SOUTHERN CALIFORNIA JOB MARKET : WEATHERING THE WORKPLACE : NURSES : Their pay, status and clout are rising as more people need the care they offer.
Nurse practitioner Loretta Mazorra’s career reaches back to a time not so many years ago, she recalled recently, when nurses “have stood up for physicians at the nurse stations and gave them our chairs!”
For that matter, Mazorra’s present title didn’t exist then. A nurse practitioner is a registered nurse who has done advanced study--a master’s degree or doctorate--and works in close medical collaboration with attending physicians.
Mazorra, who specializes in gerontology, has worked for the past three years with the extreme aged at the Grancell Village of the Jewish Homes for the Aging, a complex of residences and clinics in Reseda that serves a population whose median age is 89. She collaborates with the homes’ medical director, Dr. Dan Osterweil.
“This is really a wonderful place to work,” Mazorra said.
Nurses are now in such short supply that they are at last beginning to gain some of the professional respect and to wield some of the professional clout that has hitherto eluded them. This spells better pay, more flexible work conditions, increased job mobility and a high degree of employment security, according to the California Nurses Assn.
“It’s probably a better career now than it has ever been before,” said Mary Ann Lewis, adjunct professor of medicine and nursing at UCLA and CNA regional president for the Los Angeles Basin. “It’s a good time to be in the market.”
Nursing shortages are hardly new, Lewis said, but what is happening is unprecedented.
The number of nursing jobs is increasing at a time of virtual full employment for existing nurses. The demand stems from fundamental changes that include the “graying” of the nation’s population, advances in medical technology, the spread of AIDS and changes in how the government pays for medical services for the poor and elderly.
“The shortage is as much a function of increased demand as it is a result of people leaving nursing,” said Marilyn Rodgers, CNA state president. “Some nurses certainly are leaving the profession due to dissatisfaction over working conditions that prevent them from utilizing their training to the fullest extent. But, in fact, more nurses are actually working more today than ever before.”
The number of employed nurses is approaching a record 2 million, unemployment is less than 1% and the federal Bureau of Labor Statistics forecasts that an additional 612,000 nursing jobs will be created during the next decade.
New jobs have emerged as hospitals have responded to the federal government’s 5-year-old change in reimbursement policies governing Medicare (health insurance for the aged) and Medicaid (health insurance for the poor, called Medi-Cal in California). The traditional “cost-plus” reimbursement system--which put no pressure on hospitals to contain costs--was replaced by a list of fixed prices covering specific treatments known as “diagnosis related groups” of procedures.
Institutions that provide treatment at less than the government allows pocket the difference; those that cannot must absorb the loss.
One result has been to shorten hospital stays. This has had two major effects on nursing: Hospital populations are sicker than before, requiring more intensive patient care, and, conversely, because patients are discharged earlier, more out-patient and home-care nursing is needed.
At the same time, the elderly have become the fastest growing segment of the nation’s population. This has resulted in more cases of Alzheimer’s disease and other conditions requiring long-term nursing care.
The upshot: From a ratio of 50 nurses for every 100 patients in 1972, there now are 91. And that has at last forced hospital administrators and doctors alike to regard nurses in a new and far more flattering professional light.
For one thing, said Lewis, the pressure is on hospitals to accommodate a staff that is in short supply or risk losing authorized beds to fill.
“Hospitals may fold for want of being able to compete in the market place,” she said. “If you don’t have enough advanced practitioners, you’re not going to be able to care for the kind of patients we put into hospitals today. After all, we’re taking care of people who used to die 20 years ago.”
To improve nurse training and recruitment, the California Legislature last year created a loan-scholarship program to make financing available to minority nursing candidates and to students committed to working in under-served areas. CNA sponsored that legislation, as well a legislation to slash fees for nursing programs within the California State University system.
Meanwhile, nursing pay is slowly improving--though not yet by enough to offset the premium earned by professionals in other fields and by males generally, said Lewis.
“Overall, we still do not make salaries comparable to those of men, but there are some glimmers of change,” she said. “As hospitals realize that they cannot sell and barter us as before, we think salaries will improve.”
Hospital staff nurses in Los Angeles now start at $24,960 to $31,470 a year, according to a CNA survey, and the range rises to $34,320 to $49,920 for experienced staff nurses. Nurses who work through registries in San Francisco earned up to $39 an hour last December, the CNA found. In the Western states, the median pay of head nurses ranged up to $40,285.
A two-year study released this month attributed the difficulty that hospitals have of recruiting and retaining skilled nurses to low pay and especially to inadequate working conditions.
“Working conditions are more important than pay,” said Steven G. Vernon, a Los Angeles-based consultant with Wyatt Co., which conducted a study titled “I Love My Work. I Hate My Job.” A previous Wyatt study last July found 10% of hospital nursing jobs unfilled, with one in five registered nurses leaving each year.
Claudia J. Wyatt of the international consulting firm’s Chicago office said giving nurses more say in defining their jobs and more options concerning shifts and hours could pay off for hospitals. “Nurses are true white-collar professionals who love being in the front line of patient care,” she said, “but sometimes they feel they get treated like blue-collar workers.”
Some nurses are not waiting for administrators to respond to the new demand situation, CNA President Rodgers said. “Many nurses who have pursued advanced degrees are moving up the management chains themselves. The number of Ph.D. RNs doing their own research has grown dramatically. Nurses today serve on boards of trustees of hospitals, and some are even chief executive officers. . . .
“In many settings, the power of nurses is growing, but too frequently the public perception is that nurses are still glorified pillow-plumpers,” Rodgers said.
Time is on the side of care givers, however, as market forces create “incredible opportunities,” said CNA spokeswoman Anderson, “and the job security is unbeatable.
“After all,” she explained, “people are always going to be getting sick. And they’re not going to close down hospitals and ship them overseas.”
SALARIES OF STAFF REGISTERED NURSES
City Starting Pay ($) Top Range ($) ATLANTA Hourly 9.75-12.00 $13.65-17.84 Annual 20,280-24,960 $28,392-37,107 BOSTON Hourly 10.96-14.91 15.24-24.86 Annual 22,797-31,013 31,200-51,709 CHICAGO Hourly 10.48-12.55 11.07-20.50 Annual 21,798-26,104 23,025-42,640 CINCINNATI Hourly 10.54-11.46 13.87-16.16 Annual 21,923-23,836 28,849-33,613 DENVER Hourly 10.80-13.80 12.54-17.98 Annual 22,464-28,704 26,083-37,398 DETROIT Hourly 8.50-12.47 12.94-17.00 Annual 17,680-25,937 26,915-35,360 HOUSTON Hourly 10.58-12.00 13.18-19.90 Annual 22,006-24,960 27,414-21,392 LOS ANGELES Hourly 12.00-15.13 16.50-24.00 Annual 24,960-31,470 34,320-49,920 NEW YORK Hourly 13.00-15.14 13.72-17.85 Annual 27,040-31,500 28,540-37,128 MIAMI Hourly 10.50-13.60 14.18-16.51 Annual 21,840-28,288 29,493-34,340 MILWAUKEE Hourly 9.30-14.21 12.86-17.32 Annual 19,344-29,556 26,748-36,025 MINNEAPOLIS-- Hourly 11.35-11.63 15.40-16.88 ST. PAUL Annual 23,604-24,190 32,028-35,110 PHILADELPHIA Hourly 10.81-14.08 14.34-20.19 Annual 22,484-29,286 29,827-41,995 ST. LOUIS Hourly 9.00-11.25 11.67-15.68 Annual 18,720-23,400 24,273-32,614 SAN FRANCISCO Hourly 14.76-16.68 17.25-20.12 Annual 30,700-34,817 35,880-41,489 SEATTLE Hourly 9.60-11.25 16.76-19.23 Annual 19,968-23,400 34,860-40,000 WASHINGTON Hourly 9.92-13.29 11.02-23.40 Annual 20,633-27,643 22,921-48,669
Source: American Journal of Nursing, Salary Survey, January, 1989.
