Video: Nursing shortage hampers health care

By M. Alex Johnson Reporter
msnbc.com
updated 7/11/2008 8:42:33 AM ET 2008-07-11T12:42:33

The nation’s shortage of nurses continues to worsen, and the trend shows no signs of reversing — not because too few young people want to become nurses, but because there aren’t enough nursing teachers to train them, medical researchers and administrators say.

Medical administrators have warned for years that the crunch was coming. As the shortage reaches crisis levels — estimated at a quarter-million by the U.S. Department of Health and Human Services, on its way to half a million by 2025 — the impact on mortality is stark.

The Joint Commission, a national hospital accrediting agency, calculated that the shortage of nurses contributes to a quarter of the country’s nearly 100,000 preventable hospital deaths each year.

But the consequences can be dire even for less critical patients. HHS’s Agency for Healthcare Research and Quality found last year that adding just one patient per registered nurse per shift in U.S. hospitals raised the risk of all hospital-acquired complications by 17 percent, including pneumonia (7 percent) and “unplanned extubation,” which is doctor-speak for when a breathing tube is knocked out by accident (45 percent).

The study found that the risks fell by similar rates when nurses’ patient loads were reduced.

At least 20 states have passed or are considering legislation to lower the number of patients per nurse. The ideal proportion differs from specialty to specialty, but researchers at Baystate Medical Center in Springfield, Mass., and the University of Pennsylvania School of Nursing concluded that 4:1 was generally the best ratio.

At hospitals across the country, the reality is nowhere close.

At the Ohio Statehouse in Columbus last month, nurses organized a rally to urge legislators to relieve average patient-to-nurse ratios of 14:1 in some hospitals.

Betsy Morville, a registered nurse at St. Mary’s Hospital in West Palm Beach, Fla., joined a similar campaign to persuade Florida legislators. “I had 22 patients on the weekend” at a previous job in Pennsylvania, she said.

Too many students, not enough teachers
The problem is not, as many people assume, that no one wants to go into nursing. In fact, enrollment at nursing schools was up in 2007 for the seventh straight year.

Instead, the problem is that there aren’t enough qualified teachers.

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More than 30,700 qualified applicants were turned away, according to figures compiled by the American Association of Colleges of Nursing.

“It’s the nursing faculty shortage that’s exacerbating the nursing shortage at the bedside,” said Susan Otto, chief of the Nursing Division at Thomas University in Thomasville, Ga. “We simply don’t have enough nursing faculty to teach all of the people that want to become nurses.”

In a survey of chief executives of medical, dental, nursing and other health-related teaching institutions last year, the Association of Academic Health Centers found that 81 percent said the lack of qualified nursing teachers was a problem at their schools, ranking first on the list of their biggest concerns. Nearly half said it was a severe problem.

In Oklahoma, officials said state colleges start out by assuming they will have to reject a third of fully qualified applicants to bachelor’s-degree nursing programs because there aren’t enough instructors to teach them.

Last year in Hawaii alone, “we had 524 qualified nursing applicants who could not go to school — not accepted into nursing schools — because we didn’t have the faculty to support that,” said Suzann Filleul, chief nursing executive at Kaiser Permanente Hawaii in Honolulu.

It’s hard to find the teachers. Nurses and administrators said teaching nursing at the college level requires an advanced degree — 50 percent require an earned doctorate, the American Association of Colleges of Nursing found — and proven achievement in the field. Those nurses are the same ones who are in the highest demand in hospital emergency and operating rooms.

“Part of it is that faculty salaries are much lower than clinical salaries, so a nurse with a master’s degree can probably make $30,000 more in general out in clinical practice than she’ll make teaching,” said Carolyn Yucha, dean of the School of Nursing at the University of Nevada, Las Vegas.

That means that every year, as more nurses retire or leave because of burnout, there are fewer newly minted nurses to replace them, even as the enormous baby boom generation reaches retirement age and puts more demands on the health care system.  

“I think the ramification is the quality of care that is provided to our patients in the setting here at the medical center,” said Cindy Kamikawa, vice president of nursing at the Queens Medical Center on Oahu in Hawaii. “We need nursing care 24 hours a day, seven days a week, to care for our patients, and we know that nursing makes a difference.”

Too many openings, not enough supply
Another ramification is cannibalization. Hospitals with severe shortages are casting wide recruiting nets, luring nurses from other hospitals and causing resentment among fellow administrators.

In May, Beth Israel Medical Center in New York caused an uproar in Indianapolis when it placed an ad in The Indianapolis Star offering senior registered nurses $15,000 signing bonuses to pack up and move north.

Similarly, St. Joseph’s Hospital in Syracuse, N.Y., raised eyebrows last month when it held a recruitment drive offering a buffet table and free $25 gas cards just to get experienced nurses to walk in.

St. Joseph’s administrators said they needed nurses in the operating room, the dialysis unit and other departments, and they are offering hefty signing bonuses in a city where competition for nurses is fierce among four major hospitals with significant staffing shortages.

Hospitals and nursing schools are also pursuing nurses with untraditional backgrounds. An especially attractive market is men, who make up only 6 percent of the nation’s nurses, according to figures from the federal Bureau of Labor Statistics.

Case studies by the University of Virginia School of Nursing uncovered recruitment efforts by some Southern hospitals at NASCAR races and among men with technical skills or service-oriented backgrounds, such as Boy Scouts or military corpsmen.

George Rouse, a father of four in Cleveland, left his career as a computer programmer to go to nursing school.

“It’s very, very, scary switching careers. It’s very scary going into the unknown,” Rouse said. But with a large family, he was attracted by the promise of job stability in a field where his skills will be in demand.

“There’s so much opportunity,” he said. “It’s a career of what you make of it.”

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