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Sunday, Oct 1, 2023

HEALTH CARE–Nursing Shortage Strains Systems

A local shortage of nurses has some San Diego County hospitals importing temporary health care workers from out of state.

Mark Palmer, chief operating officer at Alvarado Hospital Medical Center in San Diego, said the nurses usually work for six weeks at a time in return for free housing, paid travel expenses, health benefits, a paycheck, and sunny weather.

Alvarado pays between $32 and $36 an hour for an outside nurse vs. between $21 and $30 hourly for a staff nurse, he said.

That’s an expense that Palmer, if he had a choice, would gladly avoid.

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“If we could be more successful in recruiting nurses (in San Diego), we could utilize the dollars in other areas, such as for new capital or programs,” Palmer said.

The acute shortage of nurses in San Diego County is putting a strain on all hospitals.

In 1999, five other major San Diego hospitals reported a total of 550 nursing vacancies, said Patricia Wahl, SDSU’s director of the school of nursing.

They are Sharp HealthCare, Scripps, Paradise Valley Hospital, Children’s Hospital and the VA San Diego Healthcare System, she said.

“That’s a very high number,” Wahl said.

But not surprising. California ranks last among the 50 states in the proportion of registered nurses per 100,000 population, according to state legislature studies.

Educated Out Of State

About half of California’s registered nurses received their nursing education elsewhere, according to the state of California Employment Development Department in Sacramento.

That’s in part forcing local hospitals to look elsewhere.

Jim McBride, a spokesman for Kaiser Permanente in San Diego, said the organization has 100 openings for nurses in San Diego.

The openings are mostly in child care, surgery and the intensive care unit, he said.

Last year, Kaiser hired 65 nurses.

“Everybody is satisfied with the benefits and pay, but it’s a question of supply,” McBride said.

Darlene Wetton, chief nursing officer at Alvarado, has been trying unsuccessfully to recruit nurses locally for nine months now.

She, too, has looked to other states and across the border to Canada to fill some 38 openings.

Alvarado was lucky enough to snatch up 10 new graduates from local schools, she said.

Fierce Rivalry

They’ll start participating in Alvarado’s eight-week training program this week, she added.

Katherine Bullard, chief nurse executive at Scripps Mercy Hospital, also began recruiting aggressively to fill vacant positions. She couldn’t give exact figures, but said the hospital has “plenty” of openings.

Palmer said the shortage has spawned a fierce rivalry among local hospitals.

“We gain nurses from all the systems and lose them to all the systems,” he said.

To lure a nurse, hospitals are offering signing bonuses (up to $5,000 for a highly skilled nurse at Alvarado alone), retirement plans, paid moving expenses, health benefits and more.

The key to making the nursing profession more attractive, Blake said, goes beyond that.

Nurses want good wages, but also seek better working conditions, Blake said.

In today’s bottom-line health care climate, nurses have few opportunities to participate in the decision-making process, such as staffing and patients’ needs.

The arrival of sophisticated technologies also enabled increased outpatient and home care, leaving only the sickest patients in hospital beds. The increase in critically ill patients in hospitals, in turn, raised hospitals’ demand for more specialized nurses.

“The industry has changed when many of the services provided in hospitals are now provided in home care,” Wozniak said.

Unattractive Lifestyle?

When young people look at a career in nursing, they see long hours, night and weekend shifts and no holidays.

“That’s not very attractive,” Blake said.

For now, many hospitals have no other recourse but to hire traveling and contracted nurses to fill the gap. But that’s not always optimal, some believe.

Palmer said any time an outside nurse walks through the door she needs to familiarize herself with new colleagues and new procedures, such as ordering supplies.

Even finding the bathroom can be a challenge for newcomers, he said.

Staff nurses also feel burdened. Besides doing their work, they often need to train unlicensed personnel, such as nursing assistants.

“Nurses feel stressed having to supervise these people,” she said.

Wahl admitted it’s likely that quality of care may suffer under such stringent conditions.

The shortage of nurses exacerbates the problem. She anticipates more data will be available in the future to point to accidental care, medication dispense problems and others.

Solutions to Shortage Being Studied

California ranks last among the 50 states in the proportion of registered nurses per 100,000 population, according to state studies.

Gov. Gray Davis signed a bill in 1999 aimed to find solutions to the problem.

The bill requires state universities and colleges with nursing programs to work with hospitals on developing strategies to raise the number of nursing graduates and provide specialty training to licensed nurses.

The Board of Registered Nursing, which coordinates the effort, will present reports required by the legislation to the governor and state legislators April 1, said Barbara Blake, state secretary of the United Nurses Association of California.

The legislators will then vote on the adoption of the best proposed plan and implement a budget, she said.

In San Diego, several hospitals are also working closely with local schools, including Grossmont College and Southwestern College, SDSU, USD and Point Loma Nazarene College, providing hospital rotations and training programs.

That includes preparing nurses to work in areas of hospitals in which the shortage of nurses is most critical, such as in intensive care and neonatal care, and the surgery room, Blake said.

But despite the effort, it’s unlikely that graduating nurses from San Diego schools would fill the demand of local hospitals for years to come.

Nursing programs have declined over the past few years as a result of the shrinking pool of applicants, Blake said.

“Women don’t want to spend four or six years to become a registered nurse,” she said. “It’s more acceptable now to get an MBA or become a doctor.”

Additionally, programs have seen their funding cut as part of the federal Balanced Budget Act of 1999, resulting in fewer scholarships and financial aid available to students.

At SDSU, however, the problem is reversed. There, demand for enrollment has long outstripped available spaces, said Dolores Wozniak, dean of the college of health and human services at SDSU.

The nursing school presently has 400 people on its undergraduate and graduate student roster, leaving only 100 available spaces for new enrollees, Wozniak said.


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