Nurses are in demand but it’s a thankless job

Paradice still enjoys taking care of patients, but finds her work less rewarding than ever.

“There’s always been a nursing shortage,” she says. “The future for nursing is bleak. New graduates may not stay in the field because there’s too much fatigue and stress, and patients are more demanding.”

Nurses are in high demand in the Northland, the Twin Cities, and around the world. Yet very few work in the field until retirement age, Paradise says. “The job is physically demanding, causing knee, back, and neck problems.”

Lifting and turning patients take its toll. She’s already had carpal tunnel surgery on one hand from overexertion at work, and she’s worried about her other hand.

Jan Rabbers, spokesperson for the Minnesota Nurses Association, the state’s largest nursing union, says injuries are a huge problem, and the profession ranks fifth in the nation for back injuries. Also frequent are needlestick injuries, she says, causing hepatitis, AIDS or other life-threatening illnesses.

Registered nurses (RNs), critical to hospitals and clinics, are in one of the most demanding professions imaginable. They are under nonstop mental stress with responsibility for human lives, many times doing hard physical labor, dealing with the public and making critical decisions. Yet it’s common for these nurses to work double-shifts because their employer is shorthanded.

Most nurses enter the field because they like to take care of people. The majority are females ages 40 and over, who entered the workforce when there weren’t as many options for women. And while the pay has improved over the years, many nurses say they still face a struggle between trying to provide adequate patient care and having enough time to do it.

Last year, the American Nurses Association surveyed 7,300 nurses about their working conditions and health care in general. The results showed 75 percent believe the quality of nursing care has declined over the last two years. More than half believe the decline occurred because of “inadequate staffing,” with 44 percent blaming the decline on decreased nurse satisfaction.

A strong 56 percent stated they spend less time on direct patient care.

“It’s kind of a sad situation,” Paradice says. “Nursing schools are dropping in their enrollment. There are so many other professions to choose from that are more lucrative and less stressful.”

Another survey by the American Nurses Association indicates that 40 percent of nurses were injured on the job in the past year, and 57 percent had been threatened or verbally abused.

Another area of concern is “bedside rationing,” Rabbers says. Nurses at bedsides are the ones choosing which patients will receive the most care or will receive their medications on time, she says.

There are about 126,000 job openings for nurses nationwide. The U.S. Department of Labor states the median wage for registered nurses across the country is $21.56 per hour, or $44,840 per year. That sounds good, but many nurses only work part-time.

MariJo Girgen, RN, is a temporary agency nurse in the Twin Cities. “Most of the nurses I know do not work fulltime,” she says. “The job is very strenuous, both physically and psychologically.” A number of her friends haven’t been able to get into two-year nursing educational programs because they are always full, she said.

In the Twin Cities, Regions Hospital is offering a $10,000 bonus to solicit new nursing staff, causing many nurses who are already employed in the metro area to change employers, Girgen says.

Associated Press reports that in the Twin Cities, nurses have the authority to temporarily close units to new admissions if nursing levels become “unsafe.” This unique option was granted to them through union contracts at six metropolitan hospitals.

The shortage has affected the Northland, but not to the extent seen to the south.

View from St. Luke’s

We don’t offer bonuses, and we haven’t seen an exodus for the ones offered in the cities,” says Dave Lucia, director of human resources at St. Luke’s. “It’s not the same environment here.”

He says “shortage” is a relative term. “In certain areas it may apply. Our vacancy level is typically 70 or 80 openings, but there is constant movement within the system because of the bidding process.” He says in higher skill areas such as surgical or critical care, there is a longer recruitment period “but not exactly a shortage.”

St. Luke’s advertises on Internet job banks, and applicants can apply online through its website. “Nurses are not lined up at the door, but we get a fairly steady trickle,” Lucia says. Nurses haven’t closed wings here as in the Twin Cities, but in several instances St. Luke’s has had to divert patients to SMDC, he says.

St. Luke’s employs 300 nurses, and recently settled an agreement with the Minnesota Nurses Association. There also are about 100 non-union nurses working at various clinics in the St. Luke’s system. It employs a total of about 1,800 fulltime and part-time workers.

Lucia says that for the last two years, St. Luke’s has not used temporary nurses. He estimates 10 percent of the nursing staff in the Twin Cities are temps. Temporary staffing is expensive, nearly double the cost of an internal nurse employee. He says St. Luke’s has a good mix of full and part-time nurses.

The health system has experienced expansion in all care delivery areas, recently adding 11 internal medical physicians, creating an additional need for nursing staff.

View from SMDC

The SMDC health care system operates 29 clinics, hospitals and specialty care facilities across the region with a staff of more than 7,000. To set policies and strategies for its 800 nurses, SMDC has set up a five-member nurse executive council.

Ruth Strom-McCutcheon, RN, is vice president of SMDC’s Patient Care Services and a council member. She says the system has dramatically fewer openings than the rest of the country. “We typically have 50 positions open for all our sites at any given time — less than 10 percent of our jobs are open.”

Double-shifts are voluntary at the hospital, Strom-McCutcheon says, but roughly 75 to 80 percent of SMDC’s nurses work part-time. She says that Minnesota has the second highest wages in the country, except for New York, has a good track record and a strong union.

SMDC does its own recruitment, and does not offer bonuses. To fill critical shortages, it hires temporary nurses through agencies, she says.

Strom-McCutcheon believes that nurses won’t flock to the cities, because this area itself is a commitment. “Once students go to school here, they typically like the area and stay,” she says.

The view from Grand Rapids

Itasca Medical Center in Grand Rapids employs 366 health workers, about 95 of them RNs.

“Yes, we are having a nursing shortage,” says Renea Bourassa, human resources director. “It’s hard for small rural hospitals to compete with larger hospitals in terms of wages and benefits.”

Bourassa says the hospital has successfully recruited RNs from out of the area, even out of the state. Nurse openings have been reduced from 15 to four over the past six months because the medical center has engineered an “employee satisfaction and focus” atmosphere, Bourassa says.

The hospital created most nursing positions as part-time to maximize flexibility: Hours can be rotated based on patient loads. Nurses are included in shift planning and the hospital recently increased wages and benefits to within 5 to 6 percent of the Twin Cities, she says.

Itasca Medical Center also offers sign-on bonuses averaging $2,500, pays for relocation expenses, and expects the new $60 million medical campus in Grand Rapids to attract nurses looking for variety with its clinic and outpatient focus, Bourassa says.

The Filipino Solution

The College of St. Scholastica in Duluth offers baccalaureate and graduate nursing programs, and has teamed with SMDC to help remedy its nursing shortage.

The two are working with Global Scholarship Alliance (GSA), a nonprofit healthcare scholarship/staffing organization with offices in St. Paul and The Philippines. The trio has set up a system in which 20 nurses from The Philippines, who have bachelor’s degrees in nursing, will work part-time for SMDC. The health system will pay for their master’s degree training at St. Scholastica. The nurses are expected to arrive in August.

Carleen Maynard, PhD, RN, and director of the graduate nursing program at St. Scholastica, will be an advisor to these foreign students to help keep them on track.

“More infusion of diversity is good for the school, hospital and Duluth,” she says. “The plan helps another country and takes pressure off the nursing staff here.”

The nurses will pay for their rent, food, transportation and clothes, and they’ll have to join the union, she says. “They will be part of the nursing community, unlike temporary nurses.”

Maynard visited The Philippines in June to interview potential nurse candidates for the program. She says the student nurses will be in the country on student visas for four years, working part-time while attending school the first three years and working fulltime at the hospital for the last year.

The nurses then will return to The Philippines, where GSA has guaranteed them a position at 25 percent higher pay than their previous earnings. “This is graduate education for these people, there is an extreme faculty shortage in the Philippines, and the nursing leaders there support this,” Maynard says.

GSA charges a lower fee than do most temporary services, she says. The nonprofit also pays all tuition costs to St. Scholastica.

MariBeth Olson, vice president of patient care operations at SMDC, traveled with Maynard to interview candidates. She was impressed with their quality, education and commitment.

“SMDC’s interest is only to benefit staffing levels,” Olson says. That’s how it’s being presented to the hospital’s nurses. “It’s a win-win situation.”

Not all agree. Girgen, who has been nursing in the Twin Cities for more than 20 years, says she’s worked with Filipino and Somalian nurses. “There have been some nurses where I had no idea what they were saying,” she says. She appreciates bodies filling a position but says language barriers can present patient care issues.

GSA provided the details of its plan to both SMDC and St. Luke’s in a presentation at St. Scholastica. St. Luke’s didn’t bite.

“We made the decision not to pursue it, we’re not at a level where we need to do that,” says St. Luke’s Lucia. “It seemed very costly, as expensive as temp nurses . . . not a cost-effective tool for us as a business,” he says.

Both hospitals offer tuition education reimbursement programs to staff at standard rates for union nurses based on their positions, with nearly comparable rates for non-union nurses.

Legislation

There also are several bills addressing nursing shortages under consideration in the House and Senate at the federal level. Typical is S.1864, introduced into the Senate in April 2001, passed in December 2001, and currently under house consideration as H.R. 3487.

The bills would authorize $132 million for the “Nurse Reinvestment Act” over a four-year period. The comprehensive bill is intended to address “all aspects of a predicted and current nursing shortage.” It would help finance scholarships, recruitment grants and loan programs.

Legislative action, however, appears to be slow-moving and can’t be counted on to bring a quick fix to the problem.

Earlier this year, Wisconsin’s Gov. Scott McCallum created a Health Care Worker Shortage Committee. Composed of various health care, educational and nurse association executives, it will develop recommendations for alleviating the state’s shortage of health care workers.

In Minnesota, state Sen. Dean Johnson, DFL-Wilmar, submitted S.F. 580 in April 2001 to create or expand programs that reduce the shortage of nurses and other health care personnel.

It’s currently under consideration by the Senate Finance Committee.

“If legislation doesn’t pass soon, people won’t be cared for at the bedside,” says Rabbers of the Minnesota Nurses Association.

Future considerations

The problem isn’t going away. The U.S. Department of Labor projects the need for registered nurses will rise 36 percent by 2020.

The Minnesota Department of Economic Security reports there currently are more than 3,000 job openings in the state for registered nurses. There also are about 1,700 openings for licensed practical nurses and 5,000 for nursing assistants.

Rabbers believes the term “nursing shortage” is a misnomer, and says instead it should be called “high demand for nurses.” She says there are 15,000 more nurses in Minnesota than 10 years ago, but that demand has increased due to technology, the aging population and sicker patients, partly because health insurance is less comprehensive and more people aren’t covered.

Hospital patients and their families are likely to notice delayed response times when nursing staffs are shorthanded.

“People need to remember that nurses are not responsible for staffing shortages,” says Paradice, the nurse at St. Luke's.

“Patients blame the nurses for it. They’re becoming more and more demanding and taking it out on the messenger.”