Staffing

The Return of the RNs

By Terese Hudson Thrall

The recession may ease the nursing shortage, but this is no time to let down your guard

Rhonda Pyburn, R.N., enjoyed the best of both worlds. In the summer she worked at a hospital near Nashville, Tenn., where she has a house and where her children and grandchildren live. In winter, she packed up her patient care skills and headed for a medical center in the sunny Southwest.

But Pyburn’s nomadic lifestyle came to an end in January when she took a full-time, permanent job at Yuma (Ariz.) Regional Medical Center. She had learned that her summertime employer in Tennessee was reducing its workforce and could no longer promise temporary nurses all the hours they requested.

“That hospital had never laid anyone off and it never occurred to me that they would,” says Pyburn, 53. “I needed to know I could work. I need a guaranteed paycheck.”

Pyburn’s experience may be emblematic of a trend rooted in the nation’s economic crisis. While many areas of the country remain ensnared in a nursing shortage, others are seeing the situation ease a bit as RNs who had quit working seek to resume their careers and part-time or temporary nurses look to stabilize their incomes.

In Los Angeles, Linda Burnes Bolton, R.N., vice president and chief nursing officer at Cedars-Sinai Medical Center, says some nurses there are delaying retirement and some who have already retired are coming back, albeit to jobs that are less physically demanding than bedside nursing. Still others are picking up extra shifts at Cedars-Sinai when their primary hospital employer in Los Angeles can’t give them enough hours because of a drop in patient census.

Another sign of the times: float pools in which nurses are paid at a higher rate to work in a variety of units had never been very popular at Cedars-Sinai. Now there’s a waiting list to join the pool, Bolton says.

The View from Yuma

While the recession is taking a heavy toll on hospitals in nearly every way, the slackening of the nurse staffing crisis is the one bright spot. But, experts warn, it’s not that bright and it probably won’t last that long, so complacency is not an option.

At 333-bed Yuma Regional Medical Center, nurse vacancy rates fell from the 12 percent to 15 percent range to the 5 percent to 7 percent range in the fiscal year ending Sept. 30, 2008, notes Sharon Gardner, the medical center’s vice president of human resources. That led to a significant decline in the need for agency nurses. In November 2008, during the busy winter season, the medical center used 4,352 agency nurse hours, compared with 10,127 hours in November 2006.

“We cut 6,000 hours of very expensive labor,” Gardner says.

Yuma Regional continues to hire new nursing graduates—about 80 will join its ranks this year—but it is reconsidering whether it needs to recruit out-of-state grads. “Before we would have taken them all,” Gardner says.

Gardner—and other hospital executives around the country—say aggressive recruitment and partnerships with nurse training programs are at least as big a reason for easing their staffing situations as is the lousy economy.

Boom and Bust

The fact that economic downturns prompt nurses to stay on the job or return to work is well-documented, says Peter Buerhaus, professor of nursing and director for the Center for Interdisciplinary Health Workforce Studies at the Institute for Medicine and Public Health at Vanderbilt University Medical Center (see charts). The question, he says, is how long the current trend will continue.

According to the Health Resources and Services Administration, about a half-million licensed RNs in 2004 were not working for various reasons. It’s impossible to predict how many of those who haven’t already returned to the workforce will ultimately do so, but Buerhaus doesn’t expect the numbers to be great. “We are wringing out a sponge,” he says. “I think the big drops have already come out.”

That could spell disaster once the recession ends. Many nurses will opt for retirement as soon as they’re financially able to do so, and many others will again leave the workforce when their spouses find employment. At the same time, hospitals will need more nurses to help meet pent-up health care demand—such as elective procedures postponed during the economic slump.

Refreshing the pipeline is critical, but nurse executives worry that hospitals and states will now be tempted to reduce their support for nurse training programs. “How do we keep from being short-sighted?” Gardner asks. “We don’t want legislators to lose sight of the fact that the population is still aging and those people are going to need health care.”

Karen Nelson, R.N., senior vice president of clinical affairs at the Massachusetts Hospital Association, adds: “If the economic downturn reverses the gains [in the nurse supply] we have made, it will set us way back, and we will be in an awful situation in the future.”
Ominous signs are already emerging. In Arizona, for example, one health care system announced layoffs in January, including some nurses; a medical center, experiencing lower nurse turnover, was unable to hire all the new RN grads it had paid to train; and a public university cut undergraduate nursing slots by 26 percent.

What may be most damaging about such incidents is the message they send to young people in the process of choosing a future profession. “When prospective students don’t see nursing as a good career and seek other careers, it takes us years to pull back,” says Pamela Thompson, R.N., chief executive officer of the American Organization of Nurse Executives. “I understand that the recession has a significant impact on hospitals, but we have to keep in mind that short-term solutions may have long-term impacts.”

Breaking In

The environment for new nursing graduates has changed, say hospital association executives from states as far-flung as Arizona and Massachusetts. “A year ago, a new grad here could walk into a hospital and pick her unit and shift, but that’s not the case anymore,” says Adda Alexander, R.N., executive vice president at the Arizona Hospital and Healthcare Association. The MHA’s Nelson says that while many new grads in Massachusetts prefer acute care hospitals because of better pay and the learning environment, there are no longer enough jobs for them all. However, nurse executives are quick to point out that plenty of openings exist in long-term care, rehab and other areas.

Patience is a virtue for nurses trying to start their careers. For instance, Tucson (Ariz.) Medical Center couldn’t hire all 27 new graduates it paid to train; still, spokesman Mike Letson says all but two of the students were already working at the medical center in other capacities, and they can stay on and wait for nursing jobs to open up.

The Truth About Layoffs

A number of hospitals have been forced to reduce their workforce over the last few months as income falls and uncompensated care surges.

“Labor is the biggest line item in a hospital’s operating budget,” says Matthew McHugh, R.N., an assistant professor of nursing at the University of Pennsylvania and a researcher at the university’s Center for Health Outcomes and Policy Research. “Nurses are most often viewed as a cost during times like these, not an investment.”

James Bentley, American Hospital Association senior vice president of strategic policy planning, worries that layoff reports can be misleading and generate a negative perception about the stability of nursing work. Often, he says, the reports don’t specify which type of jobs were cut. “Hospitals are trimming where they can,” says Bentley, “but they are trying to stay away from staff involved in patient care.”

Banner Health Care’s 10-hospital Phoenix operation announced 336 layoffs in January. But Kathy Scott, R.N., Banner’s regional vice president of clinical services, says it involved fewer than 20 nurses, and they were able to apply for other positions in the system. In March, Banner Thunderbird Medical Center in Glendale, Ariz., held a recruiting day for nurses to staff its 200-bed patient tower, which opens in May.

Scott echoed the worries of other nurse executives that layoff reports can be misinterpreted. “I’m very concerned about knee-jerk reactions to the current situation that could hurt nursing long term,” she says, citing a recent call from a state legislator. “He wondered if we really need additional funding to train nurses because his niece, a newly graduated nurse, is having trouble finding a job.”

Money for Schools

The possibility that funding for nurse education might be withdrawn is a big worry for nurse executives. Arizona State University’s nursing school in Tempe was forced to trim $1.5 million from its budget and cut 80 student slots, reducing the number of new enrollees to 220 for 2009.

“It’s gut-wrenching,” says David Hrabe, R.N., interim associate dean for academic affairs at the school. He’s had to explain to students who otherwise would have gotten into the program—and to their parents—about the cuts, even as national data still point to a long-term nurse shortage. “I tell them it’s similar to a household,” says Hrabe. “If there’s no money left in the checking account, you can’t keep spending.”

And the cuts may not be over; Arizona government leaders are continuing to trim the budget this year. “We’re expecting more budget reductions,” Hrabe says.

Nurse executives also worry that hospitals will pull out of partnerships with schools or cut tuition reimbursements, though there have been no such reports so far, according to officials at the American Association of Colleges of Nursing and the National League for Nursing.

The AHA’s Bentley says some hospitals were forced to cut education spending during the recession of the early 1990s and may be forced to do so again. “If a hospital has to lay off staff or stop tuition benefits, tuition benefits are going to go,” he says. “It depends on how deep and long the recession is.”

Rhonda Pyburn, the nurse who decided not to return to Tennessee this summer, is buying a house in Arizona and plans to settle in for the long haul. “My gut tells me this is going to last for a while,” she says.

This article 1st appeared in the April 2009 issue of HHN Magazine.

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