Nursing: The Caring Profession That Fewer And Fewer Care For

By Jan Howard

In response to one of the most severe nursing shortages ever in the state, nursing organizations, the legislature, community and state colleges, and others in Connecticut are taking steps designed to promote nursing as a career and to find incentives to improve career satisfaction and retention of existing nursing personnel.

In January, two nursing groups, the Connecticut League for Nursing and the Connecticut Nurses’ Association, formed the Nursing Career Center of Connecticut, an independent organization designed to promote nursing careers.

“Although the nursing shortage will be nationwide, it is expected to be particularly severe in Connecticut, which ranks 38th in the nation in registered nurses per 1,000 people,” said Susan McGinnis, RN, interim executive director of the Nursing Career Center.

The center is reaching out to high school and middle school students by conducting classroom presentations and taking part in career days and nurse shadowing programs. It will also work with guidance counselors to provide information about nursing careers.

Ms McGinnis said materials are being developed for those interested in beginning a nursing career or making a career change to nursing. “There seems to be quite a bit of interest,” she said.

Retention of existing nursing personnel is one of the center’s goals. Focus groups are planned with health care providers to see what can be done to improve working conditions and career satisfaction.

“There is not one easy fix,” Ms McGinnis said. “What’s really scary is the number of students is going down.”

Salary is not a problem, she said. “The pay is pretty good. A registered nurse with an associate’s degree would earn between $35,000 and $40,000 a year.”

“With the average age of nurses now being in their mid-40s, coupled with the aging baby boomers who will soon be requiring nursing care, the need for nurses in the coming years has reached nearly epidemic proportions,” said Jane Murdock, president of the Nursing Career Center’s board.

The Tri-Council for Nursing, consisting of the American Association of Colleges of Nursing, American Nurses Association, American Organization of Nurse Executives, and National League for Nursing, recently issued a policy statement listing strategies to reverse the nursing shortage.

It noted that without measures to reverse the trend, the United States is in danger of experiencing serious breakdowns in the health care system. They said, “Strategies to recruit and retain are costly and must be done with some assurance that these efforts will be accompanied by specific strategies to overcome workforce issues that discourage long-term commitment to a career in nursing.”

Educational Programs

It takes from three to five years between recruitment and completion of the rigorous education program required for eligibility to be licensed as a registered nurse.

Nurse refresher programs for individuals who have been out of nursing are being offered, such as a re-entry course to be offered by Naugatuck Valley Community College in the fall. It was offered for the spring semester, according to Pam Duchaine, nursing continuing education coordinator, “but unfortunately there were not enough students.”

The program requires 216 hours of lectures and clinical experience. A tuition installment plan is available.

Naugatuck Valley offers several courses for nurses interested in returning to the profession. There are also programs that would make it easier for licensed practical nurses to move into registered nurse positions. It also offers associate degrees in nursing.

There are three ways to become a nurse: through a diploma program, an associate’s degree, or a bachelor’s degree.

Bridgeport Hospital offers the only two-year diploma program in Connecticut. It offers a tuition incentive. If students agree to work at the hospital for two years after becoming registered nurses, the hospital will pay for their tuition, according to Mary Susan Hungerford, School of Nursing admissions coordinator and instructor.

“It’s a wonderful deal. They start work with the same benefits and base salary as everyone else,” she said.

The hospital gives its students great clinical exposure, she noted. “I tell students that they should work in acute care for two years and get a lot of experience. They need to apply their training. Then they can work anywhere. Our diploma program will get people educated well in a short period of time and to enter the profession fairly quickly.”

Not only are there fewer people applying for nursing than before, the quality of applicants is lower, she said. Because young women today have more options than they had years ago, she noted, “People with high SATs won’t go into nursing.”

Ms Hungerford feels the profession has an image problem. “It’s still seen as a women’s profession, though we do have some men coming in.”

She said nursing offers flexibility, such as being able to work a shift around family concerns. “There is no other profession where you have that flexibility or can work anywhere in the world. There are unlimited jobs in nursing. It’s not easy work, but it’s very rewarding.”

 Dr Anne Manton, acting dean of Fairfield University’s School of Nursing, said the school is bucking the trend of lower enrollments and recently enrolled the largest incoming freshman class it has had for several years.

She also noted a growing trend of more adult learners. “They’re out there in the daily grind of the work world and often the intrinsic rewards are just not there. They turn to nursing because it’s the sense of doing for, of giving back, really making a contribution and affecting people’s lives in a positive sense.”

To help attract top students and give support to those already in the nursing field, Fairfield has redesigned its curriculum to include courses on health care delivery systems, wellness, and alternative therapies. It offers a “second degree” program in which individuals with a bachelor’s degree can receive a bachelor of science in nursing in 18 months.

Fairfield has also received permission to begin a master’s degree in nursing for students with a degree in another discipline, only the second of its kind statewide. A “fast-track” MSN allows registered nurses to use, in part, life experiences to obtain a bachelor’s degree in professional studies, which enables them to pursue master’s-level studies one year earlier than usual.

Pamela Cramer, coordinator of the licensed practical nurse program at Henry Abbott Technical School in Danbury, said she has a full class. “We did more active recruiting this year,” she noted. However, to meet the 40 students she can enroll, she accepted ten applicants from Kaynor Technical School in Waterbury, which always has a waiting list.

Ms Cramer said no applications were received from high school recruitment. The average age of students is 30.  “Many times I get students that have gone to college for a year, then drop out and come here. This is more structured than college.”

The program runs for three semesters and requires 110 clinical hours and 120 hours of theory. The next classes start in September 2002. A pre-admission test is required.

LPNs are not having problems getting jobs, particularly with local nursing homes, she said.

Enrollment in the School of Nursing at Western Connecticut State University is down slightly, according to Stephanie Golub, PhD, RN, coordinator of the bachelor’s degree program. “We’ve had a slight decrease, but nothing huge,” she said.

Because of budget restrictions, she said the program is limited to 50. Forty are enrolled this year. “I usually admit 48 to 50.” Many are non-traditional students, she added, who often have to arrange college classes around the demands of a job and family, so it takes longer for them to graduate.

“Answers to the nursing shortage have to come from many places,” she said, including nursing school directors, employers, and the government. “Salaries haven’t kept pace, and nursing is less attractive because of the working conditions, which often have mandatory overtime and more patients per nurse. While the beginning salary may be competitive, there is wage compression. Ten years later their salary is the same.”

In addition, she said, “When the economy is good and husbands are employed and have insurance, nurses drop out. If the economy is poor, they go back.”

In addition, she said, “In a good economy, we’re competing with other jobs.”

Ms Golub said some practicing nurses have become frustrated. Many went into nursing to give hands-on care. “The job has become more hands-on to equipment than hands-on nursing. It’s gone from high touch to high tech.”

Patient care requirements have also changed, she noted. Patients are more acutely ill, requiring more nursing care, and people are living longer but with more disabilities. “They really need more nursing, and the working conditions are physically more demanding.”

Ms Golub said the nursing school participates in recruitment fairs, but more outside help is needed. “A lot needs to be done on the state and federal levels. More scholarships would help. Students could get through sooner and help the nursing shortage. Tuition forgiveness programs and financial aid programs may emerge as a result of the shortage.”

Joanne Wolfertz of St Vincent’s College in Bridgeport said enrollment for the school’s two-year nursing program is up ten percent this year. The college holds an open house targeted to high school students and participates in nurse shadowing programs. It offers evening and weekend programs for people who work full time or have child care needs.

“We’re having a shortage in nurses because the average age of new graduates is in the 30s,” she said. There are many other fields open for people in their early 20s, she noted, which don’t involve working shifts or weekends.

 Ms Wolfertz said there is something in nursing for everyone. Nurses are needed in day care centers and as pediatric nurses, among others. “There may be some area to appeal to you,” she said. “The flexibility is there. You need to find the right employer to negotiate with.”

Many employers will negotiate nursing shifts around family responsibilities and offer sign-on bonuses. There is also flexibility in seeking higher education, she said. “In some places, it is mandatory for advancement.”

With the existing shortage in nurses expected to peak in 2010, Ms Wolfertz said, “There will always be a job in nursing, but in a good economy we’re competing with other jobs.”

Recommendations

The Tri-Council for Nursing made several recommendations to address the nursing shortage, as follows:

Education: Develop initiatives to move nursing graduates through graduate studies more rapidly; identify options available beyond entry level; institute a system to promote more equitable compensation based on education requirements for different health care roles; support health care employers to create and sustain staff development programs and lifelong learning; and reach out to youth ages 12 to 18 to recruit younger nursing students.

Work Environment: Implement strategies to retain experienced nurses in direct patient care through greater flexibility in work environment and scheduling; reward experienced nurses for serving as mentors and/or preceptors for new registered nurses; implement appropriate salary and benefit programs; ensure adequate nurse staffing; provide nurses with sufficient autonomy over their practice; and redesign work to enable an aging workforce to remain active in direct care roles. 

Legislation and Regulation: Advocate for increased nursing education funding and for better identification of registered nursing services within Medicare, Medicaid, and other reimbursement systems.

Technology, Research and Data Collection: Investigate using technological advances to enhance the capacity of a reduced nursing workforce; support workforce planning to develop models for health workforce planning that consider the need and demand for nursing services; and promote consistent data collection at the national, state, and local levels to enable appropriate workforce planning for registered nurses.