Return to Virginia Business - January 2003

by Holly M. Rodriguez

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When Rita Baker walks through the Medical Surgery Unit of Norton Community Hospital at 7 a.m., she has 35 to 40 patients waiting for their medications. The Wise County resident knows what the day entails. Her odds of taking a sit-down break during her often 12-hour shifts are 50-50. She’ll likely have to chase down patients’ paperwork so she can administer their medicine. And, she must complete a mountain of work by the end of her shift because her company won’t tolerate excessive overtime.

But she’s used to it. Baker, 58, has been working as a licensed practical nurse for 40 years, and would not trade her job for any other. “There are days when you sit down, and days when you don’t, but I don’t mind it,” she says. “I never minded working ... but it is stressful.”

Across the commonwealth and the country, nurses must cope with the same daily stresses: constant life and death issues, more job choices elsewhere, fewer teachers to prepare new nurses and a dwindling supply of newcomers to the job. All in all, they add up to a shortage of nurses that could have profound effects on the quality of medical care. To combat it, the health care sector is trying stopgap measures such as actively recruiting nurses, paying for their school tuitions and offering sign-on and referral bonuses.

Unless corrective steps are taken, the shortage will become an unabashed crisis. The U.S. Department of Health and Human Services estimates that in 2020, 44 states, including Virginia, will have severe nursing shortages. A 21 percent shortage of full-time registered nurses is projected for the commonwealth by the year 2010. The figure is expected to increase to 36 percent by 2020. Sixty percent of registered nurses work in hospitals, which have the greatest vacancy needs.

Even in the short term, the shortage is affecting patients. The scarcity of nurses has already caused hospitals to close beds, reduce admissions and surgeries and divert patients from emergency rooms. Higher nurse-to-patient ratios are causing employees to feel burned out and dissatisfied with their jobs, according to the Journal of the American Medical Association.

The supply of nurses has been shrinking in recent years. Nursing school graduations have dropped 25 percent in the past six years, says Barbara Brown, vice president of the Virginia Hospital and Healthcare Association. Enrollment in nursing programs is down 19 percent in five years, according to the Virginia Partnership for Nursing.

While the problem is approaching critical levels in metropolitan areas, its impacts are worse in smaller localities. Ursula Butts, vice president of patient care services for Community Memorial Healthcenter in rural South Hill, says recruitment and retention in rural communities is more difficult than in the state’s larger cities. For one, salaries are better in urban areas. And there’s more to do outside of work. “There is little social or night life [here] unless you are from here, and that’s been difficult,” Butts says.

Those trends are driving efforts to recruit and retain nurses. Hospitals are improving working conditions and providing incentives, and employee referral programs and sign-on bonuses have been implemented in hospitals across the state. At Community Memorial Healthcenter in South Hill, for example, employees are paid $2,000 for recruiting an employee to the hospital.

Most localities, no matter the size, are offering full scholarship programs for nurses, in exchange for several years of service in the grantor’s community. HCA Richmond Hospitals recently announced $600,000 in grants and scholarships for students who enroll in licensed practical nursing and registered nursing programs in the Richmond and Northern Virginia areas. Funds are given to students to cover education expenses and provide living stipends to eliminate barriers — such as child or elder care or transportation issues — that often cause students to postpone or drop out of programs. In exchange for funds, students are required to work in the Richmond or Northern Virginia area for a period of three to four years, on average.

While many hospitals offer programs similar to HCA’s, some have also concentrated efforts on recruiting faculty. For example, when the Central Shenandoah Valley Region Workforce Investment Board was awarded a $2.4 million grant from the U.S. Department of Labor in 2001, local officials realized that recruiting nursing instructors was more critical than just hiring nurses, says Sharon Johnson, the project director who handles the disbursement of funds to various employment programs. Approximately $750,000 of the grant will be used to recruit students and faculty. “We think, with this concentrated effort, this will largely handle the shortage in the area short-term,” Johnson says.

Some health professionals say they’re seeing rural areas get a boost because they offer a better quality of life. “Traditionally, it has been more difficult to recruit in rural areas — thank goodness that’s beginning to change,” says Faye Matthews, director of marketing services for Community Memorial Healthcenter. “People are beginning to enjoy getting away from the hustle and bustle of the city, and we are beginning to see that change a little bit."

One rural school is going the extra mile so students don’t have to. Just a few years ago, the nursing program at Southside Virginia Community College offered the first year of study at the college, located in South Hill. The second year, however, students were required to commute an hour and a half to Richmond for clinical nurse training. “That created a barrier, because many of our students work and have families,” Matthews says.

So, Community Memorial, along with other regional groups including Greensville Memorial Hospital in Emporia, Halifax Regional Hospital in South Boston and Southside Community Hospital in Farmville, each contributed $25,000 to create a local program similar to the nurse training offered in Richmond so nurses can avoid the rough daily commute. “We’ve also been providing our facilities for training, our nurses for instruction and supervisors to help with training on-site for these students,” says Chris Lumsden, CEO of Halifax Regional Health System.

Each hospital also contributed an additional $5,000 for marketing efforts. The latest marketing efforts for the nursing profession are focused on changing the image of the profession, and reaching out to populations that have not traditionally dominated the field. “We are actually doing intense marketing,” says Nancy Langston, dean of Virginia Commonwealth University’s School of Nursing. “Historically, all we’ve had to do is give information to people who were interested, but we have to change that.”

The Virginia Partnership for Nursing has launched a poster campaign, targeting students in grades K-12. The first leg of the campaign focuses on encouraging men to consider nursing. The field is currently 95 percent female, and the typical nurse is white, and in her mid-40s. Langston says the next series, called the Color of Care, will focus on nurses of different ethnic and racial groups.

Many executives and nursing professionals say that while current marketing and recruitment efforts are off to a strong start, they are pessimistic about having an overall significant impact on the shortage. “Is there a light at the end of the tunnel? Not quickly enough,” Brown says. The main goal in the near future is to minimize the shortage as much as possible, because eliminating it, at least in the foreseeable future, probably is not realistic. “Each of our schools of nursing would have to increase by half to meet projected shortages — and that is if there was no growth in health care needs at all,” Langston says.

Return to Virginia Business - January 2003