Sharp rise in recruitment fails to plug nursing gap.

Marianne Sawchuck doesn't consider herself someone with stars in her eyes, but she admits that moving from Vancouver to Los Angeles to take a registered nursing job was a pretty easy decision.

Besides the California sunshine, what lured her was an incentive package offered by White Memorial Medical Center in East Los Angeles that included a $4,000 cash bonus, three months free rent and assistance in getting her green card. The hospital even agreed to her demands to only work weekends.

"They were very generous," recalled Sachuck, 33.

In the face of a stubborn statewide nursing shortage, hospitals all over Los Angeles have been aggressively recruiting nurses from other countries and other states--and with impressive results, according to the Board of Registered Nursing.

In data not widely known, the board issued 18,448 registered nurses licenses in the 2002-2001 fiscal year, up 57 percent from two years earlier when 11,745 licenses were issued.

Much of the increase is coming from out-of-state, as well as foreign countries, because California is unable to produce enough homegrown candidates. But even with the influx of out-of-staters, the shortage is expected to get worse before it gets better as California becomes the first state in the nation, beginning in 2004, to set specific nurse-to-patient ratios. This likely will require hospitals to hire even more nurses.

"It's as if you have a big hole in a boat and you are using a cup to bail the water," said Jim Lott, executive vice president of the Healthcare Association of Southern California, the region's hospital industry trade group. "Even if the cup gets bigger, it's not big enough."

California has an estimated 20 percent vacancy rate, or up to 12,000 positions currently unfilled. Industry studies project that the state's growing population, in combination with a lack of new graduates and an aging RN workforce, will lead to a shortage of 70,000 nurses by 2020.

Aggressive recruitment

Hospitals are being forced to fill the gap any way they can.

Five years ago, Queen of Angels/Hollywood Presbyterian Medical Center, the large East Hollywood Hospital operated by Tenet Healthcare Corp., largely recruited locally, relying on cash bonuses that ranged from $2,500 to $4,000 for a full-time nurse. Since then, the hospital has increased its recruitment efforts and in November radically increased its incentive package.

The "Get Your Career Into Gear" program offers payments on a new car for two years with an $8,000 cap, or a straight $7,000 cash bonus. The program was modeled after incentives pioneered in Silicon Valley during the tech boom, and it has already attracted eight nurses, said Paul Woerz, the hospital's director of human resources.

Antonette Gurnani, a 31-year-old registered nurse, took Tenet up on its $7,000 cash bonus offer and recently relocated from Philadelphia.

"I was astounded, but I just wanted to try out California," said Gurnani, who also will get her flights back to Philadelphia paid by Tenet for the next two years.

Johan Gedde-Dahl, a nurse recruiter who has supplied nurses to Tenet as well as to White Memorial, said California hospitals have been among the most aggressive in recruiting nurses both domestically and internationally, often from the Philippines or Canada.

Hospitals will fly in candidates, and pay for both housing and tuition for continuing education. Assistance in meeting Immigration and Naturalization Service requirements is common with international recruits. All told, the packages may top $10,000, with a boost in salary. "That is a lot of money for a nurse," said Gedde-Dahl, who has placed four recruits from Canada at White Memorial.

Those coming to California are generally in their 20s and 30s and have one to five years' experience. They may be arriving from a state like South Carolina, where they earn as little as $21 an hour, compared with over $35 an hour if they move to San Francisco, said Gedde-Dahl. "Because it's an attractive place, with sunshine and a nice climate, it's still a place people want to go to:' he said.

Uncertainty over efforts

But the nursing shortage is expected to only get worse as the state establishes safe-staffing regulations next year specifying how many nurses must be on duty for a given number of patients. Although final ratios have not been issued, hospital officials expect they will have to hire more nurses.

The state's proposed staffing ratios call for one nurse for every five patients on medical-surgical wards. The hospital industry had asked the state to set ratios half as large.

White Memorial was able to reduce the number of open RN positions to 23 late last year, down from 40. But the number rose to 33 as of Jan. 1 when the hospital, in advance of the state, beefed up its own staffing ratios, said Beverly Morris, White Memorial's human resource director.

The California Nurses Association believes that the ratios, which stem from 1999 legislation, may be a factor in attracting nurses. But the industry projects that whatever benefits the ratios may bring will be outweighed by the mandate to hire more.

On top of that, the nurse shortage is getting worse in other states and countries, that have historically supplied California with about half of its new registered nurses, said JoAnne Spetz, an industry expert with the Center for Health Professions at the University of California at San Francisco. "It's a quick fix but it does not solve the long-term demographic problem:' Spetz said.

Also unclear is how many of the newcomers are here to stay.

In the 2001-2002 fiscal year, out-of-state nurses accounted for 56 percent of the 18,488 licenses issued by the nursing board, up from 42 percent of the 11,745 licensed issued two years earlier. But many of those may be so-called traveling nurses who work weeks or months at a hospital in critical need of nurses at pay that may be double what a permanent employee receives. Then, it's on to other hospitals or states.

The numbers also may be inflated by recent labor conflicts between hospitals and nurses. Last fall, over 1,000 nurses at Long Beach Memorial Medical Center walked off their jobs in two separate one-day strikes, causing the hospital to import hundreds of traveling nurses.

No place like home

Uncertainty over the availability of out-of-state and foreign nurses has not been lost on local hospitals or political leaders.

In announcing his proposed staffing ratios last year, Gov. Gray Davis pledged $60 million in state money to train an additional 5,000 nurses over the next several years.

Meanwhile, Tenet, White Memorial and other hospitals have established relationships with local nursing programs, offering scholarships, training and other benefits to hike graduation rates and increase the number of class slots available.

Good Samaritan Hospital, a stand-alone non-profit facility, offers signing bonuses as high as $5,000 but does not aggressively recruit out of state, finding that too difficult. Instead, it works closely with 20 area nursing programs, and is offering four scholarships to seniors in the last year of training at Mount St. Mary's College, said Myra Aldana, the hospital's director of employment.

So far the results have been encouraging, with the hospital able to cut the amount it spends on traveling nurses in half.

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