A Hemorrhage in the Hospitals

When it comes to the contemporary nursing shortage, hospitals insist that they have no choice but to implement short-term “solutions.” There are, the American Hospital Assn. reports, 126,000 nursing vacancies nationwide, or 12% of capacity.

That’s why, some hospitals argue, they have to offer as much as $10,000 in signing bonuses, $1,000 to $2,000 payments to nurses who refer another RN to a hospital and money to pay for moving and even living expenses, as well as for continuing education.

While the Don Juans of the hospital industry are out seducing a whole new crop of RNs, however, they are neglecting nurses already on their payrolls. At Catholic Healthcare West, which owns 38 hospitals in California, nurses’ pay lags so far behind that nurses in the California Nurses Assn. last week staged a protest.

To staff its units, Catholic Healthcare West, like many other hospital owners across the country, hires temporary nurses through local registries. These nurses can earn between $32 and $35 an hour.

Meanwhile, one nurse who has worked for one of Catholic Healthcare West’s hospitals for 16 years told me that he “maxes out” at $27.82 an hour. This nurse asked: “Can you imagine how many nurses would come back to work for the system permanently if they made” the same amount as temporary nurses?

The chain has also sent recruiters as far as South Africa and the Philippines to troll for new nurses. In Sacramento, nurses who work for Catholic Healthcare West facilities have been asked to pick up foreign recruits at the airport, help them navigate the RN licensing process and lodge them in their homes. When expert nurses are asked to work with and orient new recruits who earn more than they make after 15 or 20 years of loyal service, the message is clear: If you want a raise, change employers, not once but over and over again.

Indeed, policies at hospitals throughout the country have created a whole new temporary work force of RNs who quit their jobs and sign on with traveling-nurse or temporary-nurse agencies. Sometimes these nurses return to their old employers--at a higher salary and with better schedules.

Given the industry’s message to veteran nurses, it’s no wonder that many nursing students view the hospital as the first rung on a career ladder that will take them “up” and away from direct bedside care.

This spring, I interviewed several hundred fourth-year nursing students in different university nursing schools across the country. When I asked them whether they wanted to do hospital nursing after graduation, about half to three-quarters raised their hands. How many, I asked, envision working in hospitals or in home care or clinics in 10 or 15 years? A few--sometimes no--hands went up.

These students believed that hospital nursing would be stifling, offer no opportunities for advancement and wouldn’t pay enough. A couple of years in a hospital to gain experience would suffice before they moved on to what they considered challenging, well-paid work as nurse practitioners, managers, nurse midwives, researchers or nurse anesthetists.

The consequences of this short-term obsession with recruitment are potentially staggering. Forced to work with only new grads or temporary nurses, veteran nurses--who depend on the expertise of colleagues to take care of sicker and sicker patients--will find their work difficult to manage and will continue their exodus from the hospital.

Without experienced nurses to teach, orient, mentor and guide them, nurses new to an institution (or a country) will find it equally difficult to learn the skills that will move them from novice to expert. Frustrated at their inability to learn and grow, their views of hospital nursing will be confirmed and they will leave for the supposedly greener pastures of primary care, research or management. This will leave an aging, intensely ill population of patients in the hands of RNs who lack the kind of expertise only years on the job can provide.

Patients had better pray that assertive nurses are able to convince the hospital industry that its frenetic focus on recruitment--absent an equally serious commitment to nurse retention--is like trying to give a blood transfusion to someone whose bleeding hasn’t been stopped. No matter how much new blood is added, the patient will eventually bleed to death.