There is an estimated 8 percent shortage of nurses in Rhode Island, but that
gap could grow to 25 percent by 2010 and to 55 percent by 2020, if the industry
does not respond quickly with sweeping systematic changes, a recent study suggests.
“There are implications for every person in Rhode Island. It should be a wake-up call for everyone,” said Mary Brunell, vice president of patient care services and chief nursing officer at Roger Williams Hospital. “If we do nothing, there won’t be enough nurses to take care of us.”
“Help Wanted: The Growing Crisis in Rhode Island’s Nursing Workforce” is a more in-depth look at the nursing profession based on the findings of the first SHAPE (Statewide Health Assessment Planning and Evaluation) study published in 2002 and funded by Blue Cross & Blue Shield.
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SHAPE Phase II was also funded by Blue Cross, but was presented by the Rhode Island SHAPE Foundation, established earlier this year to serve as an independent fact-based organization in charge of assessing the state’s health care system, according to D. Faye Sanders, executive director.
Twenty nursing and health care professionals composed the Subject Matter Experts panel for the study, which was compiled by McLean, Va.-based Booz Allen Hamilton and Harris Interactive, based in Rochester, N.Y. Three more studies will follow on the physician work force, behavioral health and the state’s health care facilities, Sanders said.
Key survey findings include:
• Demand for nurses could rise by as much as 11 percent in 2010 and 24 percent in 2020 and supply could drop by 10 percent in 2010 and up to 40 percent in 2020.
• More than one in four of Rhode Island’s licensed nurses do not work in the nursing profession here.
• About 89 percent of nurses say they are satisfied with their careers, but many are concerned with workload and compensation.
• Efforts to increase the number and availability of nurses are almost certainly
insufficient on their own to bridge the supply and demand gap.
Overtime a last resort
Hospitals have had to close beds because there aren’t enough nurses, so patients wait for a bed, said Cathy E. Duquette, senior vice president of the Hospital Association of Rhode Island. Hospitals hire part-time nurses and reassign others to take up the slack. Some nurses work extra shifts, but overtime is a last resort.
“Nurses are dealing with it the best they can. They’re doing extra hours and over the summer we offered a bonus for October for people who picked up extra shifts and didn’t decrease their hours,” Brunell said. “It’s not just the number of nurses but the intensity of the work that is much more (now). Patient stays are shorter so you have a number of them leaving at the same time, and then those beds are filling fast.”
Most alarming, according to panel members, is that just producing more nurses will not change the eventual outcome. The entire system needs reworking, from education to workplace environment to the way the industry utilizes its nurses.
“Despite the fact that nursing professionals are working on the supply side issue and nursing schools have doubled capacity, it’s not enough,” Duquette said.
One in eight practicing nurses under age 60 plans to leave the field in the next three years, a result of the physical demands of the job, the layout of hospitals and other centers and workplace conditions, experts said.
“It may be more difficult for nurses to stay in the profession,” said Pamela McCue, executive director of the Rhode Island State Nurses Association. “It’s a very scientific profession, but we still have to physically lift patients.”
The study suggests that redesigning hospital and long-term care center layout – like keeping medicine and medications close to patients – would minimize repetition of tasks and reduce nurses’ need to travel the entire building to administer care.
“We’re looking at some of the demand side, and it’s not easy to fix,” Duquette said. “The way nurses provide care requires big change. They fill out a lot of paperwork. If we could restructure the environment to be more nurse-friendly … we could reduce duplication of effort and the location of supplies.”
Although the study states there will likely be more nursing jobs in the future, with baby boomers aging and the population living longer – and nurses aging along with them – the task is not only to replace those who are retiring, but also to increase supply to anticipate future demand.
“More than 50 percent of nurses are over age 50, so retirement alone will cause that” trend, Duquette said. It’s a double-edged sword, McCue said.
“Nurses in the work force who perceive a shortage, work faster and more efficiently,
but they’re also getting burned out and leaving the profession,” she said.
Mass., Conn. pay well
According to the study, Rhode Island’s registered nurses and licensed practical nurses are paid more than the national average, but they are still making less than Massachusetts and Connecticut. The average hourly wage for RNs in Rhode Island is $24.90 and $19.28 for LPNs, compared to the $26.48 and $19.12 nurses earn in Massachusetts and the $26.40 and $20.97 they earn in Connecticut, according to 2002/2003 Bureau of Labor Statistics figures. The national average is $23.96 for RNs and $15.53 for LPNs.
“It’s easy for someone to go to Massachusetts or Connecticut,” Brunell said. “We’d love to pay nurses more and bring more people in, but with our reimbursement rate as poor as it is, we can’t do those things.” Rhode Island ranks 43rd in reimbursements.
Nursing professionals said now they must mobilize stakeholders – reach out to school systems and higher education, appeal to state officials for supportive legislation, get organized on the next plan of attack.
“The first step is to release the data and empower the stakeholders. The leadership
is already organized,” McCue said. “This is complicated but we see it very clearly.”
