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This article by Michele Alperin was prepared for the October 25,


edition of U.S. 1 Newspaper. All rights reserved.

Hiring Nurses In a Tight Market

New Jersey is facing a shortage of 14,000 registered

nurses by the year 2006, according to a forecasting model developed by

New Jersey Colleagues in Caring. "This shortage is a little different

than in the past, because it is related to the demographics of the

nurses themselves," says Catherine Cardea, director of

professional practice and quality initiatives for the New Jersey

Hospital Association. "The average age of nurses is increasing, and

they are not being replaced with younger nurses coming out of nursing

schools." Shortages are particularly evident in certain specialty

areas, like operating rooms and critical care.

Both outside economic forces and factors within the nursing

environment itself have come together to create this nursing shortage.

"The change in Medicare funding within the state has put many of the

health care agencies-both home health and hospitals-in dire straits,"

says Geri Dickson, project director of New Jersey Colleagues in

Caring. As a result, hospitals are unable to pay nurses adequately for

their services. To make things worse, the working environment of

nurses has deteriorated.

As the financial incentives in nursing have declined and the emotional

stresses have increased, women also have far wider opportunities for

employment, both within healthcare and outside. Cardea says, "In the

old days, women went into teaching or nursing. Now the sky is the

limit in terms of what women can go do."

To provide data on supply and demand forces in this nursing shortage

as well as potential solutions, the New Jersey Hospital Association

and the New Jersey Colleagues in Caring are cosponsoring a conference

entitled, "Nursing Workforce Issues: Acting Now to Shape the Future,"

on Tuesday, October 31, 8:30 a.m. to 3:30 p.m. Both Cardea and Dickson

will be speaking at the conference, which takes place at the New

Jersey Hospital Association, 760 Alexander Road. The cost is $85. Call

609-275-4113 for information.

Because the economic factors affecting nursing are not likely to

change in the short run, many of the proposed solutions to the

shortage focus on improving working conditions in order to retain

current nurses, particularly in hospitals:

Create a more receptive work environment. Cardea explains,

"You can’t necessarily afford to pay the most money, but you can

afford to create an environment that people want to work in." For

example, the opportunity for regular staff meetings, where nurses can

express their ideas on patient care, makes them feel like their ideas

are important and valuable. To promote a range of improvements in

nurses’ working environment, the American Nurses Association has

established the magnet hospital program, which grants special status

to hospitals whose nursing departments promote the growth and

development of nurses.

Increase administrative and clinical support for nurses.

Due to mergers and downsizing, support for floor nurses has

diminished, both in terms of clinical nurse specialists and staff

development nurses.

Develop leadership programs for unit and middle managers.

"Often a nurse is promoted," says Dickson, "but does not have the

necessary leadership skills. Leadership training is important in

retaining nurses. "

Provide more flexible work schedules, moving beyond

traditional eight-hour shifts. Possibilities include creating six-hour

shifts for nurses who want to be home for their children by 3 p.m. and

paying more to nurses who prefer to work nights and weekends.

Create flexible staffing plans where health aides,

L.P.N.’s, and R.N.’s work together to deliver patient care.

Institute plans and provide resources to handle the

increasing violence seen in emergency rooms and hospitals.

Reduce the impact of contagious diseases such as AIDS


hepatitis. Recent legislation requires hospitals to install


systems, so that nurses will not risk pricking their fingers with a

needle or IV containing contaminated blood.

Reduce the chance for medical errors by instituting

systems to ensure that technology, like IV pumps, is working

correctly. "Increased technology that is not working increases

stress," says Dickson.

Environmental changes are likely to have the most immediate

effect on retention of current nurses. Another contributing factor to

the current shortage, however, is the decreasing enrollment in nursing


Dickson elaborates, "Nursing schools in New Jersey have reported

declines in entry-level graduates of 12 per cent from ’97 to ’98 and

’98 to ’99." Both to recruit new nurses and to retain existing ones,

the industry is working on a marketing plan to improve the image of

nursing and to advertise changes in the working environment. For men

and women considering the nursing profession, what matters, says

Cardea, is "where the job is going to take you in terms of personal

and financial growth."

Cardea earned her R.N. degree at the Thomas Jefferson University

Hospital School of Nursing in 1970, her BSN. from Stockton State

College, and her master’s from LaSalle University. Dickson, currently

an assistant professor at the Rutgers College of Nursing, earned her

BSN (Bachelor of Science in nursing) at Alverno College in 1974, her

master’s from Marquette University, and her PhD from the University of


Dickson suggests that changes in health policy also revolve around

financial allocations that would support collaborative planning. She

would like to see legislation to establish a collaborating center for

nursing in New Jersey that will continue the work of Colleagues in

Caring. "The center would help stop the cycle of too many and too few

nurses," claims Dickson. It would monitor supply and demand to support

master planning in the state and would ensure sufficient nurses as

well as the "right type of nurse, with the right education,

competency, and specialty."

Resolving the nursing shortage will require a multi-pronged attack at

the local, state, and national levels. Planners, administrators, and

policy makers must resolve the inconsistencies between supply and

demand and improve the working environment of nurses as well as their

financial remuneration.

— Michele Alperin

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