Medical Professionals - Is There A Nurse In The Area?

The map shows the number of registered nurses per 100,000 population in 1996. The national average that year was 808. As we saw with physicians, there is a geographic mal- distribution of registered nurses. The Bureau of Health Professions points out that the national shortage of RNs is not evenly distributed across the states. Some states have experienced steeper population growth than others, leaving them with severe shortages of nurses. In 2000, 30 states were estimated to have RN shortages. By 2020, 44 states and the District of Columbia are projected to have shortages.

Notice that California ranked last in nurses per 100,000 in 1996, with Nevada and Idaho a close second- and third-to-last. These states experienced population growth between 1990-1997 of 8.3%, 39.5%, and 20.2%, respectively. Desperate for more nurses, California passed legislation in 1999 that established statewide standards for the number of patients assigned to a nurse (a too-large patient load is a common complaint among nurses). In 2002 California passed new legislation requiring the state to add 5,000 nurses by 2003. The California Nurses Association called the measure "a landmark bill that will make California the first state in the nation to require safe hospital staffing…. This is one of the most significant days in the history of nursing."

Key the name of any state on a computer, followed by the phrase "nurse shortage," and you will see that no state is immune. The consequences of a shortage of nurses are terrible to contemplate. Horror stories abound about compromised quality of care blamed on a lack of sufficient nursing staff (the nurse "struggled to give one patient blood, while another began having a heart attack and yet another strained to breathe on a respirator…").

To recruit nurses during a shortage, hospitals offer huge signing bonuses or pay two to three times the normal hourly rate for nurses to hire temporary workers. They promise lower patient-staff ratios to burned-out staff. During the nursing shortage of the 1980s, the American Nurses Association began certifying hospitals as "magnets," hospitals described as excellent places for nurses to work (in 2002, 10 hospitals qualified). One criterion for certification: the hospital must have a nurse in the top level of administration.

In July 2002, Congress passed the Nurse Reinvestment Act to help alleviate the shortage of nurses. Speaking in support of the bill, Congressman John Dingell of Michigan called nurses the "unsung heroes in health care." He noted that Detroit imports 15 to 20% of its nursing staff from Canada (which has its own nursing shortage) and that a University of Detroit-Mercy study predicted a need in Michigan by 2007 for 1.4 million registered nurses versus a predicted supply of only 656,000. The Nurse Reinvestment Act established scholarships, nurse retention, and patient safety enhancement grants, and grants for comprehensive geriatric training. It also called for public service announcements to inform "potential nurses about the resources available to them if they choose to enter this wonderful profession" (Dingell).

With reference to "this wonderful profession," it is interesting to note what Nurse Advocate has to say: "Numerous sources report that nurses and other healthcare workers are assaulted in the workplace more frequently than any other US worker group…. Nurses tend to minimize and ignore violence, and in addition, do not report violence. Nurses cite lack of employer support and fear of retaliation as common reasons for not reporting."

Sources: Map: National Center for Health Workforce Information and Analysis, State Health Workforce Profiles, http://bhpr.hrsa.gov/healthworkforce/profiles/default.htm. Bureau of Health Professions, "Projected Supply, Demand and Shortages of Registered Nurses: 2000-2020," http://bhpr.hrsa.gov/healthworkforce/rnproject/default.htm. Joan Obra, "Law intensifies the state and Valley nurse shortage," The Fresno Bee, Jan 23, 2002 pC1. Jodie Snyder, "Nurse Shortage Critical in State," Arizona Republic, Sept 1, 2002 pD1. "Looking for Quality Patient Outcomes: The American Nurses Credentialing Center's Magnet Program Recognizes Excellence," http://nursingworld.org/readroom/nti/9804nti.htm. Statement of Congressman John D. Dingell, http://www.house.gov/commerce_democrats/press/107st140.htm. Sarah A. Webster, "Stressed Nurses Quit, Hurting Patient Care," The Detroit News, November 18, 2001, http://www.detnews.com/specialreports/2001/nursing/sunlead/sunlead.htm. "California signs nurse-to-patient ratio bill," http://www.calnurse.org. Nurse Advocate: Nurses and Workplace Violence, http://www.nurseadvocate.org/nursewpv.html. Information retrieved September 30, 2002.