Heal nursing crisis

The nursing shortage is like a lot of problems: easy to predict and difficult to solve. Easy to predict because the demographics were obvious. The baby boom generation would get older, and advances in medicine would keep people alive longer. Difficult to solve because it is expensive to teach, train and retain nurses.

Take the situation in Spokane, where half of the graduates from the Intercollegiate College of Nursing take jobs elsewhere. Washington state taxpayers subsidize these educations, and then a hospital in, say, California lures away the graduates with bonuses and larger salaries. One tempting solution is to tie financial aid to service in the state, but statewide, Washington actually imported about 800 more nurses than it lost in 2006, according to a work force study commissioned by the Washington Center for Nursing.

This “raiding” of states for nurses isn’t a solution, it’s a symptom of the larger problem: There aren’t enough nurses in the world. Ireland brings them in from the Philippines. Great Britain brings them in from Africa. The U.S. brings them in from a variety of places. And the countries of origin are left begging.

Yet the richest nations still have too few nurses. Washington needs to graduate 400 more nurses a year starting in 2010 to meet future demand. But, as in most states, its colleges of nursing turn away more qualified candidates than they accept. Nationwide, 43,000 eligible nursing applicants were rejected for baccalaureate and graduate programs in 2006, because there weren’t enough instructors.

It’s difficult to encourage nurses to obtain the advanced degrees necessary to become instructors when those positions often pay less than the jobs they already hold. Because of this bottleneck, nurses and nursing instructors are getting older as the prospects for replacing them dim. About 51 percent of registered nurses in Washington are 50 and older. There are about as many RNs who are older than 65 as there are younger than 30.

Congress last took aim at this problem in 2002 by passing the Nursing Reinvestment Act, but funding hasn’t kept pace with the need to expand nursing slots at colleges, increase financial aid and improve faculty pay. In 2008, $155 million was allocated. The president’s 2009 budget calls for a $46.2 million cut. Nursing advocates are calling for $200 million, noting that Congress spent a record $161 million on nursing-shortage programs in 1974.

Catch-up funding is worth it, because the nursing shortage has a direct effect on patient safety and health care costs. Currently, nurses take on larger patient loads and incur more overtime, and the strain is causing more of them to retire. Relief would encourage many to stay in the profession.

Fixing the problem won’t be easy, and it will be expensive. But putting it off – as we have thus far – is even more costly.

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