Health Care

Pain of nurse shortages eases for hospitals: They enjoy fewer vacant positions, but still worry about coming boomer retirements

September 10, 2007

Good news. The shortage of hospital nurses isn't quite as bad as it used to be.

In the last five years, Indianapolis' hospitals have chipped away quietly at the gap in nurse staffing that seized local and national attention earlier this decade.

To achieve these modest declines in what hospitals call their nursing vacancy rates, they have revamped their recruitment and retention efforts at a time when nurses have more options outside hospitals than ever before.

Nursing schools are working hard, too, to find more teachers who can train nurses and pump more graduates into hospitals.

But is it enough? Hospitals may have gotten on top of the latest cycle of nurse staffing. But their incremental improvements so far do not solve the looming problem of the baby boomers.

As these 78 million Americans age, they'll need more health care. But a big chunk of nurses are baby boomers, too. That means hospitals are likely to lose scads of nurses at the same time they'll have more patients to serve.

"Our vacancy is not too bad right now. But over the next 10 to 15 years, we're going to see the supply definitely not meeting what the demand will be," said Jean Meyer, chief nursing officer at St. Vincent Indianapolis Hospital.

The same is true nationally, said Sandy Haeberle, a registered nurse who is now senior vice president in the health care division at Bernard Hodes Group, a New York-based recruitment agency.

"When you look at what's going to happen, with the aging work force and the aging population, we've got to keep going on this," Haeberle said.

Nationally, there are 116,000 fewer nurses than hospitals need, according to an American Hospital Association survey. In Indiana, there were more than 2,200 vacant nurse jobs at the end of 2006, according to the Indiana Hospital & Health Association.

When hospitals run short of nurses, they plug the gap with overtime hours or by hiring contract or agency nurses as needed. Some hospitals even close off beds when they don't have enough nurses to staff them.

But there has been progress, Haeberle insisted. A Bernard Hodes survey, released in 2005, found a 16.1-percent vacancy rate among registered nurses nationally. But earlier this year, an American Hospital Association survey found a vacancy rate of 8.1 percent for registered nurses-and even lower for licensed practical nurses.

"Everybody's done a good job at increasing class sizes. So new grads are on the rise a little bit," Haeberle said.

Most Indianapolis hospitals enjoy even better vacancy rates. Clarian Health Partners, for example, has driven its nurse vacancy rate all the way down to 3.1 percent so far this year. In 2001, Clarian averaged vacancies of 16.4 percent.

Community Health Network, St. Vincent Indianapolis, and St. Francis Hospital and Health Centers have either kept their vacancy rates below the national average, as reported by the American Hospital Association, or brought it under that level in the last five years. All three hospitals have rates of 5 percent or less.

The only Indianapolis hospital with a vacancy rate above the national average is Wishard Health Services, at 8.7 percent.

But Wishard, the public-safety-net hospital for Marion County, has achieved the most dramatic decreases. Less than three years ago, its vacancy rate was 15.3 percent. Chief Nursing Officer Lee Ann Blue attributes the growth to more graduates coming from nursing schools and Wishard's ability to hold on to veteran nurses.

"We've been very blessed to really get a lot of long-term staff that really embrace the mission," said Blue, who oversees Wishard's 750 nurses.

Hanging on to veterans

Most hospitals want to emulate Wishard and hold on to their veteran nurses as long as possible. The annual turnover rate for nurses is about 12 percent.

Perhaps the biggest hurdle is injury. Even the youngest baby boomer nurses are in their mid-40s now, and the physical demands of nursing take a heavier toll on their bodies.

To spare nurses from physical stress-and to keep them working at the bedside-several Indianapolis hospitals have added lift teams. These teams are fulltime employees, usually men, who do nothing but lift and move patients-so nurses don't have to.

Clarian Health Partners added a lift team last year-and got a big response from its 5,000 nurses.

"The nurses just rave about them. They call them the dream team," said Lydia Ostermeier, director of Clarian's nurse recruitment, retention and development.

St. Vincent Indianapolis has spent $2 million in the last two years to add lift equipment. Some of it can be moved from room to room. Other pieces are installed in the ceilings of patient rooms.

In addition to sparing middle-age nurses from injury, hospitals are trying to be even more accommodating on their scheduling.

If a nurse doesn't want to do 12-hour shifts, which are standard in nursing, local hospitals are offering shifts of eight, six and even four hours.

Hospitals also are trying to give nurses more input into how the hospital works.

Community, St. Vincent and other hospitals have adopted so-called "shared governance," which puts staff nurse representatives on the decision-making and policy-making bodies inside the hospital.

That approach captured Rebecca Miller, an oncology nurse at St. Vincent Indianapolis. When St. Vincent started shared governance last year, Miller joined the professional development committee for her oncology unit.

"It boosts the morale because you can get more involved. I think you feel a little more excited when you come to work," Miller said.

Pumping in fresh blood

But no matter what hospitals do, middle-age nurses will eventually become retirement-age nurses. So hospitals must find new blood.

Hospitals have tried to boost hiring in two key ways: by helping nursing schools produce more graduates and by changing where and how they recruit nurses.

In recent years, hospitals have beefed up the scholarships they give to nursing students. Community Health, for example, has already given out $350,000 in scholarships this year.

In addition to scholarships, Community and other hospitals offer assistance to students if they work at the hospital while in school or if they promise to work there for a couple of years after graduation.

"Depending on what school you go to, you can get almost all of it paid for," said Susan McRoberts, chief nursing officer at St. Francis Hospital & Health Centers.

Indianapolis' hospitals also have offered their veteran nurses to schools to handle the practical portions of nurse training.

Half a dozen of the 1,500 nurses at St. Francis do part-time teaching-but still are paid as full-time St. Francis employees.

"If I'm going to get some [nurses] in the pipeline, I've got to give somewhere," McRoberts said.

Indiana has a plethora of nursing programs at colleges and universities around the state. But a 2005 study found that those schools had to turn away 1,500 qualified applicants, primarily because they didn't have enough professors to teach them.

In Indiana, nurse faculty must have at least a master's degree in nursing. So hospitals and community foundations are contributing people and dollars to train more nurses to be professors.

Most Indianapolis hospitals recruit their entry-level nurses from Indiana's nursing schools. Internships and practical rotations often lead to a full-time nursing job.

But the in-state schools have not produced enough nurses for Clarian Health, the state's largest hospital system.

So it has taken its searches beyond state lines, with marked success, said Ostermeier, Clarian's nurse recruitment director.

In 2001, Clarian hired just eight nurses from out of state. Last year, it hired 400 from out of state-or 40 percent of all nurses it hired.

"Even with the amount of graduates we get in the Indianapolis area," Ostermeier said, "we know we have to go outside."
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