Demand for More Nurses Driven by Aging Population.

IMAGINE being in a hospital with no nurses. While this scenario is far-fetched, there is a shortage of registered nurses locally, in California and across the country. And the shortage is projected to be the worst ever, according to hospital executives throughout California.

In fact, there is concern that the United States may never catch up with a sufficient supply of nurses who are educated to work in an increasingly complex and demanding health environment.

All of the dire predictions about managed care cost-cutting and nurse workforce reduction have not materialized; states like California with higher managed care penetration have shown an increase in nursing employment, and nursing demand has grown, not declined. So what's the problem?

It lies with the increased demand for health services as our population ages. People over 85 are the fastest growing population segment in the United States, consuming a disproportionate amount of acute and chronic services.

Trouble within 10 years

The U.S. Department of Health and Human Services predicts that demand will exceed nursing supply by 2010, just as baby boomers are about to become eligible for Medicare. By 2015, 114,000 nursing jobs will be unfilled nationally, and by 2020, demand will climb nearly twice as fast as supply.

To compound this problem, nurses are aging right along with the rest of us. The average age of nurses today is 46. Approximately 50 percent of nurses are entering their 50s and many will be leaving the workforce in the next 10 years.

The fact that nurses are aging along with the overall population is no surprise. What is a surprise is how few students are choosing nursing as a profession. Entry-level baccalaureate nursing school enrollment declined 5.5 percent in 1998, the fourth consecutive year, according to the National League of Nursing.

Some schools report fewer applications, stoked by media coverage of hospital layoffs and closures, as well as lingering misperceptions of a nursing oversupply. Other schools say enrollment declined even when applications didn't because of shortages of faculty and clinical training sites.

In addition to their basic education, graduating nurses need at least two to three years of practical experience and generally require additional training to be hired into specialty areas. Hospitals are in dire need of qualified nurses in those specialty areas - critical care, operating room, emergency room and neonatal.

Nurses today have many choices of work environments. Hospitals face stiff competition for nurses from other health facilities - home care, primary care centers, nursing homes, community clinics and even call centers.

Remedies that have worked in the past will not work today. Raising wages, offering sign-on bonuses or otherwise enhancing the compensation package only serves to rearrange the existing labor force and drive up overall labor costs. Because other regions and even other countries are experiencing shortages of qualified nurses, recruitment efforts outside California will not expand the supply of competent specialty nurses or even the pool of available generalist nurses.

The search for solutions

Experts are looking for solutions on three fronts. First, public policy, legislation and funding must unite around this serious public health issue, recognizing that a nursing shortage is a threat to public health if it is not corrected, and corrected soon. California legislators took a major step in this direction with the recent passage of Assembly Bill 655, which calls for a statewide plan, strategy development and a budget to increase the number of nursing students and specialty training opportunities. Unfortunately, funding did not accompany the passage of the bill.

Second, hospitals and schools of nursing must work together to identify and meet the educational needs of both the student and the graduate nurse who desire additional specialty education and training. They must jointly identify methods to fund faculty and ensure the availability of clinical settings for nurses who need both basic and specialty training.

Lastly, hospitals must find ways to establish healthy work environments for nurses - in spite of the demands created by managed care. Those demands have decreased the time patients stay in the hospital but have increased the intensity of service requirements for the nurse. Hospitals must develop programs and incentives that motivate nurses to continue their education.

Funding is the key to all of these solutions. All of us need to be aware of this potential health care crisis and advocate strongly for nursing education. The Legislature needs to make it a top priority in public policy and funding. Corporate foundations need to stand behind this social need. And nursing schools must seek the funding and faculty and expand to meet the growing need.

Sooner or later, most of us will need hospital care. It's in all of our interests to take this issue seriously now - before it reaches crisis proportions.

Stephanie Ruh-Mearns is a registered nurse and president of the Association of California Nursing Leaders. Mary Dee Hacker is also an RN and vice president of patient care services at Childrens Hospital Los Angeles.