Number of Nurses Shrinking Despite Efforts to Retain Staff

When Gary Peichoto began nursing in 1975, he had great expectations.

"Nursing was supposed to be opening up for men," remembers Peichoto, one of only two men in his nursing class of 100 students at UC San Francisco.

After returning to school to earn a master's degree, he began working as a nurse practitioner. "I see my own patients, write prescriptions and discuss each phase of a patient's treatment with them," explains the Northern California resident, who works at the Veterans Administration in Modesto.

He expected by now the number of male nurses in this traditionally female profession would leap past the paltry 3 percent it was at that time. But more than 25 years after Peichoto entered the field, the number of men is still miniscule - only 5 percent.

This lack of growth is symptomatic of a larger issue the profession has been grappling with for the last two decades, and will feel even more acutely soon, if analyst's predictions are correct - a growing gap between the number of nurses needed and the number available.

Good Career Paths

"Nursing is a good career for a variety of reasons," says Katie Bray, a nursing workforce consultant with the Coalition for Nursing Careers in California. "Nurses contribute to the greater good of society. There's lots of flexibility and lots of mobility."

In fact, on the website operated by Sigma Theta Tau International, the Honor Society of Nursing, there are more than 41 different career paths nurses can take.

"In California, salaries are not an issue," adds Bray. "We lead the way, particularly in Northern California." Bray's take on the profession is supported by Bureau of Labor Statistics (BLS) research, which touts nursing as one of the top 10 careers in job growth through 2010.

Ironically 2010 is also the year that the number of nurses needed will actually outstrip the number available, according to a report in the January 2001 issue of Nursing World magazine.

Many on the Sidelines

And that's the quandary. While nursing is a well-respected profession, fewer people are stepping up to take the Florence Nightingale pledge. In addition, according to the BLS, many of those currently in the profession don't practice full time. For example in 2000, BLS, found that 1 in 4 nurses worked only part time.

"The number of people holding nurses licenses is more than enough to fill the shortage, but in many cases they choose not to use their degree," reports Martin Taylor, health policy specialist with the Oregon Nurses Association. He says nurses typically opt out of full-time duty, when they feel the quality of care they'll be able to provide patients is sub par.

In addition to the tough working environment chasing away nurses, other factors - an aging nurse population, declining enrollments in nursing schools because of broader career options for girls, insufficient faculty to teach classes, and a very expensive course of study - have reduced the nurse pipeline to a mere trickle rather than the torrent that is needed.

Desperate Measures

A variety of efforts are being made in California and around the nation to stop the erosion of certified healthcare personnel before the situation becomes a life and death matter. In 1999, the California state legislature passed a law requiring minimum nurse-to-patient staffing levels at hospitals.

"On January 22, 2002, they announced what the ratios were, and now they have to go through a review process," says Kay McVay, president of the California Nurses Association (CAN), which spearheaded the drive for ratios. "We believe once ratios are in place, a lot of the nurses let go because of restructuring (in the early 1980s) and those who've left the profession will come back."

California isn't the only state to pass legislation improving the nurse-patient ratio. An Oregon law recently passed requires hospitals and clinics to work with nurses and other front-line caregivers to develop staffing plans based on the needs of the patient, says Taylor.

In contrast to ratios, this approach considers the level of patient illness (acuity) and staffs accordingly. To put teeth in the law, Taylor says nurses were given the green light to report a hospital or clinic that deviates from its approved staffing plan.

Nine other states are also considering staffing legislation, according to the American Nurses Association, including Alabama, New York, South Carolina and West Virginia.

On the federal level, House and Senate versions of the Nurse Reinvestment Act were passed and must be reconciled. Both bills establish scholarship and loan repayment programs for student nurses and authorize public service announcements promoting nursing as a career.

Several other pieces of legislation are pending, including a nurse retention program and a bill to severely limit the amount of mandatory overtime nurses can be required to work.

There have also been some efforts to increase the diversity of the nursing population. Currently the nurse pool is about 5 percent male, 4.9 percent African American, 3.7 percent Asian/Pacific Islander, 2 percent Hispanic, and .5 percent Native American/Alaskan Native.

Last September, Health and Human Services Secretary Tommy Thompson announced $20.1 million in grants to 82 colleges, universities and other organizations (including Sonoma State University in Rohnert Park and UC San Francisco) to help diversify the workforce, increase the number of nurses with bachelor's and advanced degrees, and prepare more nurses to serve in public health leadership roles.

Another $7.3 million will be used to repay the educational loans of clinical care nurses who agree to work two years in designated public or nonprofit facilities facing a critical shortage of nurses.

Industry officials hope all these efforts will bring more people like 23-year-old Maria Bayog to the profession.

"I first decided to pursue nursing in high school. I thought about it, and figured they make decent money," recalls the Stockton Intensive Care Unit (ICU) nurse, who also liked the care-giving side of the profession. "Yes, I heard the horror stories, but I figured I'd try it first, after spending four years and $28,000 to get the degree."

That try has been worth the effort so far. Even though she dealt with the stress typical of understaffed floor nursing, after one year in the profession, Bayog could very well be the best advertisement the industry needs - a young, enthusiastic, committed and caring individual whose primary concern is helping patients recover.

Next week - Other careers in medicine.

American Nursing Services - American-Nurse.com, (800) 444-6877, a nurse owned and operated supplemental staffing and home care agency.

CalifNurses.org - Website for the California Nurses Association, (510) 273-2200.

Coalition for Nursing Careers in California - cncc.org

Erikson & Associates, Inc. - NurseSearch.com, (816) 743-0149, nationwide nursing jobs resource.

FASTSTAFF Nursing - Faststaff.com, specializes in staffing solutions for travel nursing.

Managed Care Resources - MCR4Jobs.com, (800) 350-1471, job listings of permanent and temporary positions.

National Nurse Search - NurseSearch.net, nationwide listing of job openings.

Nurses.com - Online community featuring comprehensive career resources.

Nursing Management Services - NMS-Nursing-USA.com, (800) 797 8707, provides healthcare professionals with short-term and long-term assignments at leading Health Care facilities throughout the World.

NursingSpectrum.com - Website for nurses with links, articles, and career and jobsearch areas.

Oregon Nurses Association - (503) 371-1757

Professional Nursing Service - ProfessionalNurse.com, (800) 777-6430, provides traveling nurses to healthcare facilities on a temporary basis.