Diagnosis: Not Enough Nurses

When Liz Tattersall first considered nursing, it sounded like a great career. It was rewarding, remunerative and in high demand. But after six years as a triage nurse at a community clinic in New London, Conn.--with dozens of charts on her desk at a time, phones ringing constantly, patients in the waiting room with guns and knives--she had burned out. "I brought the stress home with me every night," she says. "I was a disaster." Like growing numbers of her colleagues, she decided to explore one of the many other career paths open to nurses, from teaching to evaluating insurance claims. She went to work for a drug company.

Tattersall is not alone. Multiply her story by thousands of nurses across the country who've left the profession, and you can see why 30 U.S. states today have nursing shortages. It's only going to get worse. By 2020, the government projects, 44 states plus the District of Columbia will have shortfalls. That's cause for real concern. Nurses are the key to safety in hospitals and nursing homes. "You're not admitted to the hospital for medical care, but for nursing care," says Linda Stierle, CEO of the American Nurses Association. After all, many surgical procedures can be performed on an outpatient basis. "If they keep you in the hospital, it's because you need someone to monitor you 24/7," she says.

The need for new nurses has never been more acute. An aging population will increase the demand over the coming decades. At the same time, with more and more nurses approaching retirement, the supply will decline, unless enough new recruits can be trained. Yet understaffed nursing schools had to turn away more than 32,000 qualified applicants last year. And Congress budgeted only $150 million or so for financial aid, with the result that 82 percent of federal-loan applicants were rejected. "The public sector needs to take this on," says Peter Buerhaus, a health economist at Vanderbilt University. "We're talking decimal dust compared to the billions spent in Washington. Nursing levels could be a national-security issue if bird flu or bioterror strikes."

Even under normal circumstances, nursing is crucial to patient safety. A landmark 2002 study found that for every additional patient a hospital nurse had to handle, complications increased, and mortality rose 7 percent. Similarly, in nursing homes, Susan Horn of the University of Utah found recently that when nurses spent less than 15 minutes a day with each resident--a common situation--patients suffered more pressure sores, falls, infections and hospitalizations. At 30 to 40 minutes of daily nursing time, she says, outcomes were so much better that "it was actually cheaper to hire more nurses."

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Where will they come from? Foreign-born nurses have filled many of the gaps--although some developing countries now have shortages of their own as a result. So many nurses (and doctors) have left the Philippines, say recent reports, that 1,000 private hospitals have closed in the last five years. Ultimately, says Diana Mason, editor in chief of the American Journal of Nursing, "we will never have enough nurses unless we fix the work environment."

That's exactly what some hospitals are trying to do. In recent years, they've increased salaries--entry-level wages in New York City can run to $60,000. They're offering better hours, with less mandatory overtime. And growing numbers are qualifying as "magnet hospitals"--facilities recognized by the American Nurses Credentialing Center for their ability to attract and retain nurses through an emphasis on excellence in nursing. There are now more than 180 magnet institutions nationwide--about 3 percent of all U.S. hospitals.

Are such measures the cure? Even Tattersall says, "I had a fleeting moment last week when I thought about going back." Unfortunately, the urge passed quickly.

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Diagnosis: Not Enough Nurses | News