Jobs Scarce, Even for Nurses
Economic Crisis Freezes Field Once Short of Workers

By Ashley Halsey III
Washington Post Staff Writer
Sunday, April 5, 2009

For more than a decade as she raised two children, Sue Estes heard one story after another about how hospitals were desperately short of nurses.

They were getting signing bonuses, their pay was soaring to levels unheard of during Estes's years as a nurse, and bulging benefit packages now included 401(k)s. This year, ready to return to work, she has heard a different story.

"I've shipped out résumés everywhere, and I'm not even getting the courtesy callbacks," said Estes, 43. "All my friends can't believe it. They've read the stories about the shortage, and they say, 'Places are begging for nurses!' "

The economic downturn has put a Band-Aid on one of the most vexing problems in health care, a shortage of nurses that has slowed care at some hospitals and forced others to turn away the ill.

With some nurses postponing retirement and others resuming their careers for financial reasons, many hospitals across the region and the nation say they have few, if any, openings. After more than a decade when hospitals struggled to maintain sufficient staffing and when nurses could have their pick of jobs, the want ads have virtually disappeared, and only acute-care and emergency-room nurses remain in great demand.

Estes's résumé includes experience in acute care and a neurosurgical unit, and she said she has kept up with the profession and taken a refresher course to prepare for her return. She began her job search this year at Calvert Memorial, the hospital closest to her home in Owings, and has been widening the circle since.

"I've actually been shocked that some places wouldn't even talk to me," she said.

Estes, who will work as a volunteer at Anne Arundel Medical Center and hopes to land night hours at St. Mary's Hospital in Leonardtown, is typical of nursing applicants who are returning to work in recent months.

"We started to see a real uptick in January, February and March," said Skip Margot, vice president of patient care services at Shady Grove Adventist Hospital in Rockville. "We're seeing more men and women who are well-seasoned in their career. Their spouse now being out of work or the children now grown, they're willing to take a refresher course and work modified hours."

Margot has a handful of openings on a staff of more than 800 nurses.

The Inova Health System, which employs 4,353 nurses and operates Alexandria, Fairfax, Fair Oaks, Loudoun and Mount Vernon hospitals, has an extraordinarily low 3.5 percent vacancy rate, with most of the openings in critical care.

Bob McWhirt, vice president for patient care, described a similar situation at Calvert Memorial Hospital. "In medical and surgical, I have absolutely zero openings," he said. "In 20 years of doing this, I've never been able to say that."

Tammy Frankauski, a mother of three, said the economic downturn motivated her to return to full-time work as a nurse at Shady Grove.

"We've got college costs in three years and our retirement plans are losing money," said Frankauski, who had been working part time. "It's easier to keep ahead than risk falling behind, and you want to be prepared in case anything happens."

The good news for Estes and the bad news for the health-care system is that this is "a blip when the [bad] economy masks the true nursing shortage," said Nicholas Piazza, who recruits at Montgomery General Hospital and works with the Maryland Association for Health Care Recruitment.

The nursing shortage has been a chronic national challenge. The problem appeared under control in the mid-1990s but resurfaced by the end of the decade and steadily became more severe. Hospitals on Long Island and in upstate New York turned away patients when their nurse-to-patient ratio dropped too low. Emergency rooms in California sent ambulances elsewhere when they had too few nurses to handle the load. In the Washington area, nurses had plenty of employment options.

"There was a time when most hospitals, if you had a pulse and a [nursing] license, they would give you a job," Margot said.

With the growth of the U.S. population outpacing projections and with increasing health demands among aging baby boomers, federal experts forecasted that the nursing shortage would grow to 275,000 by 2010 and to 1 million in the decade that followed.

The recession may slow the growth of that shortage, but it will not resolve the underlying cause of the problem.

The American Academy of Colleges of Nursing reported that 27,771 qualified applicants were turned away by nursing schools last year largely because of a lack of instructors. The average age of a nursing instructor is 49, and simple economics have kept many younger nurses from becoming educators. Teaching requires a master's degree or a doctorate. But the salaries many receive after they get an advanced degree are lower than what they could earn as acute-care nurses.

Bipartisan legislation intended to provide an additional incentive for experienced nurses to become educators was reintroduced in Congress last month after dying in committee last year. The bill would repay loans taken out by nurses pursuing advanced degrees if they committed to teaching for four years. But its passage would provide no immediate remedy once the shortage resurfaces, a prospect forecast by those enjoying a respite from the problem.

The economic incentive that has swollen the nursing workforce during the recession seems certain to evaporate when the economy rebounds, throwing the health-care system deeper than ever into the crisis. Those who put off retirement are expected to leave the profession in droves, along with those who returned to work to stave off economic distress.

"I'm going to be in for 12 months of happy, and then the problem will be back," McWhirt said.

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