Looming Crisis in Nursing

By 2020, a time when millions of baby boomers will be retiring, the United States will have half a million fewer nurses than it needs. Hospital officials estimate that 1 in 10 nursing positions already are empty nationwide, with Western states and community hospitals and clinics faring the worst.

At the root of the shortage is the fact that as older nurses leave the profession (the average age of nurses is now 46), young people have been slow to replenish the ranks. The population of nurses under 30 has plummeted from 25% to 9% in the last two decades, partly because young women who could be counted on to fill nursing positions in the past are finding other doors open to them and partly because few people realize that nurses with only a two-year degree can earn up to $30 an hour.

Nurses may be nearly invisible on TV medical dramas, but anyone who has been in a real hospital knows they are the linchpin of today’s health care system, the medical professionals most critical to helping people pull through their most vulnerable moments.

Legislation recently introduced in the House of Representatives by former school nurse Lois Capps (D-Santa Barbara) and in the Senate by James M. Jeffords (R-Vt.) and John F. Kerry (D-Mass.) would take modest but significant steps toward easing the nursing shortage. The bipartisan bills would entice more people to become nurses by providing about $100 million in scholarships for nursing students and grants to hospitals that train nurses. An additional $20 million would go to promote the nursing profession through public service announcements on TV and through school outreach programs.

The scholarships and grants would build on the success of programs like Kaiser’s Career Ladder. The program, developed in California through a partnership between Kaiser, unions representing hospital service workers and nurses and the federal Labor Department, offers training to help people like Al Andino, who has worked as a janitor and custodian at Kaiser for 23 years. By giving Andino the flex-time and financial support he needed to attend classes, the Career Ladder recently helped him become a certified nurse assistant. Andino, the father of three, plans to continue learning and one day become a registered nurse.

These bills won’t solve the deeper malady: managed care cost-cutting that has left many nurses exhausted, forcing them to serve more patients on longer shifts and leading some to leave the profession altogether.

Ted Kennedy (D-Mass.) and Rep. Tom Lantos (D-San Mateo) are now crafting separate bills aimed at solving the staffing problem by requiring hospitals to stay within “safe” nurse-patient ratios. However, since hospitals, HMOs, doctors and nurses all have different notions of which ratios are “safe,” the Kennedy and Lantos bills are likely to become mired in a quicksand of controversy.

The legislation by Capps, Jeffords and Kerry, by contrast, is politically viable now. The bills hardly give nurses all the support they need and deserve, but they are sensible reforms that should be passed.