Supply of nurses, now up, seen headed to new shortage
By Marilyn Bowden
Right now, the supply of nurses in Miami-Dade appears to be greater than demand, but experts say the area is headed back towards significant shortages.
Before the economic downturn, medical facilities across the region reported a vacancy rate of 9%, said Ralph EgŁes Jr., executive director of the Nursing Consortium of South Florida. Now, that vacancy has disappeared — but he predicts that as soon as the economy recovers it will jump to 11% to 12%.
One cause, he said, is that full-time nurses whose spouses may have lost their jobs are picking up additional shifts. "This significantly increases their income," he said, "but it's not sustainable throughout their careers."
In addition, Mr. EgŁes said, the drop in home values has decreased workforce turnover.
"During the real estate bubble, sharply rising home values were at one point the No. 1 cause for nurse turnover," he said. "We were losing them to other parts of the country."
The aging of working nurses is a major concern, said Dr. Ora Strickland, dean of the College of Nursing and Health Sciences at FIU. She said the average age of a nurse in Florida is almost 49 — two years older than the national average.
"Most practicing nurses are baby boomers," she said, "and they will start aging out very soon."
The average age of an assistant professor of nursing is well over 50, Dr. Strickland said, "and that compounds the issue because there will be inadequate faculty to teach new nurses."
Nationally, the biggest nursing shortage is faculty, said Dr. Amy C. Pettigrew, dean of the School of Nursing at Miami Dade College, which graduates about 1,550 nurses a year, making it one of the largest nursing programs in the nation.
Over the past 10 to 15 years, she said, advanced degree programs in nursing have been preparing nurse practitioners, not educators.
"Because of the tough marketplace, we're getting many nurse practitioners who want to become educators," Dr. Pettigrew said, "but they need a lot of faculty development because their masters program had a very different focus.
"So the pool of educators isn't out there, and that's having a tremendous effect on preparing students to meet market demand."
The temporary glut is also affected by cutbacks in hiring at area hospitals, she said, as well as by the influx in recent years of 12 to 14 non-accredited, for-profit schools offering an associate degree in nursing.
This has created an alternative for students unable to get into accredited programs, Dr. Pettigrew said, but many hospitals preferentially hire nurses who have a bachelor of science in nursing (BSN) degree — and that trend is about to explode. The American Nurses Credentialing Center, a subsidiary of the American Nurses Association that awards magnet status, has a new ruling that requires that most nurses in magnet hospitals have a BSN degree.
Dr. Pettigrew said enrollment in Miami Dade College's BSN completion program for nurses with associate degrees has grown in the past three years from 90 students to 440.
But accredited colleges don't recognize associate degrees from non-accredited institutions, Mr. EgŁes said.
"One thing Nursing Consortium of South Florida does is to encourage non-accredited bodies to get on the path to accreditation as soon as they start up their programs."
With the increase in nursing programs, Dr. Pettigrew said, getting clinical placements for students in health care facilities has become very competitive, and the number of slots for training in a medical setting determines how many students can be accepted in a program.
Mr. EgŁes said nursing programs in South Florida get two to three times as many qualified applicants as they can accept.
FIU is taking the lead in using hi-tech patient simulation as an alternative to clinical spots in a hospital, said Dr. Sheldon Fields, assistant dean of clinical affairs & health policy in the College of Nursing and Health Sciences.
At the college's new Simulation Teaching and Research Center, informally called the STAR Center, "we are studying how much clinical time can be replaced with clinical simulation," he said.
Dr. Pettigrew said Miami Dade College is also adding high-fidelity simulators. "The Florida Board of Nursing allows up to 25% of clinical work to be done with simulation," she said. "We are up to maybe 10%. But at some point student nurses need to be with actual patients to be comfortable with hands-on skills."
Dr. Strickland said FIU is also launching a clinical doctorate program for nurse practitioners and anesthesiologists in January.
"This will help increase the number of nurses with doctoral degrees," she said, "in keeping with the Institute of Medicine's recommendation to double their numbers by 2020, not only in academia but also in clinical settings."
The huge influx of previously uninsured people who will have access to health care come 2014, Dr. Fields said, will provide many more opportunities for nurses with advanced degrees.
"Some say the implementation of health care reform will make the nursing shortage worse," he said. "I disagree. I think it will open great opportunity, but we need to expand the scope of nursing in some areas so everyone is functioning to the top of their license."
"We have a situation, especially in Florida, that we need to keep our eye on," Mr. EgŁes said. "We have an aging population that is certainly going to need more health care over the next 20 years.
Much of it will be provided by nurses and allied health professionals."
Because health care decisions are increasingly being made based on metrics available on line that compare outcome and patient satisfaction across the country, he said, quality of care becomes more important than ever — and the greatest influence on both outcome and patient satisfaction is the quality of nursing care.
"Health care is the third largest economic driver in South Florida," Mr. EgŁes said. "Only the public sector and tourism employ more, and the average job in the health care field pays nearly double the average job in these other sectors. So health care is hugely important for the economic health of South Florida."
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