Nursing Profession in Need of Transfusion : Health care: The shortage of RNs is so acute that hospitals have had to close wards or detour patients to other facilities.

During her first day of work at the Lawndale Health Center recently, nurse Maria Padua was greeted by 29 anxious but friendly faces. The sight of so many pregnant women moved Padua to the brink of tears--tears of frustration, not joy.

The 29 patients awaiting Padua at the health clinic were hers, all hers. And the thought of examining, counseling and processing forms for such a huge caseload single-handedly nearly sent her running back out the door.

The door to the nursing profession is revolving at an alarming rate throughout the nation, a fact dramatically mirrored at medical facilities throughout Southern California. Los Angeles County and private hospital administrators report that while they have been stepping up efforts to hire more nurses, they are falling even further behind in their recruiting drive, widening a critical gap in the area’s fragile health-care system.

“There simply are not enough nurses,” said Padua, a nurse practitioner, whose expertise is in obstetrics and gynecology. “And we’re reminded of it every day we go to work.”

Although county health officials earmarked money for nearly 5,500 full-time registered nurses, more than 1,000 positions remain unfilled. Kaiser Hospitals in Southern California, the largest private employer of nurses, turns to the nursing registry to fill most of its 500 vacant positions on a day-by-day basis.

The nursing shortage has been so bad at times that hospitals in Los Angeles and San Diego counties, caught short-handed by an unexpected upswing in the number of patients during the holidays, were forced to detour patients to facilities that had enough nurses on hand.

The nursing staff at Martin Luther King Jr./Drew Medical Center in Watts was so depleted last year that hospital officials acknowledged that at times there was only one registered nurse to care for 33 patients at the facility’s surgical ward. The situation grew so desperate that the hospital, in response to an order from state and federal health officials investigating patient-care deficiencies at King, actually closed several wards to bring the nursing-patient ratio to an acceptable level.

And even as nursing salaries and benefits have improved steadily in recent years, the pool of nurses continues to shrink, leaving Padua and others faced with the care of dozens of patients each day, and no relief in sight.

“I enjoy working with patients, but I don’t enjoy the stress of being so overwhelmed that I can’t function properly,” said Padua, who works primarily at the Imperial Heights Health Center, one of the county’s numerous health clinics. “When you’re that stretched, you make mistakes, and no one wants to make a mistake in this profession.”

Nursing school officials and recruiters blame the shortage on a multitude of problems, including lack of career advancement opportunities, lack of nursing-support workers and increased reliance on nurses to supply most of the patient care. All that is happening at a time when nurses--particularly at inner-city hospitals--are caring for sicker patients and are asked to supply “increasingly technical, complex and cost-effective patient care,” according to a Department of Health and Human Services study.

Although nursing recruiters say those areas are being addressed, they acknowledge that changes in the health-care system have contributed to poor job satisfaction, high stress and high turnover among nurses.

Southern California’s nursing vacancy rate hovers around 10%, with an annual turnover rate twice that high. This is occurring despite an increase in salaries that can provide qualified nurses between $30,000 and $100,000 annually, according to the yearly survey of nursing salaries released by the Hospital Council of Southern California recently. The salary range reflects the average starting pay and the highest pay reported by a nursing director at a large hospital chain, according to council officials.

Although nursing school teachers and recruiters say that the improvements in salaries and career opportunities are bound to help lure more high school and college students to the profession, they believe that the demand will continue to outstrip the supply in the coming years. An estimated 390,000 nursing positions in the United States will not be filled this year, and by the year 2000, the number of positions that remain unfilled will hit 580,000, according to statistics compiled by the federal government.

“We’re still trying to make up for a 25% drop-off in the past five years,” said Maureen Anderson, a spokeswoman for the California Nurses Assn. “Since it takes three to four years to get through nursing school, and we’re seeing more and more patients, I don’t think we’re going to catch up any time soon.”

Bertha Jordan can think of a few more reasons for the drop-off. Jordan, who works on the medical ward at King, sees some of the county’s sickest patients each day--a depressing mix of gunshot victims, drug addicts, crash victims and others.

Jordan said a typical day on the ward finds her with more than a dozen patients, some of them critically ill. But despite the seriousness of the injuries she must treat, she often must handle numerous clerical duties, including completing reams of paper work involving admission and insurance forms.

“I’m trying to determine if a patient is stable, and watching another stroke victim who has contracted pneumonia, and they’re asking me to process these forms and admit more patients,” said Jordan, who has worked at King for the last eight years. “I couldn’t possibly take care of the patients if even one of them developed complications.

“On top of that, they keep telling us to recruit more nurses. And I have to tell them, why would I want to recruit someone to work in these conditions?”

Officials at the Joint Commission on Accreditation of Healthcare Organizations, which accredits more than 80% of the nation’s hospitals, said that more and more medical facilities are reducing the number of patient beds to ease difficulties in finding enough nurses. “It may appear unorthodox, but in many cases it’s the only way hospitals can address the nursing shortage,” said Don Avant, a commission official.

At some county facilities, nurses have filed hundreds of complaints over working conditions in recent months, and the nurses’ Service Employees International Union, Local 660, is bringing a formal grievance against the county next month. Union officials are trying to force the county to address a number of problems, including clinics and hospitals’ ordering nurses to work longer shifts; inadequate training programs for nurses who are required to “float” to different facilities on short notice; inadequate security and lack of support staff.

“Whenever you have the kind of situations we’re faced with--too many trauma cases, an explosion in obstetrics and other things--you’re going to have an increased workload,” said Carolyn McDermott, director of nursing affairs for the county Department of Health Services. “We’re trying to reduce the workload because we agree with the nurses that they should only be concentrating on patient care. We’ve come to the realization that you can’t afford to have nurses doing non-nursing activities.”

Ada Lindsey, dean of UCLA’s School of Nursing, said that although basic nursing duties have not changed over the years, the patients have. In addition to dealing with increasing numbers of victims of city violence, hospital workers are seeing older patients--reflecting the population shift in general--and hence sicker ones. But the layoff of an estimated 100,000 non-nursing workers nationwide during the last five years means that nurses are faced with more clerical and administrative duties.

“With the increased patient acuity, you almost have to assign them on a one-to-one basis, and that’s why so many more nurses are required now,” Lindsey said. “One of the things that is happening in nursing is that they have to be better prepared to allow them to deal with the kinds of complex and technical issues that they face every day.”

But there are some encouraging signs. Recent efforts to attract more people to the profession appear to be making an impact.

After a three-year period when enrollment in nursing education programs nationwide dropped by an average of 14%, enrollment at nursing schools rose nearly 6% last fall, according to the American Assn. of Colleges of Nursing.

UCLA’s nursing school reported its first enrollment increase last fall, largely because of the steady salary increases and greater career opportunities in administration, research, academia and consulting work, Lindsey said.

The Hospital Council, in conjunction with the county and nearly 100 private hospitals, launched the Health Careers Information Center in 1987, an education program designed to attract candidates to the nursing field and employ them in Southern California. The program has been extremely popular among high school students, according to council officials who predict that enrollment in nursing programs will continue to rise.

“We began to determine that it was becoming a chief concern for hospitals in Southern California because the nursing shortage was so pronounced,” said council spokesman David Langness. “When we looked at it closely, we realized that what hospitals were doing was shifting around the same supply of nurses and that that supply was dwindling.”

The county is one of hundreds of sponsors of a national nurse-recruiting campaign to be launched in March, aimed at luring more men and minorities and people contemplating a career change into the profession. The campaign, which will include a media blitz of radio, television, newspaper and billboard ads, will focus on the theme, “If caring were enough, anyone could be a nurse,” according to officials with the National Commission on Nursing Implementation Project in Milwaukee.

“The basic idea is that we’re trying to present a positive image of nursing,” said Pam DeBack, a commission spokeswoman. “We want people to know there are a lot of career opportunities in nursing and that the field is changing.”

Those changes, such as rewarding nurses with higher pay and more input into how health care is administered at hospitals, are the only way to reverse the trend that federal health officials have termed a national crisis, according to Kay Davis, a nursing program consultant.

“If health-care organizations would look at ways to improve their salary and benefits packages, it would go a long way to keep nurses happy,” Davis said.

Padua, who has worked as a nurse at various county facilities for the last nine years, said that she has considered leaving the profession several times in recent years. But the 32-year-old nurse said she changes her mind when she sees the anxious faces of the pregnant women who line up for her services each day.

“It really bothers me when I feel like I’m being taken advantage of, especially when no one seems to care how many patients we can realistically care for,” she said. “But when you help someone who is just about to have a baby, you don’t think about the problems and the stress. You just think about them.”