BALTIMORE — It’s a Wednesday morning on Good Samaritan Nursing Center’s second floor, and nurse Alicia Merritt is having a hard time fielding questions about Maryland’s nursing shortage.
It’s not because she doesn’t have much to say.
It’s because she’s constantly interrupted while she sits at the reception desk.
“Again today we’re short,” said Merritt, a licensed practical nurse. She is in charge with one other nurse in overseeing the floor. Usually six nursing assistants work the shift, but only four were working this day, entailing split duties.
From double duty for nursing staff, to patients not getting the kind of care they received in the past, nursing shortages are taking a toll on Maryland’s health care system. And with the expected continual growth of the nation’s over-65 population, the problem of attracting and retaining nurses to care for the elderly is expected to only get worse.
Experts blame a variety of things for the shortage: longer hours make for more stressful jobs, leading to faster burn out; changing demographics and society; and even the growth of job opportunities for women no longer limited to the traditionally female-dominated nursing industry.
After peaking at 47,860 nurses in Maryland in 1998, that number dropped to 46,675 by 2000. Also that same year, student enrollment in nursing programs dropped by 6 percent.
In 1999, more than 2,300 nurses didn’t renew their licenses, according to a report released by Maryland’s Statewide Commission on The Crisis in Nursing. The report estimates by 2020, the “workforce will be 20 percent below need.”
“There is a severe shortage in nurses,” said Carmen Morano, an assistant professor of social work at the University of Maryland. “Not only in nursing homes but nursing in general.”
But nursing homes tend to be the most seriously affected.
“Naturally, if you had a staff of 10 and then that gets reduced to eight, you have more patients to care for,” said Sarah Simms, a unit secretary and sometime nursing assistant at Good Samaritan.
That can mean more patients to feed, bathe and, perhaps, turn in their beds.
Nurses are burning out from the extra work, Merritt said.
And that means more nurses leaving the field. “You combine low pay with a difficult job, and you’re not going to get a lot of people wanting to do that,” Morano said.
One nursing assistant union nearly struck last month over the issues.
Members of the Service Employees International Union District 199E-DC threatened to walk out if conditions weren’t improved when their contracts with some nursing homes ended in March.
Their main issues were with shortages and their pay, which averages $9.20 an hour for nursing assistants in Baltimore.
Negotiations, however, produced a compromise, said union spokesman Larry Rubin, but not a solution.
“These problems still exist,” Rubin said. “Staff shortages equal lack of quality care — bottom line.”
Among 258 nursing homes in the state, staffing levels are down about 11 percent from 2001, according to the union.
And a situation like Merritt’s, where she is supervising a floor that is understaffed, is common in nursing homes these days. Even in a home like Good Samaritan, where employees say they are able to meet basic patient needs despite shortages, care is affected, Simms said.
The home has been able to move people around to fill shortages during different shifts, she said. But patients just don’t get the same kind of attention they would if they’re operating at full staff all the time, she said.
“It’s a bad situation,” Simms said. “I’m just hoping things improve. How? I don’t know.”
As the nation ages, demand for nurses increases, however, the supply hasn’t, said Morano.
In the past, a major source for the nursing labor pool was women, said Linda Henderson, vice president of the Stella Maris nursing home. With more job opportunities for women, fewer of them opted for nursing.
In 1997, 1,710 nurses graduated. By 1999, that number dropped to 1,531. For Gov. Paris N. Glendening, the shortage has less to do with budgets or state policies than for that reason.
“A generation ago, it was easy to tell young women to go into nursing,” Glendening said. “Now women know their career options are unlimited.”
To combat the problem, about $800 million was added to this year’s Medicaid budget, which Glendening said should help alleviate the shortage by allowing more money to go toward hiring new recruits.
But for Good Samaritan Administrator Elliott Cahan, the governor could and should have done more sooner.
“We really wished (Glendening) would have taken a more proactive approach in dealing with this issue,” he said.
Unlike his efforts to curb Maryland’s teacher shortage where he publicly supported increased teachers’ salaries, Glendening has been relatively quiet in addressing the nursing shortage.
To address teacher shortages, Glendening supported pay raises and scholarships to college students majoring in education.
Those kinds of solutions offered for the teacher shortage may go a long way in addressing nursing shortages.
With all of the problems in attracting and retaining nurses and nursing assistants, one common solution seems to be echoed by both experts and nurses alike: increase salaries.
“It’s always money,” Simms said. “That’s definitely still tops.”
Increasing nurses’ salaries will draw more people into the industry, Morano said. Also, increasing efforts to draw students into nursing programs would also help, he said. That could be done through grants and other kinds of financial incentives to lure students into the field.