Labor shortage already serious in healthcare industry

The thought of the growing shortage of healthcare workers is highly alarming to Mindy Marshall, director of nursing at Golden Living Center Lakeview.

"It scares me to death," Marshall said. "Who's going to take care of me? Who's going to take care of my parents? What are we going to do as a society?"

There has been a national shortage of healthcare workers for at least a decade, said Laura Redoutey, president of the Nebraska Hospital Association.

And with increases in the number of retirees and an aging population, the problem isn't expected to get any better.

According to a study completed by Lee Elliott, St. Francis Medical Center's vice president of human resources and fund development, Central Nebraska , much like the rest of the nation, is expected to experience a critical shortage of labor during the next 20 years.

Beginning next year, the gap between labor supply and demand is expected to gradually increase until it reaches more than 30 million people by 2030.

For those in the healthcare profession, the trend is worrisome, to say the least.

"Research is showing that lives are being lost due to inadequate staffing," Elliott wrote in his study. "It will get much worse."



A bleak outlook

Central Community College has forecasted that by 2011, the counties served by the college will be short 930 registered nurses, 41 medical technologists, 77 respiratory therapists, 71 health information workers and 593 nurse aides.

The Nebraska Center for Nursing predicts an estimated shortage of 4,000 full-time registered nurses by 2020 as the state's work force ages and the demand for health care services increases, said Monica Seeland, vice president of quality initiatives for the Nebraska Hospital Association.

At the same time, healthcare is expected to be the fastest-growing industry in Nebraska from 2007 to 2017, according to Elliott's study.

At St. Francis in Grand Island, the human resources department is seeing shortages in all of the hospital's jobs, but some of the most serious vacancies occur in nursing, Elliott said.

Nurses tend to suffer from burnout because of the complexity of their duties, Redoutey said, and the state's nurses are aging, with the average age being 45.

Those who utilize hospitals have reason for concern about the healthcare worker shortage, as it directly impacts the quality of patient care.

One study showed that the patient mortality rate increases 31 percent when a nurse's workload is increased from four patients to eight, and general hospital employee turnover is correlated with a higher adjusted mortality index.

At nursing homes such as Golden Living Center Lakeview, open staff positions mean increased hardship on nursing staff members because of the need for overtime hours. That extra strain can affect a nurse's ability to properly care for patients, Marshall said.

"We all know sleep and just maintaining good healthy behavior is not working over 40 hours per week," Marshall said.

Shortages of workers have led hospitals in other parts of the country to close entire floors or units, Seeland said.

For St. Francis, the hospital needs to have quality care and enough people to give the care, or else it can't stay open, Elliott said.



Causes and solutions

Aside from the aging work force and an increased demand for healthcare services, the diversification of the industry has contributed to the healthcare labor shortage, said Cindy Hadenfeldt, associate dean for nursing at Central Community College in Grand Island. In the case of nurses, there are many more specialty and advanced practice positions now than there were decades ago.

Also, opportunities for women have broadened, Marshall said.

"In the past, you could be a nurse or a teacher," Marshall said. "Now, you can be anything you want to be."

As part of its recruitment and retention efforts, St. Francis helped start the Medical Pathways program with Grand Island Public Schools to train nurses and encourage interest in the medical field. A number of other hospitals and health care facilities across the state are also reaching out to young people.

Even so, the state's nursing schools are filled to capacity, and training classes for many other health care professions are also full. At Central Community College, there is a two-year-long waiting list for nursing programs, Hadenfeldt said. The college's plans to open a health and science education center in 2010 should help provide more space for students.

In Central Nebraska and across the state, the number of teachers and the amount of clinical space available are contributing factors to nursing school enrollment caps, Hadenfeldt said.

"We know that our best efforts to educate and train workers fall short of the need we will experience in the days ahead," Redoutey said. "Many states, including Nebraska, have expanded nursing education programs at the university and community college level, yet we are challenged to educate as many nurses as we will need."

To make up for this, hospitals are using nursing aides, technology and streamlined processes, among other tools, Seeland said.

The process of attracting healthcare professionals has also become highly competitive, as facilities are offering sign-on bonuses, high salaries, loan forgiveness, scholarships, improved benefits and advancement programs.

Hospital human resource departments, such as the one at St. Francis, are developing innovative programs and practices to improve their recruitment and retention efforts. The purpose of Elliott's study was to develop a strategic plan for St. Francis and outline how the hospital can combat the labor shortage issue.

Some of his suggestions include reducing workplace stress, increasing satisfaction, ensuring compensation programs are effective, providing coaching, recruiting international workers and strengthening educational support.

The hospital has also been working closely with various entities from across the state, including the Nebraska Department of Education, the Grand Island Area Chamber of Commerce, Area Health Education Center and Central Community College, among others, to address the issue.

"Because of that effort, right now we're doing OK," Elliott said. "The vulnerability we have is, what happens when people start recruiting from us?"

Recruiters have already come to Nebraska looking to draw away school teachers, Elliott said.

"What happens when the same thing starts to happen to us in healthcare? We don't know," he said.

The solutions to the healthcare worker shortage remain unclear, Elliott said, and it will take ongoing work and innovative thinking to find them.

"This is one where you really can't leave any stone unturned," Elliott said. "It's going to be an ongoing search for the rest of my career."