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A need for nurses > Back
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Nursing jobs go unfilled despite unemployed workers
who want to
train for the positions but can't due to a lack of classes.
By Ted Evanoff
ted.evanoff@indystar.com
MARION, Ind. -- Right after Tom Mott lost his job
on the Thomson TV picture tube assembly line last summer, he set
out to find a new career as a licensed practical nurse in this
distressed factory city.
He soon hit a roadblock. While Indiana faces a
serious nursing shortage, nursing teachers and classrooms also
are in such short supply that waiting lists are growing among
prospective students eager to become nurses. Mott's admission
test score was too low to win one of the 39 seats in an Ivy Tech
State College nursing class. So the 43-year-old studies at Tucker
Career and Technical Center in Marion for a job as a medical assistant
keeping records or helping nurses.
"It'll be like working in the factory. I'll
have a job, but it's not the one I want," said Mott, contemplating
his first hospital position as a medical assistant this fall at
about $10 an hour.
Indiana colleges and universities have expanded
their nursing schools in the past five years, increasing enrollments
about 35percent. They need to expand much more to make room for
hundreds of workers such as Mott and to address the nursing shortage
fueled by baby boomers' growing health needs.
Unless hospitals and the legislature designate
millions of dollars for more nursing faculty and laboratory equipment
for more classrooms, the shortage will become more severe. Experts
say the state ought to continue to expand nursing schools, offer
nursing scholarships and increase salaries for nursing faculty,
as a few other states have. No one has estimated the cost of this
in Indiana. Nor has anyone with clout taken the lead in pushing
for more resources.
Cash-strapped Indiana faces a bind -- the loss
of 101,200 manufacturing jobs in this downturn, which requires
economic development initiatives, combined with a $750 million
budget deficit.
Job retraining agencies try to steer unemployed
workers into nursing, yet those interested confront limited classroom
seats.
"People are very interested in getting jobs
in nursing, but there isn't enough room in the schools,"
said Beth Planck, head of the Marion-area's Work One retraining
agency.
State Rep. Mary Kay Budak, R-LaPorte, twice has
introduced legislation that would make nursing scholarships available
using money from the license fees that nurses must pay every other
year. Each time the measure died in committee.
"It's like a mortal sin these days if you
put in any bill that asks for money," said Budak, who's a
member of the House Public Health committee and head of the General
Assembly's Women's Caucus.
Although the state has nearly quadrupled the fees
to $50 per nurse, and Budak urged spending $20 of that on the
scholarship program, the nursing fees pour into the general fund.
With or without scholarships, more nurses are needed.
Currently, more than 2,000 nursing jobs are unfilled across Indiana,
including 1,500 in hospitals.
"We've been fortunate in Indiana that our
shortage is moderate right now. We know it's going to get worse
before it gets better," said Bob Morr, vice president of
the Indiana Hospital and Health Association.
Although about 70,000 nurses are licensed in Indiana,
only about 45,000 work in medical settings. Many have left nursing,
citing stress in hospitals and clinics trying to control costs
by having fewer employees.
By 2008, hospitals, nursing homes and medical clinics
in Indiana will require about 52,000 nurses, and 60,000 by 2020,
an increase of 33 percent over today's levels, according to the
U.S. Department of Health and Human Services.
Schools in the state graduate about 1,800 registered
nurses each year. As many as 5,000 graduates a year will be needed
to head off a medical care crisis as baby boomers, including veteran
nurses, retire, medical experts said. Today's typical nurse is
45 years old, and many newer nurses are career changers in their
mid- to late 30s.
Without more nurses, patient care could deteriorate.
A study funded by the U.S. Department of Health and Human Services
tracked 6 million patients discharged from 799 hospitals throughout
the nation in 1997. Three to 9 percent more cases of shock, pneumonia
and gastrointestinal bleeding were found in patients cared for
in hospitals with low levels of registered nurses.
"There's a huge need in nursing for people
with higher education levels," said Karlene Kerfoot, senior
vice president for nursing and patient care at Clarian Health
Partners, which runs Methodist, Riley and Indiana University medical
centers. Nursing experts say only by bringing men and minorities
into a profession dominated by white women can Indiana head off
a nursing shortage. One solution is to steer idled factory workers
into health care fields, a move that also could help Indiana's
economy.
Wages for new registered nurses average about $750
a week in Indiana, close to the state's average manufacturing
wage of $753 a week, and far above the typical pay in the service
sector, $493 a week, according to federal labor reports.
"We need to find a way to make sure we have
adequate opportunities to educate people in the health professions,"
Miller said.
A sense of job security
Looking through the newspapers, Mott saw lots of
ads for nursing jobs, but none for factory workers.
A divorced father of an 8-year-old daughter, he
had worked 12 years at Thomson's TV picture tube plant when he
was laid off last summer. Hospitals, he sensed, offered more job
security than plants in an era when factories are closing, automating
or moving to lower-wage regions.
"They gave us a few weeks to decide what we
wanted to do with the rest of our life," Mott said about
the Work One retraining program he entered last year. "I
used to like math in high school, but I didn't know what the job
situation was like for accountants. But I saw in the paper every
day it seemed like they were begging for nurses."
By the time Thomson closed its huge factory in
March, Mott was enrolled in Tucker Career, a vocational school
set up by Marion High School with state-funded Ivy Tech State
College.
Studying algebra, anatomy, medical terminology
and physiology, Mott was intent on a nursing career. Twice in
2003 he took the Ivy Tech nursing school admission test. Even
though he said he scored in the 80s in math and science out of
a possible 100, he said spelling grades in the 20s kept him out
of the nursing class.
Ivy Tech can afford to be selective. The state-funded
two-year school estimates it has more than 2,000 applications
on hand for its 840 nursing school seats.
Mott wasn't embarrassed by failing the test twice.
About a third of Ivy Tech's students require remedial studies
in basic subjects such as spelling and mathematics. But he was
concerned.
He said he was told students can take the nursing
school test only twice in a year. He can't afford to wait a year
to take it again. As a dislocated worker, a federal program pays
for his tuition, but only for two years, which means the aid would
expire by the time he hopes to qualify for a nursing class next
fall.
So Mott has a new plan: Graduate as a medical assistant
this year and hire in at a Marion hospital, then try to get the
hospital to pay the $7,300-per-year fee for nursing school.
"I'm hoping they'll like me and they'll help
me continue my education," Mott said. "I want to be
a licensed practical nurse."
Recruiting nurses
Getting tuition reimbursement from a hospital isn't
unheard of in this decade. Across the state, hospitals have been
exercising their ingenuity in a search to fill vacant nursing
positions.
In Indianapolis, Clarian's widespread advertising
landed 611 new nurses last year, 52 from out of state, for its
staff of 3,500 nurses. Clarian also maintains a scholarship fund
for nurses. Other hospitals have put on nursing fairs and offered
bonuses of $1,000 and more to attract registered nurses. St. Vincent
Hospital spent $10 million last year on temporary nurses.
Facing a shortage of registered nurses, Marion
General Hospital is recruiting 30 RNs from the Philippines, the
first time it's gone abroad for nurses.
RNs study at least two years in college, though
many obtain four-year bachelor's degrees, compared to one year
for licensed practical nurses, or LPNs. Most hospitals prefer
RNs because they are trained for more medical care than practical
nurses.
"If we thought there was a better way, an
easier way, we wouldn't go over to the Philippines and go through
all that trouble" finding nurses, said Gary Johnson, Marion
General human resources vice president.
The hospital, which employs 220 RNs and 60 LPNs,
faces a short-term crunch that officials hope Filipino nurses
can ease. But the shortage will become more severe in a few years
as the population ages and nurses retire, Johnson said.
While employers have been offering nurses hiring
bonuses, factories, which employ nearly one in five Hoosiers,
have been giving them pink slips. More than 300 plants in Indiana
have closed in the past decade. Thomson, the largest employer
in Marion four years ago with 3,000 workers, permanently closed
its plant in March, shifting production to Mexicali, Mexico.
As a result of Thomson and other closings in the
Marion area, Grant County has lost about 3,500 industrial jobs
in a decade, or about a third of its manufacturing base. At the
same time, Marion-area health care firms have added about 1,000
jobs, growing by 25 percent in a decade.
Because state funds are scarce, Marion General
also has done what other hospitals have had to do. It's loaned
Ivy Tech in Marion a teacher. Susan Smoker, an RN employed by
Marion General, will set up a course modeled after other Ivy Tech
programs. It will prepare licensed practical nurses to become
registered nurses in a year.
"It will certainly add RNs to our work force,"
Smoker said. "Will it solve the problem? No."
Almost every state has the same nursing issue and
the same problem of tight budgets.
"A lot of people are being turned away from
nursing schools because the schools don't have the capacity,"
said Tim Henderson, a director in the Institute for Primary Care
at the National Conference of State Legislatures in Washington.
No state, Henderson said, has come up with an innovative
solution to end its nursing shortage. California has committed
$24 million in federal money for training 2,400 nurses, money
used for hiring more faculty. Colorado and Louisiana offer scholarships
for nurses who agree to work in underserved areas for several
years. South Dakota reimburses tuition for 60 nurses each year.
Indiana is still looking for a solution.
"The state of Indiana has to do some long-range
planning," Kerfoot said. "We need to really think what
our needs are for the next five to 10 years."
Today's nursing shortage results from too few nursing
students in the 1990s. Pressure to cut costs led hospitals to
rearrange the workplace so fewer people did more tasks. As a result,
nursing school enrollments dropped.
With heavy advertising, enrollment numbers have
risen in recent years. Ball State University in Muncie has 35
percent more seats in its nursing school. Purdue University is
up 40 percent to 140 students. Indiana University South Bend will
have graduated about 50 nurses in the past year, though it's raising
capacity to 60 students.
Although enrollments and applications to nursing
schools are climbing, faculty members are still in short supply.
IU-South Bend now has 15 full-time and six part-time faculty,
but to reach the 60-student level, the school will need two more
full-time faculty members, said Mary Jo Regan-Kubinski, the school's
dean of nursing and health professions.
Because of the nursing shortage, nursing salaries
in hospitals usually exceed teaching salaries by $10,000 to $15,000,
even though nursing faculty must have master's degrees. The problem
is particularly acute in Indiana. A study last year by the Indiana
Nursing Workforce Coalition, a group organized late last year
by health care providers, estimated it would cost $1 million to
bring the salaries of Indiana nursing teachers to the national
average.
"The state will fall all over itself to entice
a new employer with 200 to 300 to 500 jobs to come into the state,"
Morr said. "And we're the ones sitting here with 1,500 jobs
open, and our education system is inadequate to meet the needs
of Indiana."
Long-range plans
State Rep. Budak said political leaders in the
state have been too preoccupied with Indiana's budget crisis to
deal with the health care issue. Even now, health care officials
discuss the nursing shortage, Budak said, but no political leaders
are talking about drafting specific future legislation to deal
with it.
Hammered by a manufacturing downturn, Indiana is
hardly in position for a rapid expansion of its nursing schools.
Still, it's made efforts.
Ivy Tech State College, with 23 regional campuses
across the state, received $1.5 million last year from the state
for expansion of its nursing schools. And it's completing an $18
million renovation of a building at the former Fort Benjamin Harrison
in Indianapolis that will add seats for nursing students.
Throughout Indiana, Ivy Tech currently enrolls
850 nursing students and will be able to accommodate 1,400 once
the expansions are completed.
The college intends to ask for an additional $3
million from the state next year for more expansions, including
sites in Marion and Valparaiso.
"We're a long way off from graduating enough
nurses in this state," said Jerry Lamkin, Ivy Tech president.
The problem, of course, is finding enough money.
Rather than focus on the nursing shortage, the General Assembly
has been tied up with tax reform, budget shortfalls and economic
development.
"What it really boils down to is having space
for more students. That means more teachers, too," said state
Rep. Peggy Welch, D-Indianapolis, a registered nurse on the Ways
and Means Committee.
A health industry survey identified more than 2,000
vacant RN positions in Indiana. A shortfall of 7,000 RN positions
is expected in several years.
Sources: Indiana Health Industry Forum 2002 survey,
U.S. Department of Health and Human Services
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