Flexestaff News & Events

R.I. facing nursing shortage

By FELICE J. FREYER
October 6, 2004

By 2020, a study says, Rhode Island could have fewer than half the number of nurses it needs.

WARWICK -- Rhode Island faces an alarming shortage of nurses over the next decade and a half, and the state's nursing schools cannot possibly expand fast enough to fill the gap, according to a study released yesterday.

The chief problem is demographics: The nursing work force is aging, and so is the rest of the population. That means the demand for nurses will grow just as their ranks dwindle from retirements. There are fewer younger people to replace them, and they have many other career choices.

To make matters worse, some nurses aren't practicing, some are practicing out of state, and some younger nurses are considering leaving the profession. Meanwhile, people aren't just getting older -- they're living longer, often afflicted with Alzheimer's disease, asthma, obesity and other illnesses that require nursing care.

The result is that today there are about 8 percent fewer nurses than needed -- and by 2020 the state could have fewer than half the number needed.

"I was alarmed by the findings," said Dayle Joseph, dean of the University of Rhode Island 's College of Nursing and chairwoman of the experts' panel that worked on the study. "If we don't move quickly, we really could be putting ourselves in a difficult situation."

"We have to do something today," said the study's author, Minoo Javanmardian, a principal with Booz Allan Hamilton, who presented the findings yesterday at the Community College of Rhode Island . "Otherwise, it's going to be very difficult to deal with these things."

The $1.1-million study, commissioned by a foundation established and financed by Blue Cross & Blue Shield of Rhode Island, drew from interviews with more than 20 nursing leaders, five focus groups, a survey completed by nearly 2,400 nurses, and analysis of data from different work settings, such as hospitals and nursing homes. Booz Allen Hamilton, an international management consulting firm with expertise in health care, conducted the study along with Harris Interactive.

Titled "Help Wanted: The Growing Crisis in Rhode Island 's Nursing Workforce," the study was intended to provide data, not remedies. But it did offer a strong suggestion: Do everything possible to boost the supply of nurses -- recruit young people into the profession, improve working conditions and salaries, expand the nursing schools -- but don't stop there.

"Although we all feel more comfortable with supply-side solutions -- throwing more money and more bodies at it -- that is not going to work," Javanmardian said.

Something also must be done about the demand for nurses, the report urges; that could include finding ways to better use nurses' time, and emphasizing preventive care that will keep people healthier longer.

Linda McDonald, president of United Nurses and Allied Professionals, the state's biggest nurses' union, said that simple solutions, such as policies that nurses will not lift patients, can make a big difference. "Most nurses, by the time they're in their 50s, their knees, hips and backs are in serious trouble," she said. Needless injuries can sideline nurses for weeks, she said.

Calling the report "credible," McDonald said it would bolster nurses' efforts to involve the greater health-care community in finding solutions. "Everybody needs to work together now," she said.

About a third of the 20,000 licensed nurses in the state work part-time, so there are about 12,000 full-time equivalents -- and a need for 12,500 to 13,500. Today's nursing shortage is most severe in nursing homes, where the vacancy rate ranges from 15 percent to 20 percent.

By 2010, the study projects, the statewide nursing shortage will be around 25 percent. By 2020, depending upon how quickly nurses retire, it could range from 35 percent to 60 percent.

Of the nurses with Rhode Island licenses, 14 percent are not practicing at all, and another 14 percent are practicing out of state.

More than 30 percent of registered nurses are age 50 or older, and more than 50 percent of licensed practical nurses (less-trained nurses who perform nursing work but don't assess patients or write care plans) are 50 or older. Although retirement is approaching for many, even younger nurses are thinking of leaving the profession. One in eight practicing nurses under age 60 plans to leave the field within the next three years.

That's in spite of the fact that the vast majority of nurses surveyed (89 percent of registered nurses and 82 percent of licensed practical nurses) said they were satisfied with their choice of nursing as a career.

They also had complaints about the work environment, particularly the workload and inconvenient hours, and 60 percent believed they were underpaid. Nursing salaries in Rhode Island are similar to the rest of the nation, but lower than bordering states.

The survey had a 70-percent response rate, well above expectations.

"The nurses in Rhode Island , individually and collectively, are very concerned," said Pamela McCue, executive director of the Rhode Island State Nurses Association. For example, she said, nurses were paid $25 to answer the survey, but one-quarter of respondents agreed to donate their payment to a nursing scholarship fund; they raised $13,000.

The nursing work-force study is the first of four studies planned by the Rhode Island SHAPE Foundation, a nonprofit group formed last February. The foundation was an outgrowth of Blue Cross' "SHAPE study" -- for Statewide Health Assessment Planning and Evaluation -- which came out in 2002. Blue Cross established the foundation and committed to financing the four studies. The next one will look at the physician work force, followed by studies of behavioral health care and health-care facilities.

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