Associated Press
February 14, 1999

Nurse Shortage Blamed on Economics

TROY, N.Y. (AP) -- Lisa Haaf wants a career taking care of the critically ill.

She has her nursing diploma, a biology degree to boot, and the zeal of a Florence Nightingale heading on to the battlefield. But this 27-year-old graduate is entering a profession whipsawed by managed care cuts, growing health needs of an aging population and warnings of nursing shortages.

``If it's true that a nursing shortage is occurring, hopefully it will also highlight the fact that we do good,'' said Haaf, who graduated from Russell Sage College north of Albany in December and moved to New Hampshire because of her husband's job.

A week into her job search, she had promising interviews at one hospital and a nursing home. Salaries ranged from $14,000 to $20,000.

``I would love something in the $16,000-$18,000 range, but salaries are not showing there's any strain as far as a shortage,'' Haaf said. ``They're not increasing wages up here yet to attract individuals.''

Just as in real estate, the key to success in nursing often turns on location.

South Carolina hospitals, where registered nurses make an average of $37,000 a year, are offering signing bonuses of up to $4,000 and sending recruiters to Northern states. Their counterparts in Massachusetts were flooded with applicants right out of school.

California reported nursing shortages a year ago, with nurses complaining that understaffing was a threat to patients. In New Hampshire, Haaf said only one of the four hospitals where she applied mentioned a shortage of nurses.

``It's not all throughout the U.S.,'' said Beverly Malone, president of the American Nurses Association, who believes that shortages are more prevalent along the East and West coasts and in Chicago. Other industry observers said demand is greatest in the South and Southwest, where population growth is most dramatic.

``It is usually in the areas of specialities that we're feeling it first,'' Malone said. Signing bonuses and lots of newspaper help-wanted ads are the telltale signs.

A neonatal nurse in San Francisco can make $90,000 these days, Malone said, adding that solving shortage problems is complicated. ``It's not just a matter of throwing dollars at the problem.''

To ensure that there are enough nurses in coming years, there needs to be more planning to recruit, train and sustain a nurse workforce, she said.

The cyclical nature of nursing works like this:

When hospitals cut nursing jobs, many leave the profession and fewer students pursue nursing degrees. The demand then starts to build again.

But this shortage is different, Malone believes, and is complicated by several factors.

First, Malone said, managed care caused a reduction in nurses across the country and nurse duties were changed, prompting nurses to seek other professions.

Second, the American Association of Colleges of Nursing reports a 5.5 percent decline in entry-level enrollment in bachelor's degree programs.

Third, the baby boomer population is aging and people are going to live longer with chronic illnesses, meaning nurses will be needed.

Finally, nurses are also aging. The average age of all registered nurses nationally was 44 in 1996. More than 62 percent of RNs were 40 or older.

There may be a significant demand for nurses in coming years, industry observers predict, because nurses begin leaving the profession in greater numbers in their 50s and dramatically in their 60s.

Researcher Carol Brewer believes warnings of shortages are an over-reaction.

``We've always had somewhat cyclical changes in the nursing labor supply,'' said Brewer, of the State University of New York at Buffalo.

Talk of shortages is now the buzz among nurse industry executives, she conceded. But wages are another factor that influence nursing supply. If employers are just unwilling to pay the wages nurses expect, then it's not a real shortage, Brewer pointed out.

The average salary for all types of registered nurses was $42,071, according to a 1996 national survey conducted by the U.S. Bureau of Health Professions. For hospital staff nurses it was $40,097.

Nursing wages have been essentially flat since the early 1980s, according to Janet Coffman, associate director for work force policy at the Center for the Health Professions at the University of California, San Francisco.

Before declaring a shortage, the market needs time to respond with higher wages, Coffman said.

``We're seeing industry making some movement to address wages and working conditions,'' Coffman said, citing a California nurses contract with Kaiser Permanente last year that gave nurses more responsibility as well as a wage increase.

``I think a lot will depend on how industry decides it's going to value registered nurses,'' Coffman said of predicted shortages. ``Does it value them enough to address their concerns and invest in them in the long run?''