Think of nursing as an extra value meal. With your hospital room, you get a side of RNs.
Sounds degrading? Well, that could be one of the reasons Colorado, and the nation, is mired in a nursing shortage that, despite some recent growth, could still be spiraling toward epidemic proportions.
"Nursing has been viewed as a cost of doing business rather than a source of revenue," said Linda Metzner, head of the Colorado Nurses Association. "Nursing has been bundled into the price of the room and is looked at as an area of price control rather than a function of high-quality care."
Metzner sites the "corporatization" of health care as being one of the factors in the perception that nursing has shifted from being a profession to being a commodity. She’s quick to point out that such "corporatization" needed to happen, but this particular side effect is one of the factors that has led to a shortage of nurses here in Colorado.
The Colorado Department of Regulatory Agencies Board of Nursing said there were 46,676 RNs active in Colorado as of June 2001. But, numbers from a February 2000 survey conducted by the Health Resources and Services Administration suggests that only about 79.1 percent of those are employed in nursing.
More disturbing numbers come from the Colorado Alliance of Nursing Workforce Development Opportunities. In August 2001, the alliance sited 1,487 vacancies for RNs, with another 80 for LPNs. About 1,000 of those were in central Colorado along the Front Range.
There are two more worrying factors. The alliance reported the average age of nurses in Colorado has risen to approximately 47 years old, higher than the national average the Health Resources and Services Administration reported of 45.2. Metzner added that some 60 percent of Colorado’s nurses were over the age of 45. And 17 percent of RNs told an alliance survey they didn’t plan to be in nursing within five years, while another 27.8 percent said they were unsure.
Over the next few years, the heath care community will be faced with figuring out how to attract more people into the profession and how to retain them once they get in. Then it’s a matter of tackling some of the image issues in which the profession is mired.
According to the American Association of Colleges of Nursing, enrollments in entry-level baccalaureate programs increased in fall 2001 for the first time in six years, with 106,557 entering programs. The number represents an increase of 3.7 percent compared with fall 2000 enrollments. Findings were based on a survey of 548 (80.8 percent) of the nation’s nursing schools with bachelor and graduate level programs.
The numbers sound encouraging until they are compared with numbers from 1995, the last year before the decline, when there were 127,683 enrollees. Moreover, the Health Resources and Services Administration reports that while the population of the United States increased 13.7 percent from 1990 to 2000, the number of nurses entering the workforce over the last half of the decade represented just 4.1 percent, down from 14.2 percent over in the first half.
"I think we’re seeing some upswing related to dot-com fallout and the economic drop off, but it’s not going to be enough in the long run," Metzner said.
"Now is the time to act, to stimulate an interest in kids getting interested in a health care career," said Dr. Denise Geolot, the director of the Health Resources and Services Administration’s Division of Nursing.
Geolot said there are several approaches being taken to increase enrollments. Members of the health care community are visiting schools and talking with K-12th graders about the rewards of a health care career, which she said will show success.
Inherent to the problem has been attracting ethnic groups and men into the nursing profession. According to the Health Resources and Services Administration survey, 86.6 percent of nurses are White (non-Hispanic). Further, only 5.4 percent of nurses are men.
Metzner went on to say that it’s even getting harder to attract women to nursing because of the number of professions that previously were less receptive to women, such as the legal profession, are now wide open. And even within the health care community, some people that are currently nurses are working on advanced degrees to go into administration or to become physicians’ assistants, for example.
The federal government has stepped in for those attending or considering entering programs, with its Nurse Education Loan Repayment Program and grants directly to colleges, universities and other organizations.
Loan repayment is exchanged for a two-year commitment to nursing in under-served populations, such as rural health clinics, public facilities and Native American health centers. Contributions to the program have risen from $2.239 million in 1999 to $10.2 million in 2002. President Bush plans to ask for $15 million for 2003, which would support 675 new and 125 third-year nursing education loan agreements.
In September 2001, the U.S. Department of Health and Human Services announced a series of grants totaling $27.4 million to help combat the nursing shortage. The University of Colorado Health Sciences Center won two Basic Nurse Education and Practice grants of the 94 total grants, totaling $515,800. Geolot said some of the money was aimed for Web-based education programs for rural nurses, baccalaureate programs and other such programs.
Metzner said she is glad the federal government has set the precedent with such programs and while legislation isn’t her first choice, she hopes such incentive programs filter down from the national level to the state level.
"You would think that in a market-driven economy (such programs) would have happened already, but that hasn’t happened freely. That’s why we’ve had to go the legislative route," she said.
Metzner cited several factors as to why nurses might be leaving the workplace. She said the 12-hour shift has become the norm in many hospitals, which hasn’t been as attractive to the older segments of the workforce. She said she’s surprised that while such groups as pilots and medical interns have had their maximum shift times mandated, the same principle hasn’t reached nursing.
She also said that many nurses feel that although they were educated to be professionals, they are treated like blue collar workers when they enter the workforce, with little or no control over their scheduling or number of patients they are seeing.
Metzner said she is surprised that a few of the ideas that have been around for years haven’t been implemented. One of her favorites would be to see hospitals market the professional nature of their nursing staff much as the physicians are marketed. She also would like to see nursing care billed separately from hospital bills.
"I’m waiting for hospitals to realize the marketing potential of providing high-quality nursing care," she said. "That would certainly generate revenue just like advertising doctors."
Geolot agreed, saying that the heath care community will have to figure out how to capitalize on the expertise of its nurses.
"We’re seeing a lot of thought being given to the nature of the work, improving the work environment and enhancing patient care," she said. She added that besides the basic issue of respect, strong nursing leadership and nursing autonomy are two of the areas that the community will have to review in the coming years.
Metzner sees some opportunity out of this latest shortage.
"I hope this shortage gives us the opportunity to solve the chronic problems in nursing that lead to these cyclical shortages," she said.