WASHINGTON – Maryland hospitals face a shortage of experienced registered nurses in specialty care areas such as emergency and operating rooms and critical care, at a time when nursing groups say skilled care is needed most.
While the number of patients in hospitals is declining, health care officials said those people who are in the hospital now are sicker than before.
As a result, hospitals have been scrambling in the past year to recruit skilled nurses, even offering incentives as they compete with each other for a limited pool of qualified candidates.
“The hospitals cannot fill the jobs,” said Donna Dorsey, with the Maryland Board of Nursing. “They are saying, ‘We are not able to hire enough nurses, we are not getting people with the right skills.’
“That’s why they are offering incentives, like $5,000 bonuses, to E.R. and critical care nurses,” Dorsey said.
A survey conducted in early March for Columbia-based MedStar Health backs her up. The survey of 13 hospitals in Maryland and Washington, D.C., said it takes area hospitals 60 days to fill vacancies for experienced general R.N.’s, compared to 45 days nationwide and, for 90 days to hire critical care nurses, compared to 60 days nationally.
A spokeswoman for the Maryland Hospital Association said patient care had not been short-changed by the nursing shortage, however.
Nancy Fiedler said fewer patients have been admitted to the state’s hospitals each year for in-patient, overnight stays. She said the drop in patient admissions is driving the trends in hospital employment.
“Hospitals are only staffing the beds they have occupied,” Fiedler said, adding that nurse-to-patient ratios remain largely unchanged.
But the Maryland Nurses Association said that the demand for skilled nurses is driven not just by patient numbers but by patient acuity — just how sick people are.
“While a lot of healthcare has been driven outside of hospitals by managed care,” patients admitted to hospitals tend to be sicker than ever before and in need of more skilled nursing, said Kathryn Hall, executive director of the nurses association.
She said that, under managed-care-related cost cuts, hospitals several years ago began reducing the number of registered nurses on staff and shifted some of their direct-care responsibilities to less expensive, unlicensed caregivers, such as nurses’ assistants.
“The hospitals’ thinking was that they could have two or three bodies in place of one and get more bang for their buck,” Hall said.
But, she added, those hospitals miscalculated because the unlicensed caregivers were not qualified to tend to the increasingly sicker patients.
“There are less nurses, but sicker patients,” said Maria Jurlano, a registered nurse who has worked for five years in the emergency room of Holy Cross Hospital in Silver Spring. “HMOs send patients home sooner and so they come back sicker.”
Jurlano said staffing has always been a problem, but that it now feels as if each nurse “does the work of two R.N.s.”
“The expectations [placed on nurses]have escalated through the years,” she added.
Hall said that within the past year, hospitals realized their mistake and began offering registered nurses incentives to return to hospital settings.
“Every hospital in the area has to face the issue that there is a nursing shortage,” said Robert Jepson, a spokesman for Shady Grove and Washington Adventist Hospitals in Montgomery County.
Jepson was quick to say that the nursing shortage has not hurt patient care at Adventist HealthCare, which runs the two hospitals. He said the hospitals have developed an internship program that trains nurses interested in those specialty areas to provide the skilled care in high demand.
Donna Richardson, a spokeswoman for Peninsula Regional Medical Center in Salisbury, agreed that nurse recruiting has become highly competitive. She said her hospital has relied on its affiliations with college nursing programs to help fill vacancies.
Some hospitals have responded by hiring agency nurses to fill vacancies temporarily. But they said in the MedStar survey that they remain worried about quality and continuity of patient care with those temp nurses, who come at twice the cost of full-time nurses.
Sharon Sopp, a spokeswoman for St. Joseph’s Medical Center in Baltimore, said that the shortage in nurses being felt today is not entirely due to hospital staff cuts of recent years. With the long-term care industry booming, Sopp said, today’s nurses simply have many more options available to them than in the past.
Susan Stein, a recruiter with Helix Health System, sees that trend firsthand. She said many older, experienced nurses are now opting for 9-to-5 jobs.
Dorsey, of the board of nursing, agreed.
“A lot of nurses don’t want to work in hospitals anymore,” she said.
The nursing board reported that 31,237 registered nurses licensed in Maryland said they worked in hospitals last year, while 36,366 reported working in other settings, such as nursing homes, home healthcare, doctors’ offices and schools. It also reported a 55 percent jump in the number of registered nurses working in long-term care from 1996 to 1998, rising from 3,569 to 5,547.