Nurse Shortage Raises Concern for Long Term : Health Care: An unusual holiday crunch may mean that San Diego can no longer sit on its laurels as a desirable place to work.

Nursing staffs at several San Diego County hospitals--already stretched thin by a national nursing shortage--were hit by a “triple whammy” during the holiday season, forcing doctors at one hospital to admit their patients to other facilities.

Several hospitals asked available nurses to work double shifts and holidays.

The urgent lack of staff led some health-care administrators to predict a worsening long-term nursing situation for the county.

Historically, the demand for hospital care falls during the holiday season, and most local hospitals set lower-than-normal staffing levels. But in late December, admissions unexpectedly rose, and many wards suddenly were filled, largely by older patients with respiratory problems.

As admissions increased, the supply of nurses at some hospitals began to shrink as nurses fell victim to a flu bug.

“What we experienced was different than every other Christmas, when (the county’s patient) census has gone down,” said Sonya Healy, director of patient care services at UC San Diego Medical Center. “The shortage, the higher patient census, the flu . . . was like a triple whammy. The demand outweighed our supply.”

The patient load created an especially heavy demand for nurses in intensive-care and trauma units, Healy said.

“Many hospitals’ critical-care beds were full, resulting in backup in the emergency rooms,” said Carrie Scott, Paradise Valley Hospital’s vice president for patient care services.

At the same time, hospital staffs and nursing registries, which were hit hard by the flu as well as nurse vacations, “were unable to supply additional nurses to meet the increased demand,” Scott said.

The nursing shortage seemed to hit hardest at Kaiser Permanente, which was forced to admit patients to hospitals where nursing staffs could provide proper care.

Kaiser directed some patients to local hospitals that hold contracts to treat the health maintenance organization’s patients, said Marina Bareoff, an assistant administrator at Kaiser’s San Diego hospital. Kaiser also admitted patients to non-contract hospitals, an unusual step, “so as not to jeopardize anyone’s health,” Bareoff said.

The shortage extended into January at Kaiser, which, at week’s end, still had about 30 patients at other hospitals, she said, adding that Kaiser typically might have about three patients at other hospitals.

Kaiser and at least one other hospital also asked doctors to postpone some elective surgery until the shortage ended.

While UCSD Medical Center and Paradise Valley were not forced to admit patients to other hospitals, nurses did work additional shifts. They “went the extra mile by working extra shifts and additional holidays,” Scott said.

Scripps Memorial Hospital in La Jolla experienced an unexpected surge in patients, mostly from the flu, but the hospital had an adequate supply of nurses, according to spokeswoman Edie High. Scripps turned to a pool of nurses who had not been scheduled to work the holidays because their ward was closed for renovations.

Mercy Hospital had “some close calls,” but no patients were turned away or admitted elsewhere, according to Eileen Smith, director of nursing. “The (load) was very heavy, the patients were sick, and some of the staff was sick.”

Health-care providers in San Diego disagreed on whether the seasonal shortage was an indication that the long-term shortage is worsening.

Statewide, about 20% of hospital nursing positions are unfilled, said James Lott, president of the Hospital Council of San Diego and Imperial counties. The shortage has not been as deep in San Diego, where the vacancy rate is at 8%, he said.

That lower-than-average vacancy rate is linked to San Diego’s reputation as an attractive place to live, Lott said. Also, local hospitals benefit from the supply of nurses that each year leave the Navy’s large hospital in Balboa Park, Lott said.

However, San Diego’s vacancy rate is expected to nearly double to 15% within three years as the national shortage begins to make its presence felt, he said.

San Diego hospitals can “no longer sit back and rest on their laurels,” Lott said. “The (seasonal shortage) was really scary because there’s not that much experience in this town with a severe nursing shortage.”

Elsewhere in California, the shortage is “like a car going downhill without brakes; it’s only going to go faster,” said Maureen Anderson, a spokeswoman for the San Francisco-based California Nurses Assn. Average patient stays in the state have fallen in recent years, but patients “are sicker when they’re in there,” Anderson said. “The intensity of the care they demand is greater.”

As hospitals pare costs, they typically “are scaling down . . . the number of nurses they employ,” said Dr. Rosemary Goodyear, director of the University of San Diego’s graduate-level family-nurse practitioner program. The long-term shortage worsens when “more intensive care is needed, because you have that one (nurse) to one (patient) ratio.”

The staff cuts also make it difficult for Goodyear to find clinical internships for students at hospitals because nurses and doctors have less time to dedicate to the graduate students.

“How can I prepare people (for graduation) when I can’t find places to put them?” she asked.

To alleviate San Diego’s nursing shortage, 10 area hospitals have anted up $5,000 each to fund a television advertising campaign that encourages San Diegans to consider nursing as a career. The commercials, which began running on a local channel Tuesday, are directed at high school students and at adults who are considering a career change.

Hospitals are trying to coax inactive nurses to return to the field, said Healy, the UCSD director of patient care services. In a recent survey of 1,500 inactive nurses in San Diego County, nearly 200 indicated a desire to return to work, she said.

Nursing professionals elsewhere in the nation suggested that hospitals must band together to solve the crisis.

“Regional efforts such as (commercials) are the creative kind of things that must be done to meet the needs of a specific area,” according to Cynthia Cizmek, a spokeswoman for the Kansas City-based American Nurses Assn. “These creative things really need to be encouraged, because that’s the only way to meet the needs of your local area.”

Local hospitals are largely past the holiday crunch, “but the everyday crunch is continuing,” Healy said. While the seasonal nursing shortage in San Diego apparently did not threaten health care for San Diegans, the shortage reached crisis proportions in some cities.

New York regulators last week ordered hospitals to cancel elective operations in order to make room for 900 patients who could not be placed in already crowded public hospitals. The city system has enough beds but “can’t get enough nurses,” according to a New York hospital administrator.

Nationally, the number of students entering nursing programs has fallen by about 25% during the past decade. At San Diego State University, the number of new nursing students entering each semester has remained steady at 65, but the number of applicants for admission has tumbled to 100 from a high of 200 in 1985, according to Jan Heineken, associate director of the SDSU School of Nursing.

With that drop in applicants, the “quality of students has shifted,” Heineken said, and SDSU is graduating fewer students. “It’s a rigorous program.”

Heineken said relatively low pay and difficult working conditions are to blame for the declining interest in nursing nationally.

But as the number of new nurses entering the field falls, demand is rising. An estimated 390,000 nursing positions in the United States will not be filled during 1990, and by 2000, the number of positions that remain unfilled will hit 578,000, according to statistics supplied by the federal government.