If America is to solve its nurse shortage crisis, health-care leaders will have to figure out a way to keep people such as Nancy Burtis in the profession.
Burtis, 52, was an emergency room and surgical nurse in the Chicago area for almost 25 years. But after growing weary from the constant stress of the job - including forced overtime and extra shifts - and seeing peers in understaffed units suffering with backaches from lifting patients without help, Burtis left the profession six years ago for a research job in the suburbs with a pharmaceutical company.
"You were always running, trying to get everything done, always afraid you were missing something or forgetting something," she said. "I don't think anybody can work that hard for that long."
A perfect storm of retiring baby boomers, an aging nurse population that's leaving the profession and too few nursing instructors is setting up a health-care crisis. One report estimates that by 2020, there will be a staggering shortage of nurses - possibly more than 1 million vacancies.
States are trying to head off that shortage by helping colleges turn out more nurses and by improving their working conditions. But the question remains whether it's enough to avert a crisis.
The country is expected to be short about 1 million nurses by 2020, the Health Resources and Services Administration reported four years ago. According to the Kaiser Family Foundation
, 30 states had a shortage of nurses in 2000; by 2020, 44 are expected to face a shortage.
Nurses are leaving the profession in droves, largely because of retirement - the average age of a nurse is 47 - but also because of stressful working conditions.
At the same time, schools aren't graduating enough replacements. A shortage of nursing instructors has left 40,000 qualified students on waiting lists nationwide. Because nurses can make more money working in clinics or hospitals than teaching, few return to school to earn the advanced degrees needed to teach.
States are pouring money into the problem. More than two-thirds of states have committed funds to nursing education in the past five years, increasing money for scholarships and loan-forgiveness programs for nurses who return to school.
In Mississippi, for example, where nursing educators' salaries had been well below the southeastern U.S. average, the state Legislature approved a $12,000 pay increase in 2006 for nursing faculty, a move that drew younger nurses into teaching and helped keep faculty who were planning to retire.
The Legislature this year awarded enough funding for one extra full-time faculty position at each of the state's five public universities and 14 community colleges that have nursing programs. "That was just phenomenal in a state which typically has a deficit," said Wanda Jones, executive director of the Mississippi Office of Nursing Workforce
Jones said the strong partnership among her office, the Legislature, state colleges and the state's nursing associations helped Mississippi almost double the number of its nursing graduates since 2001, from 820 to more than 1,530.
Kansas also has seen success so far with a 10-year, $30 million plan initiated in 2006 to boost the number of nurses by 25 percent. Colleges compete for the money, made up of both state funding and matching dollars from the schools.
While the Legislature expected schools would turn out an extra 250 nursing slots annually, they instead turned out 507 during the first year of the program. They also added 28 full-time and 23 part-time faculty positions.
It's so successful this year that Kansas expanded the program, awarding $100,000 in grants to private nursing programs.
"When you make it a competitive process, that's how you get the kind of results that we did," said Blake Flanders, vice president of workforce development for the Kansas Board of Regents
, which administers the grants. "I really don't know of a more successful nursing initiative … than we've had in Kansas for the amount of dollars that were invested."
But even if states succeed in getting more future nurses in the pipeline, nurses will continue to leave the profession if hospitals don't begin fixing workplace problems, they say. Shortages have led to mandatory overtime and fewer nurses to take care of more patients. Those conditions, in turn, have worsened patient care and also been linked to an increase in violence against nurses, many times by patients or their families.
"Out of 300 nurses we graduate, we lose anywhere from 100 to 150 because the hospitals don't appreciate the resources," said Deborah Burger, president of the California Nurses Association
In 1999, California became the only state to limit the number of patients under one nurse's care in hospitals to five. Though critics say the law removes flexibility for hospitals, the California Nurses Association maintains the law promotes better patient care.
No other state has enacted a similar law, although several have considered it, and the Massachusetts state nursing union has been pushing for one.
Instead of backing nurse-to-patient ratios, the ANA supports legislation requiring hospitals to have committees, half of which are nurses, to draw up staffing plans. The committee would determine staffing based on employee skill and experience, as well as the typical patient population. This year, three states - Connecticut, Ohio and Washington - enacted safe staffing legislation, bringing to at least 13the number of states with similar laws.
Mandatory overtime is also a long-standing problem for nurses. So far, 14 states have placed limits on or banned mandatory overtime for nurses.
Seven states also have laws requiring hospitals to have workplace violence prevention programs that include requiring hospitals to track how often there are violent incidents against health-care workers, and offering assault prevention and protection training. Oregon and New Jersey enacted laws last year. Another eight states have increased penalties for violence against nurses.
One big fear about the nursing shortage is that the need for nurses will lead schools and hospitals to lower standards. Some states already allow aides to perform tasks in nursing homes that 30 years ago only nurses could do, such as administering medicine and injections, said the ANA's Haebler.
"I'm already worried," she said. "I'm aging and I'm worried about who's going to be taking care of me."