At first glance, you might not notice anything special about Nursing senior Jamie Lorent. Except that next spring, practically every hospital in America will want to hire her. And Lorent isn't a special case. An alarming trend has arisen in the health-care industry, with the projected demand for nurses sharply exceeding supply. The Department of Health and Human Services estimates that by 2010, there will be a shortage of registered nurses in the country. The long working hours, strenuous conditions and limited pay are all downers. And while years ago nursing was one the few professions open to women, this is no longer the case. But the need for nurses is still as great, and no one seems to have found a solution to this increasingly pressing problem. Right now, it seems like the Nursing School is hotter than the Wharton School.
The statistics
A recent study published in the Journal of the American Medical Association predicts that by the year 2020, the size of the registered nurse work force will be 20 percent below the projected requirements -- a shortage of over 400,000 RNs. By 2010, 78 million baby boomers will begin to retire and enroll in the Medicare program. The U.S. Administration on Aging predicts that by the year 2020, there will be an additional 20 million Americans over 65 years of age. Combined with the fact that Americans are living longer than ever, a nursing shortage, unless fixed, spells trouble for health care. The current reports "are telling us very clearly that there will be a growing shortage of RNs, as well as other members of the health care profession," said Maureen McCausland, chief nursing executive of the University of Pennsylvania Health System. Though currently the number of nurses is adequate, certain specialities are already feeling the squeeze. Hospitals in New York City have unfilled vacancies for nurses with experience in critical care and operating rooms. The Hospital of the University of Pennsylvania had to close some critical-care beds this summer because it did not have enough specialized nurses to staff them. Nursing, a profession which is traditionally 95 percent female, has long been a cyclical profession with periods of need and excess. Still, this shortage may be different. "The nation's schools of nursing have almost uniformly experienced significant declines in enrollment," interim Nursing Dean Neville Strumpf said in a written statement. Strumpf said reasons for the decline may include instability in health-care jobs and a wider range of professional options for women.
A lagging interest
With fewer young women signing on to be nurses, the RN population is aging -- over 40 percent of the work force expected to be older than 50 by 2010; the average age is 45. And under current projections, as these older nurses begin to retire, fewer young people will be entering the profession. "The aging of the work force adds a new wrinkle to the problem, something that is different from the other shortages in history," said Nursing Professor Julie Sochalski, assistant director of the Center for Health Outcomes and Policy Research. In an era where more people have entered college than ever before, nursing enrollments have been declining. The American Association of Colleges of Nursing recently reported that enrollments in entry level nursing programs decreased by 4.6 percent in 1999, the fifth decrease in as many years. In 1998, graduations from all nursing programs fell about 13 percent in just four years. Penn's applicant numbers seem to have been stable during this downturn. "What is happening now is the slowing of the spigot, with not as many new people coming into the profession," Sochalski said.
Working conditions
Another cause of the problem has been the work conditions of nurses. The long hours and strenuous work days are just not that appealing. Many nurses also complain that managed care cost-cutting has led to a decrease in quality of health care, along with more work and sicker patients. Some states are also planning to pass legislation mandating nurse overtime because there are so few nurses. "What is happening now with managed care is really a shame because it means lower-quality care for patients," a nurse at HUP said. Instability in the profession has also deterred many from entering. Just five years ago, nurses were being laid off due to the changes brought by managed care. Each year the American Nurses Credentialing Center names several hospitals as "magnet hospitals," meaning that they offer excellent nursing care. Nursing Professor Linda Aiken studied the magnets. She found that there were higher nurse-to-patient ratios, higher nurse satisfaction and less nurse turnover at these hospitals, suggesting that better work conditions would attract and retain more people in the field.
Paychecks
The average starting salary for Penn Nursing students is about $40,000 -- higher than the average Wharton starting salary. But in the overall field, salaries vary and raises and promotions are all too rare. For RNs, it is hard to make more than $45,000, even after years of experience. During these times of shortage, many of these financial and working conditions are changing in order to retain as many nurses as possible. In a strike at Washington Hospital Center settled earlier this month, nurses will receive a 14 percent raise over three years, new limits on and extra pay for overtime and wider participation on patient care committees. "Salary is never a satisfier, but it can be a dissatisfier," McCausland said. "The satisfier is a practice environment where nurses have the ability to influence patient care decisions and have reasonable work assignments." And Sochalski noted that unless the profession moves in a new direction, the future could be difficult. "Though we could face tough times in the future, the future is in our hands," she said. With the shortage, hospitals are targeting Penn even more for top-notch nurses. "There has definitely been an increase in interest from health-care organizations from across the country in recruiting nurses at Penn," Nursing Career Counselor Genny Dunne said. "Many companies are coming here asking to serve students lunch, along with many other perks."
Nursing students
Even in this era of declining nurse enrollment, nursing students at Penn said they are happy with their career plans. Though the reasons for being a nurse vary greatly, they share one thing in common -- a sincere love for the field, even in the face of less-than-perfect working conditions. Lorent, who will go back home to New Jersey to practice critical care nursing, didn't decide on nursing until late into high school. When Lorent was in high school, her grandparents were sick, and she spent time with them in the hospital. "I just loved watching the nurses work in hospitals, which inspired me to enter nursing," Lorent said. Others, however, have always wanted to enter the health-care profession. Nursing junior Anna Bruns wanted to be a doctor when she was younger, but ultimately decided on nursing, in part because of the extensive schooling physicians endured and because nurses have more patient interaction. "We actually do learn some things during junior and senior years that aren't taught to doctors until medical school," Bruns said. Medicine was also on the mind of Nursing junior Megan McVey, who also looked at nursing not planning to go into it, until a call came from Penn describing the opportunities in the field. "Doctors deal more with the diseases, but nurses deal with the patients themselves, which I really enjoy," McVey said. Though she recognizes that there are negatives, she noted, "there are downsides to every profession."
