Thursday, February 27, 2003
Copyright © Las Vegas Mercury

Anybody want to be a nurse?

Growing demand for nurses conflicts with diminishing interest in job

By Larry Wills

While millions of Americans are pounding the streets looking for work in this recession, hospitals can't find enough nurses to maintain consistent levels of health care.

Nurses are being lured from one job to another by help wanted ads offering bonuses and education perks, and as medical facilities compete over the shrinking market. Even the overseas talent pool, a rich source of professional nurses, has hit a geopolitical snag.

The want ads say it all. "New rates! Up to $28 an hour." "You may qualify for a $5,000 bonus." "Great Pay. Great People. Travel Assignments."

Training upgrades are commonly offered to convince nurses to change jobs, and some hospitals have forgiven student loans.

"We are aggressively recruiting nationally and internationally," says Mike Tymczyn, head of marketing for the Valley Health System. "We spend $1 million a year in recruitment and retention."

Tymczyn's organization operates the Valley, Desert Springs and Summerlin hospitals and is building another in the Spring Valley area.

"Several times a year, we travel to international locations, such as the Philippines, European countries and India. Unfortunately, since the Sept. 11 tragedy, the procedures to bring in a nurse have significantly intensified, taking six months or more."

Tymczyn says the nurse shortage isn't critical yet, but he sees trouble on the horizon. "The average age of a nurse is over 45," he says. "We'll have more acute problems in 15 to 20 years."

Already, hospitals are being forced to cut back operations if not enough nurses show up for duty. "If we don't have enough nurses to staff all areas of the hospital, we have to limit the number of patients we can take," Tymczyn says. "As the nursing problem becomes more severe, the amount of patients will be restricted."

So far, those restrictions have been limited to noncritical areas, such as elective surgeries.

Cheryl Smith, spokeswoman for Columbia's Sunrise Hospital, faces similar headaches. "It's certainly a challenge," she says. She calls overseas recruitment time-consuming and frustrating. "There's an enormous amount of lag time. Processing through INS is huge. We also have extremely stringent standards. Not everyone overseas is qualified."

So hospitals are trying to sweeten the pot for qualified applicants at home.

"We have sign-on bonuses," Smith says. "We have a tuition reimbursement for individuals who wish to go on to school." About 20 scholarships are now available.

The Valley Health System targets students at the Community College of Southern Nevada in a program called Adopt-a-Student.

"If they maintain a minimum average, we will give up to $2,000 per semester in their last two years," Tymczyn says. "All we ask is they sign an agreement to work two years. We have 40 students in the program. It's a very competitive environment in Las Vegas."

Gretchen Papez, marketing director at Valley Hospital, says another emphasis is keeping nurses once they're on staff. "The hospital tries to retain its nurses," she says. "They have a lot of options."

That strategy seems to be working well at University Medical Center, where there are only 14 openings in a staff of 1,400.

"Our turnover is less than 4 percent," says Laura Green, nurse recruiter at UMC. "We're the only teaching hospital. There's a lot of opportunity for learning and professional advancement. You don't have to leave UMC if you decide to leave pediatrics or surgery."

She says an excellent benefit package keeps the nurses on the job, but she believes the national shortage will eventually affect UMC. Many nurses also find working in a pubic hospital is appealing to them, since all income groups receive care.

"We have a lot of nurses here who are getting older," Green says. "It is more difficult to find nurses for those positions." She says less than 10 percent of the nurses are under age 30.

Add to that a decade of neglect amid the uproar in the nation's health-care system, and nursing just isn't as attractive as it once was.

"In the '80s and '90s, hospitals were looked at as businesses," Green says. "A majority of labor costs are in nursing. So they started cutting them back. Now we're trying to catch up."

But Green concedes that won't be easy in the current labor market. "A Bureau of Labor Statistics study showed nursing wages were flat since 1992," she says.

So the focus now may be shifting to an emerging talent pool at Southern Nevada's high schools. Hospitals also have developed close working relationships with Nevada's nursing schools.

Maureen Matteson-Kane, a UNLV department of nursing recruiter, hits the local high schools to drum up interest. "I talk to the high school kids and I still find young people interested in nursing," she says. "Once we get them, we hang on to them and get them through the system."

But Rosemary Witt, department chair, says there are distractions for many young people. "There are so many more options right now," she says. "Some have less commitment and less hard work and more money." Witt says nurse pay usually tops out after five years and, with hospitals trying to contain costs, that can discourage many people from entering the profession.

"It's hard to come into the field when there's a feeling you're overworked," Witt says.

Even when high school grads do enter nursing school, they can be in for a shock. It isn't easy. "Students are not as well prepared as they used to be in math and science," Witt says. So the nursing school has resorted to tutoring students and providing assistance in course work to help get them through the program.

Despite all that, Witt has 250 students in her program and a local placement rate of 89 to 90 percent. And a quarter of the students are men.

Witt's faculty takes students to local hospitals and walks them through the daily routines they can expect after graduation, keeping checks on patients and ensuring the right medications are given. In a 12-hour shift, it becomes a high-pressure grind and a parade of tough judgment calls.

Carol Rayfield, a UNLV nursing faculty member, takes her class to Valley Hospital at dawn and gives them a whole day on the job, learning a nurse's routine.

"Nursing is as much thinking as doing," Witt says. "We have eight students per faculty. We also care for patients in the whole gamut of conditions. It's the first line of defense. The doctors are not there."

But Witt concedes that enrollment lags behind the need at local health-care facilities and the career's opportunities need to be better sold to young people.

Smith agrees. "We need to introduce students to the medical field, anything we can do to help foster young people."

But support for nursing isn't a high priority in Nevada.

"We don't see a lot of philanthropy" compared to other fields, Matteson-Kane says. "We need more rooms, more faculty. There's no funding for faculty in the summer."

To Green, the answer lies in state subsidies for nurses who choose to stay in Nevada. Witt says the state Legislature took a small step in that direction two years ago, mandating a plan to double enrollment in Nevada's seven nursing schools. But that plan may have little chance of passing in this year's budget crisis.

In the meantime, Witt hopes to convince more young people that nursing is a career that provides job satisfaction and security. "We can do a better job of saying why nursing is attractive."