II t's a godsend," exclaimed Arlington Hospital nurse Lynn Thomas last week as she introduced her 16-month-old daughter to the hospital's new day care center.
Nursing Director Susan Simms couldn't agree more. For Simms, the low-cost center set up exclusively for hospital employes gives her one more bit of ammunition in the battle against chronic nursing shortages.
Just before 3 p.m. each day last week, exuberant mothers -- all night-shift nurses at Arlington Hospital -- dropped off their infants and toddlers at the day care center before reporting to work at nursing stations down the hall.
"For me, it's great," said nurse Pat Charette as she deposited her 9-month-old daughter Jeannie in a carpeted "play pit" filled with toys. "I might have just stayed home (after Jeannie's birth) and not worked if it hadn't been for this. This made it possible for me to work part time."
Although the nursing shortage is a persistent national problem, Northern Virginia hospitals are trying to conquer it with solutions ranging from flexible hours and better pay to improved fringe benefits and special programs like in-hospital day care centers.
And so far, the hospitals seem to be winning some initial skirmishes in the battle to recruit and retain nurses.
For example, at some Northern Virginia facilities, as few as 5 percent of the nursing slots are unfilled, compared with a national vacancy rate averaging slightly above 10 percent. The turnover rate among nurses, 30 to 40 percent nationwide, generally is 20 to 30 percent in Northern Virginia hospitals, according to discussions with area hospital officials. And at Loudoun Memorial Hospital in Leesburg, officials report a turnover rate this year of no more than 3 percent.
Despite a picture that looks statistically rosy, nurses and hospital officials in Northern Virginia say the numbers don't tell the whole story.
Fairfax Hospital, for example, which boasts a 5 percent vacancy rate and currently has all but 40 of its 832 nursing slots filled, occassionally has been forced to close beds in its intensive care units because of inadequate nursing staff, said Gertrude Rodgers, director of nursing.
And nurses throughout the area describe almost daily situations in which they are shorthanded and unable to provide top-notch patient care.
"I doubt that patients ever really notice," said a veteran nurse at Fairfax Hospital. "But there's a lot of frustration for all the nurses involved. They don't have time to do the things they need to do, and to take time to sit with a patient and talk about their problems."
Hospital administrators contend the nursing shortage has not created unsafe situations for patients. But many nurses say privately there have been some scary nights -- traditionally the hardest shifts to staff at many hospitals -- especially on units with critically ill patients, when they have felt dangerously close to trouble because there were not enough nurses.
The American Hospital Association predicts the nursing shortage will worsen in the next few years as nursing school enrollments continue to slip and as the demand for nurses grows, a result of increased hospital admissions, longer hospital stays, more complex and sophisticated medical technology and an aging population that probably will need more and more hospital care.
At the root of the problem, the National Commission on Nursing found in recent hearings throughout the country, is a long list of professional woes: low pay, undesirable weekend and night hours, stressful working conditions, tense nurse-doctor relationships and a lowly image of the nurse as "handmaiden to the physician."
Compounding the problem, experts say, is the wider variety of career choices open to women.
While nursing competes with those new career options, hospitals vie with each other, with other health care institutions and with private physicians for the limited supply of nurses.
In this area, where the shortage generally is considered to be more severe at city hospitals, nurse recruiters from 22 hospitals in Northern Virginia, suburban Maryland and the District have banded together to produce a brochure and advertising extolling the virtues of working as a nurse in metropolitan Washington. Once a year, the association pools its resources to hold a mammoth nursing fair which all its members attend in an effort to sign up nurses.
"One more new nurse to the area, we'll be happy to get, instead of fighting for every nurse who comes to town," says Angela Sweetin, vice president of the the Washington Metropolitan Nurse Recruiters Association.
Nevertheless, job-hopping is common as nurses look for the best pay and the best hours, and local nursing directors say they constantly check the competition to avoid losing nurses to other hospitals.
Many nursing chiefs start their week like Mary Roberts, nursing administrator at the National Hospital for Orthopaedics and Rehabilitation in Arlington, who scans "help wanted" ads from the Sunday papers, comparing benefits among hospitals and salary offers in other fields such as teaching and engineering.
With low salaries one of the most common complaints from nurses, hospital administrators are starting to upgrade pay scales.
In 1980, the median starting salary in Northern Virginia for a newly graduated RN with no experience was $13,749 a year, according to Tom Terbush, data director for the Virginia Hospital Association. By comparison, he said, the median starting salary statewide was $12,418 last year.
Several area hospitals already are way ahead on the salary scale, at least for starting pay. Fairfax, Mount Vernon and Commonwealth hospitals, all members of the Fairfax Hospital Association, pay new nurses $16,654 a year, and as much as $19,254 for night shifts, said Peggy Pond, a spokeswoman for the three hospitals. Nurses at Arlington Hospital received a 17 percent pay hike this year, bringing wages for a new graduate to $8.22 an hour, or about $17,100 a year, said nursing director Susan Simms.
While starting salaries are improving, area nursing directors say a staff nurse with seven years experience, usually regarded as the top of the pay scale, generally can earn no more than about $23,000 a year on day shifts. Several hospitals, however, are creating "clinical ladders," which are designed to significantly boost salaries for experienced nurses with medical specialities such as pediatrics, surgery and intensive care. The Fairfax Hospital Association pays a specialized nurse with 10 years experience nearly $28,000 a year, more for night or weekend work, said nursing director Rodgers.
Despite the contention of several nursing groups that higher pay is the answer to the nursing shortages, a recent survey of inactive nurses by a task force of seven Virginia health agencies showed otherwise.
The survey found the chief reasons nurses left their jobs were pregnancy and family responsibilities, not low pay. Based on the survey, the task force recommended that hospitals focus on providing flexible working hours and child care, followed by increased salaries and refresher courses to bring nurses up to date on changes in the profession.
Make-your-own-hours is now a common offer at several Northern Virginia hospitals.
One of the most innovative systems appears to be at Loudoun Memorial Hospital, where one-third of the nurses are on "flexible time," according to Helen Thomas, director of nursing services.
Thomas said nurses can choose "mother's hours," six-hour shifts when their children are in school; four-day work weeks, in which nurses work four 9-hour shifts while receiving a full week's salary for 36 hours of work (the standard work week is 40 hours); or special 12-hour shifts on intensive care units, working three days one week and four the next. For nurses who prefer the traditional, the hospital still offers five-day work weeks of eight hours a day on three separate shifts: 7 a.m. to 3 p.m., 3 to 11 p.m. and 11 p.m. to 7 a.m.
The options, Thomas said, are designed to help nurses "stay in the profession and help them meet their family obligations."
The second recommendation by the task force, to provide hospital-based child care, also is gaining support in Northern Virginia.
Last year, Jefferson Memorial Hospital in Alexandria opened a day care center for 2- to 6-year-old children of employes, and 90 percent of the parents using the service are nurses, said hospital administrator Carl Linton. The center has 35 children enrolled. Care costs parents $1.30 a hour, about equal to rates for day care in other area centers, according to several other day care directors.
"It has done some good," Linton said. "It may have attracted nurses, but mostly it's been a morale booster. They feel better having the child close to them."
The infant care center at Arlington Hospital, which officials hope to expand soon from just the evening shift to a 24-hour, seven-day service, has been such a hit with nurses that several expectant nurses already have reserved places for their yet-to-be-born children, nursing director Simms said.
Mount Vernon Hospital also is planning a child care center, expected to open in January, as are Fairfax and Commonwealth Hospital, said spokeswoman Peggy Pond.
Nurses shopping for a job in Northern Virginia have plenty of other perks to choose from, too. Sunday want ads promise benefits such as tuition reimbursement for advanced education, improved health and medical insurance and free parking. Many Northern Virginia hospital use their suburban location as a drawing card for nurses unwilling to work in the city.
To attract nurses in the first place, recruiters are using gimmicks ranging from open houses and career fairs to special parties for new graduates. Arlington Hospital invited new graduates to a wine-and-cheese party last month, and nursing director Simms said she expects to hire about a dozen of the 17 nurses who attended the party. In her pursuit of recent graduates, Simms also plans to advertise in newspapers in Ocean City, Rehoboth and Virginia Beach, hoping to lure vacationers to Arlington after a summer in the sand.
When all else fails and hospitals are left with empty slots, as most are, they turn to temporary agencies, which provide nurses on a "Kelly Girl" type of arrangement.
Temporary firms pay nurses as much as $14 an hour, considerably higher than the $12 an hour many experienced nurses earn. The pay discrepancy is a bone of contention with some nurses, who contend full-time staff should receive as much as substitutes.
"The money is there," said Ann Lewis of the Virginia Nurses' Association. "If they're paying the temporary nurses $12 to $14 an hour, they can afford to pay the staff nurses more."
Several hospitals have set up their own substitute systems. Since temporary agencies bill hospitals about $20 an hour, and sometimes more, for the services of their nurses, cost would seem to be a major factor in setting up an in-house system. But nursing directors at several hospitals say that was not the prime consideration in starting their own substitute systems.
"We couldn't control the quality of care (with temporaries from outside the hospital)," Simms said, "They were not our employes. They were here eight hours and gone. They flew in and flew out without taking responsibility."
Roberts at Arlington's National Hospital echoes Simms. National set up its own in-house pool of nurses, Roberts said, to be assured of having staff familiar with the hospital's own procedures. The pool nurses, Roberts said, earn $9.50 to $10.50 an hour, depending upon experience and the shift, compared with $7.40 to $9.90 an hour for regular nurses, she said. But despite the generally higher pay, Roberts noted, temporaries forgo many of the benefits regular nurses receive, such as health insurance.
Nursing officials in Northern Virginia say they haven't found a perfect formula to end the nursing shortage, but they generally agree the answer hinges on shoring up nurses' self-esteem.
Said Roberts: "These are professional people and you treat them like that."