Spokane-area hospitals are bracing for another upsurge in the cyclical shortage of nursesonly this cycle is expected to be more significant and longer-lasting than those experienced in the past.


This (shortage) isnt going to go awayat least not anytime soon, says Anne Hirsch, associate dean of academic affairs and a professor at the Intercollegiate Center for Nursing Education (ICNE), in Spokane.


Hirsch attributes the nursing shortagewhich is just now hitting hereto an aging population, an increase in chronic illness, and a trend in which more people are getting medical care outside of hospital settings, requiring more nurses to operate in the field.


Some hospitals here, such as Deaconess Medical Center, already are beginning to feel the effects of the shortage, which has been a problem in places such as California and Seattle for some time. Sacred Heart Medical Center, however, says it hasnt felt the pinch yet.


Gordon Spunich, human resources director at Deaconess, says the Spokane hospital currently has 40 openings for registered nurses, which is about twice as many openings as is typical.


Deaconess main difficulty has been in hiring nurse managers and in recruiting nurses who have at least three years of experience, Spunich says. Deaconess recently began recruiting nurses from outside of Eastern Washington and even has employed about six traveling nurses during the last six months to help with the patient workload as the hospital looks for permanent employees, he says. Traveling nurses stay at a particular hospital for about 13 or 14 weeks, then move on.


Meanwhile, the shortage has been a positive trend for ICNEs students. Recent graduates of the nursing school, which is a consortium that instructs students from Washington State University, Eastern Washington University, Gonzaga University, and Whitworth College, have received multiple job offers with salaries starting at about $40,000 a year. Many ICNE graduates have been offered incentives such as $5,000 signing bonuses, by hospitals in Wenatchee, the Tri-Cities, and Moses Lake, Hirsch says. As a recruiting tool, some hospitals also are agreeing to cover moving expenses and are offering to pay nurses for 40 hours of work a week if theyll work either three 12-hour shifts during the week or two 12-hour shifts on the weekends, she says.


Hirsch says that ICNE currently has a job-placement rate of about 100 percent, meaning that virtually all of the institutions graduates find jobs once they graduate.


If someones not employed at graduation, its by choice, Hirsch says. She adds, though, that ICNEs placement rate hasnt always been that high. In the early 1990s, when there were more nurses available, it was lower, she says.


Worst is yet to come


The demand for nurses and other health-care professionals is expected to grow even more in coming years. Hirsch says that by 2010, its projected that as many as 114,000 registered nurse positions will be unfilled nationwide.


The growing demand partly is due to the fact that many nurses working today will be at retirement age within the next 10 to 20 years. Kris Petti-bone, Sacred Hearts resource manager, says that the average age of the about 1,300 registered nurses employed at the big Spokane hospital is 42, compared with a national average of about 46.


Not only are the nurses in the current work force aging, but the U.S. population as a whole is aging. Members of the massive baby-boom generation are edging toward a time in their lives when theyll need more medical care, which also will create a greater demand for nurses.


Eventually the entire work force is going to be competing for people. So the hospitals also will have to compete for those people and convince them to come into the health-care profession, says Carol Sheridan, a vice president and the chief nurse executive at Sacred Heart.


Sacred Heart is preparing for the onslaught of retiring nurses by trying to find creative, flexible ways to accommodate nurses who might agree to cut back on their hours rather than retire completely. Also, in an effort to fill the pipeline, Sacred Heart has teamed up with the other hospitals here to persuade middle-school and high-school students to consider nursing as a career.


They really need to begin taking the science courses when theyre in high school so that theyll have the background they need to continue on to nursing school, says Marilyn Thordarson, a spokeswoman at Sacred Heart.


Severity of illnesses increases


The growing demand for nurses also partly can be attributed to the increasing severity of conditions that hospital patients now suffer. Hirsch says that people in general are living longer, which means that the hospitals are seeing patients who have more chronic illnesses and age-related diseases.


Spunich says that because patients are more ill, theyre requiring more intensive care.


He says that Deaconess has had a difficult time finding nurses to fill surgical services and neonatal and pediatric intensive-care positions, as well as positions for midwives and enterostrimal therapists, who provide wound care. He says that those positions are taking, in some cases, more than three months to fill, whereas previously they were being filled in one to three months.


Sacred Hearts Sheridan says that although Sacred Heart isnt currently experiencing a nursing shortage, when it does hit, the medical center projects that positions in the operating room and in the various intensive-care areas will be the most difficult to fill. She says that during the last nursing shortage in the 1980s, the hospitals here collaborated to hire a recruiter to find available nurses and other health-care specialists.


Nurses in the field


Since new government reimbursement policies have shortened patients stays in the hospital, there is a greater need now for nurses who can provide care not just in hospitals, but also elsewhere in the community, at places such as retirement facilities, schools, community clinics, and in private homes, Hirsch says. Nurses always have been needed in those places, but the demand for such care is increasing as some patients are requiring treatment in their homes, she says.


Sacred Hearts Pettibone says that long-term care facilities, such as nursing homes, have been placing a greater number of employment ads in the Sunday edition of the daily newspaper here lately. She says that some long-term care facilities even are offering signing bonuses.


Youll see the long-term care facilities usually getting hit by nursing shortages before the hospitals do, Pettibone says. The increase in (employment) ads in the Sunday newspaper is a good indication that the shortage is coming.


To meet the nursing demand in areas outside of hospitalswhere a broader range of skills often is requirednurses will have to earn at least a four-year bachelors degree, Hirsch contends. She says that a number of registered nurses have only an associates degree. The two-year degree, which focuses mostly on acute, hospital-based care, was developed as a result of an earlier nursing shortage produce nurses more quickly.


A bachelors degree, however, is designed to teach registered nurses leadership skills, as well as train them to provide patient care in the community.


To help registered nurses who have associates degrees earn bachelors degrees, ICNE offers what it calls an RN to BSN program. Starting this fall, that course will be offered via the Internet.


The baccalaureate program produces independent, critical thinkers. Thats what we need to provide care, and that care isnt going to be needed in just the hospitals, Hirsch says.