Looming shortage of nurses

  • By Debra Smith For HBJ
  • Thursday, July 31, 2014 3:11pm

Sharon White’s new fifth wheel is parked in the driveway, and she’s ready for adventure.

The Snohomish woman spent more than three decades as a nurse, most of that time as a manager in the emergency room at Providence Regional Medical Center Everett.

She loved it. Helping people. Learning new things.

Trying to unlock the mystery of what’s wrong with a patient — if possible before the doctors could.

Now at age 58, it’s time to retire.

“(My husband and I) feel like we’ve accomplished quite a bit in our careers, and it’s time to take time and enjoy it,” White said.

Her last day was in July. She’s part of a wave of seasoned nurses ready to retire right when they’re about to be needed most.

Researchers in a 2011 University of Washington study concluded that there won’t be enough registered nurses to fill the need in this state starting in just three years.

And that’s under the most optimistic scenario.

In the long-term, the same study predicted the state could be 20,000 nurses short by 2031. While it’s unclear the impact of federal health care reform will have, it’s almost certain the need will be even greater.

And nurses are needed not just at hospitals, but in long-term care facilities and other settings.

“This is a real challenge,” said Barbara Hyland-Hill, chief nursing officer at Providence Regional Medical Center Everett. “We have an aging workforce, continued demand for health care, more chronic disease and an aging population. We will see a huge nursing shortage.”

***

This isn’t the first nursing shortage. In this state, the need for registered nurses reached critical levels in the early part of the last decade. In 2001, more than half of hospital emergency rooms statewide redirected ambulances to other hospitals because they didn’t have enough nurses on hand, according to a report by the Center for Studying Health System Change.

In response, hospitals and other organizations banded together to recruit more students and expand education programs. Millions of state and federal dollars were spent. It worked.

In the past decade, the number of registered nurses statewide increased from around 54,000 to more than 68,000, according to state data on the number of licensed registered nurses.

Then just as more nurses began graduating, the economy hit the skids. Nurses put off retirement and others went from part- to full-time or back to work as their spouses were laid off.

Now that the economy is more stable, more positions are opening and officials are yet again thinking about a shortage in the future.

In the 2011 study, researchers examined data from state and national sources, including factors such as retirement, graduation rates and population changes.

In the best case scenario, researchers concluded that by 2031, the state would need nearly 90,000 nurses — but only about 77,000 would be available to work. In the worst case scenario, the state would be around 20,000 nurses short.

This year, there are 68,665 registered nurses with state licenses and Washington addresses, just under 10 percent them located in Snohomish County.

National health care reform has made forecasting even muddier since that report came out, said Linda Tieman, executive director of the Washington Center for Nursing.

The nonprofit, which paid for the study, is a statewide nursing organization that serves as a resource center and works to ensure there is an adequate nursing workforce.

“I would say this is a serious concern for the health of the people who live in this state,” Tieman said.

Additionally, data on how many nursing positions need to be filled is challenging to get in this state. There is no state requirement that employers of nurses provide the data.

“We’re in the middle of dramatic health care reform,” Tieman said. “It’s harder to project.”

***

Hyland-Hill oversees the nursing staff of both of Providence’s hospitals in Everett — about 1,350 total nurses, including supervisors.

At the moment, Providence has about 80 positions open, although many of those aren’t full time.

Part of the problem is that hospitals can’t hire all new graduates. Imagine the emergency room at Providence, the 10th busiest in the nation with 90,000 patients seen annually, staffed only with brand new nurses. Nursing is a highly skilled, often stressful profession. It takes time and practice for even the best-educated and capable nurse to become comfortable at the job. It’s hard to find seasoned nurses, Hyland-Hill said.

“Experienced nurses need less time training and they bring a wealth of knowledge that benefits us. It takes less time to orient them to our organization,” Hyland-Hill said. “However, it’s not that easy to find really experienced nurses.”

That’s going to get even harder as the workforce grows older. The average age of registered nurses statewide is 48.1 years. That’s about the same in Snohomish County.

Nurses in the Baby Boomer generation are poised to retire now and in the next few years.

Providence plans to hire 73 new graduates this year spread between various departments, she said. The hospital takes steps to ease new nurses into the job. New nurses are placed in a residency program that ranges from eight to 26 weeks depending on what unit they work in.

They are more closely supervised and gradually exposed to practices and procedures.

A potential nursing shortage is something Providence officials are keeping close tabs on.

“We can’t deliver high quality care without high quality staff and the right number of staff,” she said.

***

Florence Nightingale laid the groundwork for professional nursing when she created the first training school for nurses in London in 1860.

By the turn of the century, large hospitals in the U.S. were setting up nursing schools that emphasized practical skills. Students learned hands on in a hospital setting, often serving as a cheap labor.

After World War II nurses were in short supply, and programs at community colleges sprouted up to quickly get nurses into the workforce.

Everett Community College’s nursing program began in 1950 and is one of the oldest in the state.

Today, most nursing students are educated at community colleges or universities, rather than in hospital-run schools. Two-year programs such as Everett Community College’s provide a quick and less expensive route to the workforce.

Potential students are lining up.

At EvCC, the school routinely receives up to 120 applications for 40 slots a quarter. All schools — universities or community colleges — prepare students to take the same state licensing exam to become a registered nurse. For years, that credential is largely all that mattered. That’s changing.

Professional organizations and employers are now pushing for nurses to earn a bachelor’s degree. While that’s good for patients, it adds another wrinkle to getting nurses educated and into the workforce.

Researchers found hospitals that employed more nurses with bachelor’s degrees had better patient outcomes.

A landmark report published in 2011 by the Institute of Medicine recommended that 80 percent of the nation’s nurses hold bachelor’s degrees or higher by 2020.

That’s a high bar. To put that in perspective, just under half of Providence’s registered nurses have a four-year degree. Like other hospitals, Providence wants to increase that number.

Two years ago the hospital began requiring all the registered nurses it hires to earn a bachelor’s degree in five years. Providence offers its nurses scholarship money, flexible schedules and tuition reimbursement to help reach that goal.

Patient care is increasingly complex, said Kathy Watson, associate dean of nursing at Everett Community College. Nurses who go through two-year programs such as Everett’s are well-trained to care for patient needs and perform procedures.

About half of registered nurses are educated at two-year programs, she said. The advantage of a four-year degree is that it broadens a student’s horizons.

The extra education exposes nursing students to research-based practices, public health policy and other larger health issues.

***

Health care leaders, professional organizations and schools are working to make it easier for nurses to obtain and advance their educations. Community colleges and universities in this state agreed to a common set of prerequisites so that registered nurses with two-year degrees can more easily obtain a bachelor’s degree. Everett Community College is an early adopter.

EvCC also partnered with UW Bothell to offer an innovative program called “The First Year Track.” Students attend the first year of university at UW Bothell, the next two years at EvCC and the last at UW Bothell.

Another program located at EvCC allows registered nurses with two-year degrees to earn a bachelor’s degree while working. The degree is from UW Bothell but students take classes at EvCC.

The solution to a nursing shortage might seem as easy as expanding nursing education programs but both community colleges and universities have trouble finding qualified faculty. It’s not hard for EvCC to find working nurses who might want to teach a class or two. But finding full-time faculty is difficult because teaching pays far less than professional nursing — in some cases a third less.

Nursing faculty need at least a master’s degree.

The Legislature controls how much public schools can pay and, so far, nursing organizations haven’t had luck convincing state leaders to increase funding. Community college teacher unions also tend to favor keeping pay for all faculty the same.

Nursing students also need time working with patients. Area hospitals can only handle so many students at once.

EvCC students do some of their clinical training in a lab that features high-tech simulation mannequins.

The lab is part of a new $37.5 million building at EvCC. Students can practice real-life situations such as how to care for a mother in a labor, administer medicine or deal with a heart attack.

It’s not clear how much time in the lab can replace work in a hospital setting, Watson said.

***

It’s hard to believe how much things have changed since newly retired nurse Sharon White graduated from school in a white nursing cap in 1976.

Records have moved from paper to electronic, so patient information is easily available. Machines handle some tasks that used to be performed manually.

A computer can alert a nurse when a patient’s oxygen level is too low or blood pressure too high.

Advances in technology are mind-blowing, giving a nurse far better information on a patient’s condition.

“CT wasn’t even developed when I came in,” she said. No more pushing and poking to figure out what might be going on in someone’s gut.

White described nursing as hard work, a job that can involve life and death decisions daily.

Still, it’s a career she would recommend, especially to those who like people and do well at science and who are curious about how the human body works.

“I wouldn’t change my career for the world,” White said. “I found it exceedingly fascinating, never the same day twice. I still love it as much or more than the day I started.”

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