The Colorado nursing shortage – twice that of the rest of the country – is an artificial creation caused by staffing ratios and low pay in the state’s hospitals.
That’s according to a report from the Nurses Alliance of Colorado, part of the Service Employees International Union, which represents 1.3 million hospital employees nationwide.
“There’s no real shortage of nurses,” said Rebecca Matthys, a former nurse who works as a lactation consultant and served on the NAC policy committee that issued the report. “There’s a lack of nurses willing to work at the bedside in hospitals.”
But the report only tells part of the story, said health care author Tom Olivo, who wrote “Impending Crisis: Too Many Jobs, Too Few People.”
“I can guarantee you that the health care work environment is driving people away, but that’s not the case in every hospital,” he said. “Memorial in Colorado Springs is an example of a hospital putting in best practices to keep their nurses.”
It is estimated that there are 100,000 nursing vacancies throughout the country. While some experts claim the United States could fall 400,000 nurses short of the number needed in 2020, Olivo says that’s not necessarily the case.
“We’re going to change the jobs,” he said. “We’re going to change the way things are done so you don’t have to have an advanced degree to perform some health care jobs.”
According to the nurses’ alliance, for every full-time nurse, there are six other licensed registered nurses who choose not to work at hospitals – frequently leaving the field completely.
“If only 20 percent of those nurses decided to go back to hospital work, the vacancies throughout Colorado would be filled,” Matthys said.
Matthys said she chose to leave the nursing profession after years of being stressed-out and overworked.
“You have to leave, you just get so burnt out,” she said. “I felt like I was playing Russian roulette. The staffing levels were so low, and nurses are responsible for more people than ever before. I had to leave before I made a horrible mistake.”
Some nurses choose to work in doctors’ offices or as home health nurses, she said. But frequently, they leave the field altogether.
“I have one friend who is now in real estate,” she said. “Another who works as a preschool teacher. They just don’t want to do it at all anymore.”
Memorial Health System is feeling the pinch from the nursing shortage, to some extent, said Ron Burnside, human resources director. However, he said the hospital took steps a few years ago to avoid nurse burn-out and to become “the employer of choice.”
“This has taken us down a road where we have seen some real benefit by way of creating what we think is a great place to work,” Burnside said. “There are some difficulties of staffing 24/7 acute care intensive hospital. We felt we could create a workplace that would overcome difficulties and differentiate us in a way that would soften the impact that the health care worker shortage is predicted to cause.”
More flexible schedules are one of the cornerstones of the program.
“We took a very thoughtful look at how we went about scheduling, programs that allow nursed to work solely on weekends, which can afford the rest of the group not to work weekends,” he said. “We also have what we call bailer positions, where a nurse can work 12 hours shifts on weekends, evenings and night shifts – but those kinds of staffing patterns require that we have premium pay in place.”
Burnside disagreed with the alliance’s assertion that nurses are completely leaving the field. Instead, changes in medical care have led nurses to leave hospitals for more attractive workplaces.
“Some nurses are well-suited for hospitals; their passion is for nursing in a hospital setting,” he said. “Other nurses are interested in a day surgery program or working next to a physician in office setting. There are a lot of nurses who are very good at the paperwork needed for dealing with insurance companies. There are different kinds of nursing, with many different interests to provide health care.”
The Nurses Alliance of Colorado calls the situation a “crisis,” not a “shortage.” According to its report, released in August, Colorado has 51,000 registered nurses who are licensed to practice in the state. However, only 30,000 choose to work in hospitals.
“Twenty-one percent of nurses who work at the bedside in U.S. hospitals leave their jobs every year,” according to the report. “New nurses must be recruited, hired and trained to take their places. Experts estimate that the hospital’s total cost of replacing an RN, the ‘turnover cost’ is 100 percent of a nurse’s annual salary.”
Hospitals in Colorado spend $166 million every year on turnover costs. That money, according to the nurses’ alliance, could insure another 60,000 Coloradoans.
Short staffing isn’t the only reason nurses are leaving hospitals in droves. According to Matthys, wages for Colorado nurses fall far short below those in other states.
“The wages just aren’t competitive,” she said. “Nurses make more in California and Washington. They make more in other western cities. They make more in a lot of different places. They are being asked to work harder for less money.”
The bottom line for the nurses’ alliance: patients suffer when there aren’t enough nurses.
“A 2002 study printed in the Journal of the American Medical Association reported ‘detectable differences in adjusted mortality and failure-to-rescue rates across hospitals with different registered nursing staffing ratios,’” the report said. “A 2004 report by the Agency for Healthcare Quality and Research associated high levels of temporary nurses with negative patient outcomes like hospital-acquired infections.”
Matthys said Colorado research shows a similar finding. The Colorado State Board of Nurses asks nurses who were renewing their license about the biggest issue facing patient wellness. More than 63 percent said nurses were overworked and over-tired. Another 65 percent blamed patient-staff ratios, she said.
Olivo looks at the association’s report with a skeptical eye. He said that the numbers and statistics could be manipulated to reach a certain conclusion. In this case, he believes the conclusion reached by the association is false.
“You can’t say that’s the total reason why there are fewer nurses in hospitals,” he said. “Another reason is the lack of nursing educators. A senior nurse can make more money in health care than they can in teaching — so they don’t teach. Nursing schools have waiting lists. There’s not a lack of interest, there’s a lack of teachers.”
He cautions against placing great emphasis on the nurses alliance information.
“They obviously have something they want to get out there,” he said. “So people need to be careful, examine all the factors, not just a single one.”