Critical Care_lowres


When members of the New Orleans chapter of the Black Nurses Association welcomed the thousands of members coming to town last week for the group's 31st annual conference, the local nurses did not lay out the red carpet via some lavish dinner or a meet-and-greet cocktail hour. Rather, they worked to create an event true to a nurse's calling: helping people achieve better health.

With the blessing of the Rev. C.S. Gordon Jr., the group transformed the historic New Zion Baptist Church at the corner of First Street and Simon Bolivar Avenue in Central City into a community health clinic. Hundreds of neighborhood residents entered the church to receive medical and social services -- everything from vision screens to cholesterol, diabetes and blood pressure tests -- from myriad local agencies. While the five-day conference will address many issues in the nursing profession, only a job fair last Friday addressed the biggest problem: a shortage of nurses, which is having a dramatic impact on the medical industry. Exhausted and stressed-out nurses are pushed to the breaking point by increased workloads; a reduced pool of qualified nurses is often unable to meet the demands of an aging population.

Data shows how much the nursing profession has changed in recent years. In July 2002, the federal Health Resources and Services Administration reported that 30 percent of states faced nursing shortages, with that number expected to grow to an estimated 44 percent by 2020. Local health officials estimate that there are anywhere from 900 to 1,000 vacant Registered Nurse (RN) positions on a given day, a deficit that represents roughly 13 percent of the total nurses working in metropolitan New Orleans.

To combat the problem, local nursing schools are undertaking initiatives ranging from accelerated and restructured programs to arrangements through which hospitals pay for students' tuition in exchange for contracts to work for their institutions. The efforts in New Orleans mirror those nationwide, with the American Association of Colleges of Nursing (AACN) releasing a December 2002 survey that showed an eight percent increase in enrollments in entry-level baccalaureate programs from the previous year. Still, the U.S. Department of Labor released a report in 2002 that indicates one million new and replacement nurses will be needed by 2010. Current student levels are not high enough to meet that demand.

"The nursing shortage is really a complex problem; there are just so many factors involved," says Rebecca Harris-Smith, speaking from the church while taking a break from her duties as the event's chairwoman. "Nurses are very frustrated and discouraged right now. It's not the money; nurses just don't feel appreciated. You have MBAs running hospitals now and, to save money, they're increasing the workload of nurses. The result is a lack of quality care."

In many ways, Harris-Smith reflects the shifts in the nursing profession. Admittedly "worn out" from decades working maternity wards and specializing in parent-child care, Smith, who has suffered a herniated disc as a result of the physical strains of her job, is taking a teaching position at Charity School of Nursing at Delgado Community College this fall. "The baby boomers are growing older," Harris-Smith says. "That means more people are sick in the hospitals, and it also means that the nurses are moving out of bedside care and into administrative and academic positions because we physically just cannot do that type of work any more."

"The hospitals are hurting," says Dean of Nursing Patricia Egers, head of the Charity School of Nursing at Delgado Community College. "The nurse-patient ratios are too high, and that's hard on the nurses. We've had to ask hospitals' help with getting more faculty, as they often offer some of their expert nurses to come and teach clinical (hands-on training), and they're telling us they can't do it because they're too short on nurses."

There are many factors for the shortage, Egers says. "There are more options for women now; they don't have to be limited to just a few career choices," she says. "We need to recruit more male nurses."

Delgado has been successful in recruiting more students. Fall 2003's total enrollment was 613, an increase over 459 in fall 2001. The school is starting an evening division in spring 2004, which will perhaps accommodate the 2,600 students in pre-nursing programs at Delgado's City Park campus. The largest local nursing school, Delgado has the fourth largest enrollment among 1,200 community college nursing programs nationwide. "Applications are up," Egers says. "We could fill half a class with every class we have. The economy has a lot to do with it. People are going back to school because they lost their job, and they hear about the nursing shortage and know there's opportunity there."

Yet Delgado struggles to meet the rise in students, required as the college is by law to maintain nothing higher than a 10-to-1 student/faculty ratio. "One of the difficulties in getting faculty is that we simply can't pay them enough," says Egers, who adds that the average age of a nursing teacher is over 50, with many now nearing retirement. "Many nurses want to come back and teach, but they can't afford it. They're required to have a master's degree, but if they have their masters, that means they're high up on the career ladder. It would mean a cut in salary to come back and teach, essentially starting your career all over again. We can't match the salaries they'd make working."

To recruit nursing teachers, the Louisiana Board of Regents, which oversees the state's universities and community colleges, has created 30 fellowships to be awarded annually for nurses wanting a master's in nursing. The fellowships allow the nurses to go back to school with their tuition covered, as long as they teach in a state public institution after graduation.

"The shortage is really hard to deal with," Egers concludes. "People need to understand that you just don't throw people at the problem; we need a holistic solution. Hospitals need to learn how to keep experienced nurses, and we, the schools, need to look into how to prepare more.

"The problem is even more difficult because it's nursing," Egers adds. "It's dealing with real people and real lives. You put more of yourself into it; it's not like a desk job that you can just walk away from things when it gets tough. That's hard. But still, it's a wonderful profession."

To combat the nursing crisis, Tulane University Hospital and Clinic this fall will begin a three-year partnership with Our Lady of the Lake College in Baton Rouge's nursing program to establish an accelerated program. The concept allows students with a bachelor of science in nursing (BSN) degree to earn an associate degree in nursing in two semesters, a course of study that typically takes two years.

"As part of the Greater New Orleans Hospital Council, we do surveys every six months in various issues in the local community," says Larry Balyeat, vice president of human resources for Tulane University Hospital and Clinic. "We found that there was just not enough nurses coming out of the programs to meet the demand. This results in closing beds, limiting the service you provide or filling the voids with contract nurses, which is very expensive and definitely has an adverse impact on the quality of patient care."

Balyeat says future nurses who come through the partnership plan will come largely from the New Orleans area, even though roughly 50 percent of Tulane's current working nurses come from out of state. He describes the students in the accelerated program "as filling a different niche," as they must already have a bachelor of science degree that gives them knowledge in prerequisites such as anatomy, chemistry, physiology, sociology and microbiology. "The average age is in the early 30s, so they're mature and dedicated; it's mostly people looking for a career change," says Balyeat. "It's attracting a very high caliber of student."

With a maximum of 50 students, program graduates will become RNs upon passing the state Board of Nursing's licensing test. "These students will still have the same amount of clinical time and classroom time, and still pass the state board," Balyeat says, refuting concerns that the program might rush students into crucial jobs. "They're not taking anything less than a nurse at any other program."

Not all hospitals are feeling the nursing shortage, a factor attributed to creating a nurturing, positive work environment. Last year, East Jefferson General Hospital joined only 74 hospitals nationwide in the designation as "magnet hospitals" by the American Nurses Credentialing Center (ANCC), which identifies institutions that "create a work environment that recognizes and rewards professional nursing." The Metairie hospital is the only one in Louisiana to earn the distinction.

East Jefferson has a vacancy rate of three percent -- contrasted with the area's 13 percent rate -- and has an average tenure for nurses of 10 years. "One of our keys to success is that we're a place where nurses can feel satisfied with their work environment," says Janice Kishner, senior vice president of clinical operations for the hospital. "The staff-patient ratios here are appropriate, and nurses here feel good about their professional development. Word about that travels fast."

Despite the dire forecasts for the immediate future of the nursing profession, the career, as much a calling as anything else, remains in its basic elements the same. "Nursing has never been glamorous," says Harris-Smith. "It's hard work, but it's not about the money. You have to have the heart for it. If you love it, you love it, and that's the only way to be a great nurse."