Supply of Nurses Needs Urgent Care

By Don Colburn, The Oregonian, Portland, Ore.

May 28–Everyone is getting — have you heard? — older. Not just the people most likely to need medical care soon but also nurses on the front lines providing that care.

And — here’s the rub for a mismatched health system — so are the nurses whose job it is to train the next generation, to replace those about to retire in droves.

“Nursing is caught in the perfect storm of demographic and social change,” says Joanne Warner, dean of the University of Portland School of Nursing, which produces more nurses than any Oregon campus.

Warner sees the shortage as less cause than symptom of “an intractably broken health care system.” To say the nurse shortage is the problem, Warner says, is like blaming a skin rash for a total-body allergic reaction.

The lack of nurses is not new. It could be said to date back to when a cave dweller first yelled-in sick with flulike symptoms or stubbed his toe on a rock. But think about the health care worker you are most likely to encounter first when you or your child or your parent gets sick — it’s probably a nurse.

Susan King, an emergency care nurse and executive director of the Oregon Nurses Association, says the current shortage is the third major one in her 35-year career.

“We’ve had a mismatch of supply and demand about once every 10 years — early 1980s, early 1990s and now,” King says.

Two factors make today’s pinch harder. First, the demand for basic nursing care is rising as baby boomers hit age 60 and require more medical attention.

In Oregon the older population is growing rapidly, as in-state retirees stay and out-of-state retirees move in. By 2025, more than a million Oregonians will be past age 65 and Oregon will rank No. 4 among states for proportion of older residents, the Census Bureau predicts. The effect reaches beyond census spreadsheets: People older than 65 spend more than four times as many days in the hospital as others.

The second factor is that the supply of nurses itself is growing old.

The average age of an Oregon nurse is 47 — at least a decade older than the majority of Americans. Nursing school faculty members average 52 years old, and full professors nearly 60.

“I keep aging with the average — it’s me,” says UP’s Warner, who is 57.

More than half of the state’s nursing school faculty plan to retire during the next 12 years, says Kris Campbell, executive director of the Oregon Center for Nursing. “The faculty shortage is now our most critical shortage.”

Paradoxically, the shortage looms as more students than ever are going to nursing school. The number of registered nurses in the state has grown every year since 1990 — less from expanding classes than from out-of-state nurses moving to Oregon.

About 20 schools in Oregon produce nurses ready to take the licensing exam that makes them registered nurses. Collectively, they graduated 1,199 nurses this year, up from 695 in 2001. Oregon Health & Science University is the biggest, with 221 graduates on its four campuses. UP has tripled its graduating class of nurses from 55 in 2000 to 180 this year.

“The problem is,” King says, “unless you retain them in the profession over time, all they’re doing is coming in the front door, but the back door is open and they’re leaving.”

The shortage of nurses ranges across the board, King says, but particularly in operating room and surgical specialties, neonatal intensive care units, out-of-hospital jobs and mental health care. Rural areas run chronically short of nurses.

Pay has improved, and starting salaries have never been higher — about $56,000, plus overtime, for prime hospital jobs in the Portland area. Salaries tend to be lower at long-term care centers, health clinics — and on the faculty of community college nursing programs.

Another factor is “salary compression.” Raises have not kept pace with starting salaries, King says, which means that many nurses “top out” after 15 years — an incentive to retire early.

One fact unchanged is the predominance of women. Even in Oregon, which in 2002 coined the recruiting slogan “Are You Man Enough to Be a Nurse?” and where the percentage of male nurses is higher than nationwide, nearly 90 percent of nurses are women.

Increasing the number of trained nurses quickly is difficult for two main reasons, UP’s Warner says. “We don’t have enough faculty, and we don’t have enough clinical sites.”

Oregon has two to three times more qualified applicants than it has the capacity to educate, the Oregon Nursing Leadership Council concluded.

And not just Oregon. Nationwide, 426 nursing schools have increased enrollment for the past seven years — yet still turned away more than 30,000 qualified applicants last year, according to the American Association of Colleges of Nursing.

Nursing’s challenge goes beyond sheer numbers, Warner says. The jobs grow ever more demanding, with more and sicker patients, more science to learn and more data to track.

That cuts two ways. Nurses have more responsibility. But it’s hard work — physically, mentally and emotionally. Many nurses say neither pay nor staff support has kept up with the load.

Numerous studies have linked higher nurse staffing levels with better patient care and results. A study in 2003 in the Journal of the American Medical Association found that doubling the number of patients per surgical nurse not only increased nurse burnout, but also raised the mortality rate by 31 percent.

Earlier nurse shortages partly reflected widening job opportunities and expectations for women. More than half of medical students now are women, and increasing numbers of women have joined professions such as law, dentistry and engineering.

During previous nurse shortages, some slack was taken up by nurses who had cut back to part time or left jobs to raise children — and then were coaxed back into the work force.

“What’s different about this shortage,” Campbell says, “is there’s no one to come back.”

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Copyright (c) 2008, The Oregonian, Portland, Ore.

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