A Thriving Need for Nursing Skills

While vacationing in Los Angeles this summer, Barbara Rivers, a registered nurse from Alexandria, Va., contacted a nursing agency here that was willing to offer her temporary work in a hospital during her stay if she needed extra spending money.

Although Rivers, who had secured a California endorsement of her Virginia nursing license in April before leaving home, decided that she would rather relax during her one-month stay in Los Angeles, her success at quickly landing a job here as a registered nurse was not unusual.

While medical cost containment has put a crimp on the net income of doctors and hospitals and slowed growth in much of the $426-billion-a-year health care industry, the market for the nation’s 1.5 million registered nurses is booming, experts say.

The Bureau of Labor Statistics projects that “employment of registered nurses is expected to rise much faster than the average for all occupations through the mid-1990s in response to the health care needs of a growing and aging population.”

“There’s a shortage of registered nurses,” said Carol A. Balta, director of nursing for Staff Builders Health Care Services, a temporary nursing service in Sherman Oaks. “We’re having to pay top dollar because there are not enough men and women going into the field.”

Added Ron Kass, president of Hospital Staff Services, a Fort Lauderdale, Fla., company that supplies temporary nurse help in 16 states: “The demand for nurses is quite strong, particularly in the Sun Belt states.”

So strong is the demand that Rivers has the luxury each day of picking and choosing from among three employers in her home town. She said she works part time for the Alexandria Board of Education, is on staff at a local hospital and handles temporary assignments for a local nursing agency.

In Southern California, Cherie Purnell, a registered nurse at Encino Hospital, said that many of her colleagues also work multiple nursing jobs.

“I know a lot of nurses who work a regular job and then work one or two days through a (nursing) registry,” Purnell said.

The strong demand for registered nurses is in sharp contrast to the lackluster job market for hospital managers, who have been forced by industry cutbacks to seek work in allied health care fields such as insurance, health maintenance organizations and nursing homes, according to a recent survey by the Arlington, Va., Assn. of University Programs in Health Administration.

Financially troubled American Medical International Inc., for example, has laid off more than 500 managers and support staff in the past year at its Beverly Hills headquarters. However, AMI expects to hire additional nurses during the next year, said George Chesney, vice president of human resources.

Cedars-Sinai Medical Center, which hired 45 nurses this summer, expects to hire an additional 150 to 200 nurses to the hospital’s 1,100-member nursing staff during the next 12 months, said Jane Ramseyer, director of nursing.

And at Humana Inc., whose 90 hospitals have also held the line on hiring additional managers and administrators, there are about 150 nurse openings in four facilities at the chain’s Louisville, Ky., headquarters, according to Herbert Phillips, Humana’s senior vice president for administration.

Belying the growth in demand for nurses, the need for workers in allied fields, such as biotechnology, is expected to be only about average, despite recent advances in genetic research that could lead to new drugs and medical discoveries. Analysts say that brisk job growth will occur once these new products are ready for mass production and marketing.

Meanwhile, cost containment has dimmed the outlook for technicians and clinical laboratory workers, as many hospitals eliminate many tests and forgo purchasing costly equipment. Most openings for hospital technicians, the Bureau of Labor Statistics predicts, “will result from the need to replace experienced” personnel.

Yet today’s austere cost environment has actually contributed to the increased demand for nurses. That’s because most of the nation’s 6,000 hospitals are treating more people on an outpatient basis in order to save money. As a result, those patients who are admitted to the hospital are much sicker and require much more intensive care.

The home has also become an increasingly important practice site for nurses, not only because hospital patients are discharged more quickly to recuperate at home, but also because there has come to be a consumer preference for care at home or in community settings, particularly for the elderly.

And because of their ability to perform various technical skills as well as perform general administrative and clerical responsibilities, registered nurses are increasingly preferred over more specialized personnel for jobs in the rapidly growing industry of health maintenance organizations and ambulatory surgical centers.

The expanded job opportunities, however, have increased the physical demands on those in nursing, practitioners say.

Nurses can spend considerable time walking hospital corridors checking on patients, tending to mountains of paper work and coping with the human suffering and frequent emergencies that arise in their daily work.

And because patients in hospitals and nursing homes require care at all times, staff nurses at these facilities may have to work nights, weekends and holidays.

As a result, nursing work increasingly is being seen as less attractive than some other health care jobs. Fewer people are choosing to enter the nursing profession, and enrollments have leveled off in the nation’s 1,500 nurse training programs, experts say.

That’s especially true among women, who because of expanded opportunities in other fields are increasingly avoiding nursing work.

“Females have a lot more options now,” explained Ramseyer of Cedars-Sinai. “They don’t need to be just a teacher or a nurse anymore. And the slack is not being taken up by male nurses.”

Gerri Stephens, who works as a registered nurse at USC Medical Center, said that at her hospital, the work load can often be stressful.

“There’s paper work and charting to do,” Stephens explained. “You are responsible for all the medication and IV (intravenous) drugs. You have to bathe and wash patients . . . and sometimes there’s not even a clerk to answer the phone.” Stephens added that some registered nurses at the medical center can find themselves in charge of as many as 25 patients.

But so far, the increased job responsibilities and the shortage of nurses has not translated into significantly higher salaries for nurses, who have traditionally been among health care’s poorest-paid professionals.

The median yearly salary of registered nurses who worked full time in 1984 was about $21,000, according to the Bureau of Labor Statistics. Nurses employed in all federal government agencies earned an average of about $24,500 in 1984.

Meanwhile, registered nurses farmed out to hospitals on a temporary basis make between $18 and $24 an hour in Southern California, local nursing agency officials say. However, in many cases such nurses do not receive the health care and other benefits of full-time nurses, they note.

“I love nursing,” said Stephens. “But it’s not something you do for the money alone. You have to be dedicated.”