With four recent hires, the recovery floor at Valley Medical Center (VMC) is doing all right. Registered nurse Tess Alviz knows that much. She’s not so sure about the rest of the hospital’s departments.
“On some floors what I hear is patient dissatisfaction with wait times or whatever, but not necessarily on my floor,” she says.
She also hears about overtime. Lots of overtime.
Overtime that will only increase as the nursing shortage worsens. That shortage is happening across the country as nurses and nursing teachers age. More than half of Washington’s nurses and nursing teachers will likely retire within 10 to 15 years.
According to VMC spokesperson Kim Blakeley, the average age of a registered nurse in Washington is 48.8. Most faculty members are about 52.
As they age and retire, those nurses and nursing teachers will not only leave a gaping hole in the healthcare system, but they will need increased healthcare, as will their fellow baby boomers.
Schools simply can’t graduate enough nurses to fill the expected abyss.
To meet the predicted demand for registered nurses under the current healthcare system, registered nurse graduation rates need to increase by 400 each year for the next 15 years, Blakeley says. With all those retiring nursing teachers, that won’t likely happen.
“Nursing schools cannot possibly handle the number of nurses necessary,” says Scott Alleman, chief nursing officer and senior vice president of Patient Care Services at VMC.
At 54, Alleman is part of the soon-to-retire baby boomer generation. He finished nursing school at University of South Louisiana in 1977 and has since witnessed a wave of nursing shortages.
He says some past nursing shortages were caused by good economic situations, when women withdrew from the workforce. This shortage is different, he says.
“What’s different about this one is the size and the magnitude of it,” he says.
Before coming to VMC, Alleman oversaw nursing programs at hospitals in Chicago and Louisiana, where he says the effects of the nursing shortage were “the same, or maybe a little worse.”
The looming shortage has many contributing factors. A lack of nursing-school applicants is not one of those factors. The Sept. 11 attacks and the sagging economy have attracted many to the do-good nursing profession.
Nursing schools simply don’t have enough slots for applicants. Alleman says all nursing schools turn away half of qualified applicants. Three local colleges confirm that claim.
Renton Technical College turns away a couple hundred students a year. Eighteen students are in RTC’s registered nurse program, 53 in its licensed practical nurse program.
Highline Community College accepted 52 of about 160 applicants this year. A hundred students are in Highline’s registered nurse program, 12 in its licensed practical nurse program.
University of Washington (UW) usually receives 300 to 400 applications for 96 nursing spots. About 90 percent of those applicants are qualified. UW offers a bachelor’s of nursing science, a graduate-entry program in nursing, a master’s of nursing and two doctorate nursing programs.
All three of these colleges are short on nursing faculty. RTC has six full timers, six part-timers and four open positions: two full time and two part time. Highline has six full-time and about six part-time nursing teachers. UW has more than 100 nursing faculty members, but needs 20 to 25 more, says Marla Salmon, dean of the UW School of Nursing. A hiring freeze is on those positions.
“Pretty much any school you talk to in the state has a vacancy — they all have at least one,” says Heather Stephens-Selby, director of nursing and dean of allied health at RTC.
One of the reasons for the faculty shortage is pay. Stephens-Selby says she makes $25,000 to $30,000 less as a nurse at a college than she would as a nurse on the floor.
The main problem caused by the faculty shortage is not so much limited classroom sizes, but limited supervision during clinical hospital work. State regulations require one nursing faculty member for every 10 students.
“We can’t enroll (more) students because we can’t place them in clinicals without faculty,” Stephens-Selby says.
Even without those extra students, Alleman of VMC says his hospital is “overrun” with student nurses each day. Even if nursing schools were producing enough nurses, hospitals might not have enough space for them.
The nursing shortage will surely get worse before it gets better. But that doesn’t mean no one is trying to prevent the worse from happening.
Alleman calls nurses “frontline caregivers.”
The UW’s Salmon agrees.
“If we’re going to have healthy communities and healthy workplaces, we’re going to require enough nurses out there,” she says.
Work must be done to increase nursing ranks, she adds.
The UW and those other two local colleges — RTC and Highline — are doing much of that work.
All are using, and trying to increase, simulation. That means “mannequins that vomit and talk and bleed,” like on the TV show “Grey’s Anatomy,” RTC’s Stephens-Selby explains.
Highline is recruiting nurses at high schools. RTC is working with VMC and Highline to create and share more faculty, like the childbirth instructor who teaches at three colleges.
Stephens-Selby helped start a program to better organize nursing students at clinical sites. She’s also developing a program to help foreign nurses become nurses in the United States.
At RTC, non-English speaking students can also take a package of English as a Second Language, general education and nursing classes.
As part of the Consortium of Nursing Educators of Washington, Stephens-Selby even helped develop a master plan to improve nursing education. The plan was mandated by the Washington Department of Health. The Consortium of Nursing Educators of Washington represents the state’s nursing schools.
“That’s a good example of how bad things really are,” Stephens-Selby says of the need for the master plan.
VMC is also strengthening the nursing-supply pipeline. A scholarship program for students to attend nursing school is under development. The Renton hospital has also begun importing nurses from the Philippines. Forty-eight are expected within the next year. VMC is also working to ensure the comfort of its current nursing staff by providing back-friendly equipment such as motorized stretchers and slings.
Alleman says VMC’s pipeline is strong enough for now. He calls the hospital’s recently improved nurse-to-patient ratio “very generous.” That ratio is one nurse to four patients during the day shift, one to five during the evening shift and six to one during the night shift.
Because VMC is consistently ranked a good place to work, Alleman says his hospital will weather the nursing shortage better than most hospitals.
“We’ll do better than other hospitals, but we won’t be able to escape the shortage,” he says.
To truly escape, every nursing group must work together, not just to increase the number of nurses, but to transform the nation’s healthcare system.
“It’s going to take all of us stakeholders getting together,” Stephens-Selby says. “That means the legislature, all the healthcare organizations, all the labor management groups — even down to schools, nurses, patients — we can’t keep trying to solve the problem in our own silos.”
