Nursing shortage spurs solutions

Accelerated programs, flexible shifts help recruit new students

Help wanted: 1 million nurses.

There’s a growing nursing shortage in America, and that shortage is about to transform into a crisis unless more people can be lured into the profession.

In June 2001, the American Hospital Association counted 126,000 unfilled nursing positions across the nation’s hospitals. The Bureau of Labor Statistics projects the need for a million new registered nurses by the year 2010. And by 2020, it’s predicted that Colorado alone will have nearly 15,000 unfilled nursing positions.

Compound those statistics with the fact that only 55 percent of currently practicing nurses in the state expect to be in the profession in five years — and the fact that only 6.4 percent of the state’s nurses are under 30 years old with the mean age being 47 — and it’s easy to see that a nursing crisis is well under way.

Fortunately, hospitals in the region have been addressing the problem over the past several years, raising pay scales, offering flexible schedules and designing new programs to recruit new nurses and retain the ones they already have. But with a faculty shortage limiting the number of new students that nursing schools can accept, the pinch is still being felt.

Every year gets worse

“We’re definitely feeling it more every year,´ said Candace Pruett, nurse recruiter for Poudre Valley Hospital. “We’re ending up with more positions that are not filling as quickly. Every year it gets a little worse.”

Pruett said the Fort Collins hospital currently has 58 openings for full-time nurses. With more than 750 nurses on staff, that’s a vacancy rate between 7 percent and 8 percent.

To cover the shortage, Pruett said the hospital is implementing many different strategies including hiring traveling nurses.

PVH is also trying to decrease its turnover rate, which reached 15.1 percent in 2001. Nationally, nurse turnover rates were at 21.3 percent in 2000, according to the American Organization of Nurse Executives. “We’re trying to offer a variety of different shifts, whether it’s three 12-hour shifts or eight-hour shifts — whatever works best with their lifestyle,” she said.

Faster learning programs

In addition to the flex shifts and differentials for night and double shifts that make for higher retention rates, PVH is working closely with area nursing schools to bring new nurses into the profession.

In the spring of 2001, PVH joined with the University of Northern Colorado to provide nine students who already had a bachelor’s degree with the opportunity to earn a BSN in 18 months. It is one of 90 accelerated nursing programs in the nation.

“Poudre is really the strongest hospital in the region in terms of providing funding to admit more students,´ said Sandy Baird, director of UNC’s School of Nursing. The first round of students, who are set to graduate in December, receive 100 percent of tuition costs, with the agreement to serve PVH for four years after graduation. A second round of students receives 50 percent of tuition for two years service in return.

Along with the student scholarships, Poudre is also sponsoring an additional faculty position — imperative for accommodating the increase in enrollment.

“We were capped at 72 students. Now, with Poudre Valley’s grant, that makes 72 plus 18. It’s a significant increase,” Baird said. “I think Poudre really wanted to address the need for putting more nurses in the pipeline.”

The hospital is also working with Front Range Community College’s Larimer Campus nursing program, which recently doubled the number of nursing students it accepts per year.

“Because of the nursing shortage and the length of our waiting list this year, we’re going to double the number of students in the program, accepting 50 in both the fall and spring semesters,” said Rebekah Lynch, Front Range’s director of nursing.

Lynch said the increased enrollment is possible because recent renovations created larger classrooms, and three new faculty positions have been added. “PVH will be supporting one of those faculty positions,” she said.

The college and the hospital are also in the process of developing a scholarship program for an accelerated nursing program.

While PVH’s financial support is facilitating the school’s expansion, Lynch said that all the hospitals in the region are “very supportive” when it comes to providing nursing students with clinical experience.

“It’s important to let people know that at this point in time hospitals and nurses in the region are working very hard not to compromise patient care,” she said. “In other areas of the country they’ve had to turn away patients & we’re all trying to address it and work closely to assure patient care is not compromised.”

Two other hospitals in the region, Greeley’s North Colorado Medical Center and Loveland’s McKee Medical Center, are both run by Phoenix-based Banner Health Systems. Both hospitals provide scholarships for nursing students using a slightly different formula than Poudre Valley. For every $2,500 provided to the student, the Banner-run hospitals ask for one year of service in return.

Commitments in return for help

“With recruitment we want to make it easier for people to go to school, but also we need to get some level of commitment from them,´ said Dorma Eastman, director of nursing support services at McKee. So far, 10 nursing students have signed up for the program, Eastman said. The Banner hospitals also offer new graduates a loan forgiveness program, using the same formula, where the hospital makes payments toward students’ loans for a return commitment of service.

Eastman said the nursing shortage at McKee reflects the national trend, which is most severe in specialty areas such as intensive care, obstetrics and surgical services. To recruit nurses in high need areas, the hospital sometimes offers sign-on bonuses and relocation assistance on a case-by-case basis.

On the retention end, Eastman said the hospital recently eliminated mandatory overtime, increased the number of managers and implemented a modified self-schedule program, where nurses can choose preferred shifts.

McKee currently has 24 openings for nurses, with the vacancy rate ranging from 6 percent to 10 percent this year. The hospital’s turnover rate for nurses is at 13.8 percent, which is significantly lower than the past three years, Eastman said.

At NCMC, the nurse vacancy rate is between 6 percent and 7 percent. “We were well into the double digits when I began 31/2 years ago,´ said Joanne Fenton, chief nursing officer. Fenton said the average vacancy rate in Colorado is about 19 percent.

“Compared to the rest of the world we don’t have a shortage,” she said.

With 450 nurses under her charge, Fenton said her job is to focus on retention. “Our recruitment strategy is a retention strategy,” she said. “We want to keep the people we have.” To achieve that, the hospital provides flexible schedules, assures low nurse-to-patient ratios and works on maintaining positive working relationships. One innovative program the hospital recently implemented is its clinical development unit. A professor from UNC works with a group of nurses to measure the outcomes of their practice. “They’re working on improving their practice and creating higher satisfaction and better outcomes for the patients,” she said.

With a nurse turnover rate at about 11 percent and the biggest need in the cardiovascular units, Fenton said, “My biggest responsibility is to create an environment where people want to work. Then we won’t lose people, and also we become a magnet to attract other people.”

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