ANNAPOLIS – Maryland needs nurses critically in almost every aspect of health care, yet the General Assembly has done little to attract and retain them, critics say.
Legislators proposed about a dozen bills this session aimed at recruiting and retaining nurses, but financial assistance for nursing students seems to be the only one they support.
“I think that everybody to some extent is talking a good game and knows what has to be done,” said Sen. Paula Hollinger, D-Baltimore, a registered nurse. “My fear is that by the time we decide that this really does need help there’s not going to be anyone left (in nursing).”
Several nursing organizations were lobbying for two identical bills to prohibit an employer from requiring a nurse to work more than 8 hours a day or 40 hours in a week.
Nurses charge that they are forced to work 16-hour days, and that, Hollinger said, is one of the reasons they are leaving the field.
The bills received unfavorable committee reports.
“We now have nurses stuck in situations where they have to choose between nursing and raising children,” said Ward Morrow, an attorney for the Maryland Federation of Nurses and Health Professionals. “We’ve got to do something to at least ease the situation while we work on a comprehensive solution.”
Two other bills failed to make it out of their respective committees. One would have expanded eligibility for HOPE scholarships to include nursing students who entered a nursing program more than two years after secondary school. The second bill would have required a community college to charge an out-of-county student enrolled in a specific nursing program the same fees as an in-county resident.
Five bills would have granted tax breaks to registered nurses, licensed practical nurses, nurses in nursing homes and certified nursing assistants, all returning to nursing, along with nurses seeking re-certification. They were referred to an interim study.
“We don’t see this improving,” said Fiedler. “It isn’t something you can immediately fix. This is a long-term issue.”
There were 2,000 fewer registered nurses in Maryland 1999 than in 1998, as well as a 10 percent decline in nursing school enrollment, according to the Maryland Board of Nursing. Nationwide, enrollment in five-year baccalaureate nursing schools is down 16.6 percent, from 74,452 in 1996 to 60,443 in 2000, according to the American Association of Colleges and Nursing.
By 2020, the nursing workforce will be 20 percent below requirements, according to the Journal of the American Medical Association. At the same time, the average age of working nurses is expected to rise.
“This is a very long-term problem,” said Barbara Heller, dean of the University of Maryland School of Nursing. “Not only are people leaving because of dissatisfaction, we’re not getting people into the schools.”
The shortage comes at the same time the state is experiencing a teacher shortfall.
Maryland will have to hire 12,715 teachers to begin the 2003-2004 school year, according to a recent Maryland Teacher Staffing Report. This means the number of teachers needed to start that year will be almost triple the number needed just eight years ago, when 4,588 teachers were hired at the start of the 1996-97 year.
Both shortages are the result of demographics in the workforce and a decline in students choosing those professions. However, a shift in the use of nurses in the health care field is also to blame.
More nurses are opting to work in private settings where they have more control over their hours, leaving a nursing shortage in hospitals. As a result, hospitals are sometimes forced to close beds or reschedule surgeries.
“(The shortage) is certainly making it more challenging for the remaining nurses to be able to provide the level of care they would like to provide,” said Nancy Fielder, spokeswoman for the Maryland Hospitals Association.
Legislators supported several education bills last year, including scholarships, reemployment of retired teachers and principals, tuition tax credits, stipends and signing bonuses, said Ron Peiffer, spokesman for the Maryland State Department of Education.
That same year, Maryland Gov. Parris N. Glendening passed a teacher salary challenge. If a local school system granted a 4 percent salary raise to teachers each year over the next two years, Glendening would match it with a 2 percent raise over the same time period.
Nursing isn’t getting the same kind of attention from the state’s leaders.
The nursing shortage has not made it onto Glendening’s personal agenda, said Raquel Guillory, his spokeswoman.
And while legislators agree it’s a problem, they are mainly supporting scholarship upgrades for nursing students.
That’s not enough to solve the increasing shortage, said Hollinger.
Under one bill, students in Maryland nursing schools would be eligible for $3,000 per year. Another bill would allow recipients of nursing scholarships under the Economic Development Student Assistance Grant Programs to receive other state scholarships.
“This would be a tremendous boost for us in the School of Nursing in terms of offering more scholarship support to students, and it seems to be in critical need,” said Heller.
The nursing shortage leaves many health care facilities relying on nurse staffing agencies. While most employers would choose to have those nurses as part of their staff, agency nurses find they have more control and avoid some of the working environment issues, such as mandatory overtime.
“Agencies are meeting the needs of some of the workers that are out there,” said Kathy Hall, executive director of the Maryland Nurses Association. “The benefit is one way or the other they are in the workforce.”
Last year, the General Assembly approved the creation of the Statewide Commission on the Crisis of Nursing to examine the shortage. Four workgroups, made up of nurse practitioners, educators, the Maryland Nurses Association and the Maryland Hospitals Association, are focusing on retention, education, recruitment and work environment and will submit their reports to the Legislature in April.
But Fielder said the problem is going to take a while to fix. She said hospitals are focusing on staff retention, while they wait and hope new nurses come into the field.
The nursing shortage is only expected to get worse, especially with the aging of the Baby Boom generation. For every eight nurses who retire, three enter the field.
“We’ve been through shortages,” said Hollinger. “We haven’t had one, quite frankly, that is going to have the overall impact that this has. If we can’t entice more people to go into the field there’s really going to be no one left.”