experts. “As soon as the economy strengthens, a good number of the nurses will exit the health care system once again,” William Cody, dean of the Presbyterian School of Nursing at Queens University of Charlotte, North Carolina, told the Charlotte Business Journal. “Don’t get distracted. This is a short-run phenomenon,” agrees Peter Buerhaus, director of the Center for Interdisciplinary Health Workforce Studies at the Institute for Medicine and Public Health at Vanderbilt University Medical Center. “Around the country, we’re seeing ‘spot outbreaks’ of certain institutions proclaiming that they’ve filled up their vacancies. We’ve seen this in the past with prior recessions, but when the recession ends and unemployment rates start to drop, that will reduce the economic pressure on nurses, and it’s likely that many will leave the workforce. Then, we’re right where we were.” So maybe we won’t hit that “tipping point” in 2010 — but even if the nursing shortage is coming later, it’s still coming. “We still have an aging baby boom generation of nurses that’s going to be retiring, and baby boomer patients needing more care,” said Buerhaus. “Demand is going up, and our supply is growing slowly at a pace that won’t meet demand.” So what? What happens if there’s a shortage of nurses? For one thing, the quality of care in hospitals and other health care facilities suffers. “Research tells us that in hospitals that have low staffing of nurses, patients are at increased risk for a number of complications, and some studies even say of death,” said Buerhaus. Complication rates that increase when nurses are in short supply include infections, falls, medication errors, skin pressure ulcers, and pneumonia. “There’s a big quality and safety issue immediately on the horizon if you get these large shortages,” Buerhaus noted. What’s more, a serious nursing shortage may equal a lack of access to care for everyone else. We may have enough hospitals and doctors, but if there aren’t enough nurses — frequently called the glue that holds the health system together — the system gets clogged up. Buerhaus thinks that hospitals, nursing schools and policymakers should take advantage of the short “reprieve” in the nursing numbers to try to remedy the situation, in two major ways. First, make it easier for older nurses to stay employed as long as possible. This means ergonomic improvements to the workplace — lifting devices, equipment that minimizes reaching and bending over, and eliminating systems that are poorly designed. “All these little things are relatively straightforward to correct and not very costly, but they’re very important for nurses,” Buerhaus explained. “About 30 percent to 40 percent of nurses suffer musculoskeletal injuries each year, and with the obese population growing, that’s increasing the wear and tear on this workforce. We have a great stock of older nurses, and we need to keep them in place as long as possible. You don’t want them all to bail out once the recession gets better. You want at least some of them thinking, it’s nice to be back.” Second, fill the pipeline with younger nurses. This is a huge problem: For years, qualified nursing applicants have been turned away because schools didn’t have the space, the faculty and the budget for them. “We’re turning away the very people we need to replace this workforce,” Buerhaus pointed out. Locally, Georgetown University Medical Center’s nationally ranked nursing school is doing its part to prime the pipeline with new scholarships and job programs. Last year, it launched a 16-month accelerated second-degree program in nursing, open to college graduates with a bachelor’s degree or higher in another field. The $2 million program, a partnership with Washington Hospital Center (WHC), offers an 80 percent tuition scholarship and aims to provide WHC with some 200 nurses over the next several years. Will programs like these be enough? It’s hard to talk about spending more public money in these tight economic times, but Buerhaus doesn’t think the market alone will help open up the capacity of nursing education, and proposes government support — with strings. “If we need to subsidize schools financially, they should be at risk,” he said. “We’ll give you money, but you’ve got to do a much better job with quality and safety in your curriculum. And tie subsidies to things like educating more nurses who can deal with geriatrics, a huge coming issue where the schools are not doing well, and educating more men and Hispanics, underrepresented groups in nursing.” If both of these issues are addressed, then the looming nursing shortage might be defused, according to Buerhaus. “If we could get the pipeline expanded, maybe by the time the recession ends and people start to leave again, we may have a larger new pool of qualified, talented nurses entering the workforce at just the right time.” Gina Shaw is the medical writer for The Washington Diplomat.

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