Health Care Providers Try To Cope

With An Acute Shortage Of Nurses

By Jan Howard

A critical nursing shortage exists in Connecticut as well as across the nation.

Ashlar of Newtown, an affiliate of Masonicare, and other healthcare providers in the state, such as Visiting Nurses Associations that offer home nursing care, are feeling the effects of the shortage. But the people who feel the nursing shortage the most are those who need it the most, the residents of the state, especially the elderly.

Health care providers in the area agree something has to be done to attract and keep more nurses in the profession. With an average age of nurses being in the late 40s, and significantly fewer nurses entering the profession than are retiring from it, the current critical nursing shortage will only get worse. Add to that a national population that is aging and the scenario becomes even more critical.

Changes in how health care is provided because of managed care and Medicare cutbacks have led to downsizing and cutbacks in personnel, often to the nursing staff, which makes up the largest segment of employees. This lack of job security has led, some believe, to nurses looking elsewhere for careers.

Some of the shortage has to do with the increased career options for nurses today, such as in administrative and nurse practitioner roles. There are fewer nurses involved in direct, hands-on patient care in nursing homes and other healthcare facilities and for home care.

Ashlar has taken some innovative steps to meet the needs of its employees so they can work as well as meet family and community responsibilities. Among its programs, Ashlar offers flexible work schedules that would make it possible for health care professionals to consider entering or returning to the industry.

“Ashlar, like any other health care facility, is facing staffing challenges,” Tom Gutner, Ashlar’s president, said. “It’s a nationwide problem. We are trying proactive measures to assure we continue to deliver quality of care to our residents. We have undertaken initiatives in the last six months to recruit and retain licensed nurses and certified nursing assistants [CNAs].”

Mr Gutner said Ashlar has always offered tuition assistance, a sign-on bonus, and recruitment bonus. Masonicare is also working with search firms to identify licensed nurses and refer them to Ashlar. “It’s a unique approach,” he said.

During January, Ashlar began running advertisements on cable TV that are targeted to attract nurses, Mr Gutner said. “It was an effort to get our name out there. It has produced a couple of applicants for us.”

Ashlar has also partnered with Med-Care in Brookfield, which offers a 100-hour training course for CNAs. As Med-Care’s clinical training site, Ashlar will provide hands-on training for the students.

Ashlar has also created a unit assistant position, which enables individuals interested in entering nursing to be hired below the hiring rate for CNAs because they are not as yet certified. These individuals do tasks such as transporting patients, making beds, and distributing water pitchers.

“If they are good candidates, we would then pay for the certification program in return for a period of service,” Mr Gutner said. One person is already functioning in this position with two more to start. “It’s another way of attracting people to the profession and supplementing staffing.”

Mr Gutner said Ashlar is also working with area schools that provide nursing training, such as Bullard Havens and Henry Abbott Technical School, and Fairfield University’s master’s to nursing program.

 “Enrollment in nursing programs is down,” he said. “It’s a nationwide problem. We need to reverse the trend. As baby boomers age, there will be a greater need for health care. There are some serious trends that are challenging us today to overcome.”

Mr Gutner believes salaries for nurses are competitive, but that health care has changed. “Nursing is still a noble profession, but the healthcare environment has changed with managed care and the documentation required. Nurses’ responsibilities are significant. They are not having as much time to spend with the patient. These are caring people who went into the profession for that reason. The rewards that were there may not be quite the same.”

The complexity of care required for residents has also changed. Nurses, he said, are managing many tasks, but they are still dedicated and committed to residents’ quality of life.

“People are living longer, and need more care,” he said. “The nurses are incredibly dedicated. They do a great job in managing their personal families in addition to coming here and making a major impact on residents’ lives.”

The good economic times have also affected the health care industry, Mr Gutner said. “There are a variety of factors hitting at the same time. It’s a cyclical thing.

“People have other options today, especially young women. There are a thousand choices out there,” he said. “Fewer people are choosing to go into nursing.

 “The current situation is a very serious problem requiring time, effort, and creativity to meet the challenge,” he said. “Nurses are reaching retirement, and less people are coming in. Managed care and decreased Medicare reimbursement has impacted on providers, and certainly there are nursing homes and hospitals in financial difficulty. They could cut back in services and staff.”

Retention of nurses is equally as important as recruitment, Mr Gutner said. He said Ashlar tries to be as flexible as it can in working around employees’ school schedules and family responsibilities while still meeting staff needs.

Mr Gutner noted health care providers and state health care organizations are “banding together to make the issue a primary focus, and to educate the state legislature of this issue.”

Still A Rewarding         Profession

“Even with all the government regulation and Medicare problems, in the end the field of nursing is a rewarding profession,” he said. “It can be and is attractive to many people.”

Sheri Zadrovitz, a registered nurse, was a full time RN at Bridgeport Hospital until the late 1980s, when she left to raise her family. She wanted to return to nursing, but also wanted to be at home with her children as well as to be active in the community.

In 1992, she joined Ashlar and now works a budgeted schedule as weekend supervisor on days. “It offers flexibility for me to do other things,” she said. Because of her flexible work schedule, she has been able to continue to be active and productive in her profession but balance that with family and community activities.

Ashlar also offers three and five-day part-time work schedules, and per diem hours, where nurses work when they are available, she said. There are also incentives to work more hours than scheduled. There are shift differentials and additional pay for supervisory positions.

 “We do have understaffing situations on weekends,” she said. “They’re aware of it. It’s something I deal with every weekend, with sickness, bad weather, and not having enough nurses available.”

In spite of the shortage, Ms Zadrovitz said, “We work our hardest to see people are given the best care.”

Ms Zadrovitz said multiple tasks are now required of nurses. Patients are also discharged from the hospital more acutely ill than in the past. Regulations and the need for documentation by the nurses “takes away from the extras you would give to your patients,” she said.

Ms Zadrovitz agreed that the nursing shortage is critical. She said she was happy to see Ashlar’s advertisements on TV, adding, “I hope they will help.”

Barbara Summo has worked at Ashlar as a certified nursing assistant for three years. She began her career as a home health care aid and teacher’s assistant, and then received her training as a CNA. Because of family responsibilities, Mrs Summo wanted to set her own work schedule, which she has been able to do at Ashlar.

CNAs perform personal tasks for residents, such as feeding and dressing them, and taking them to activities. “We help with activities of daily living, ” she said. They do not provide treatment or dispense medicines. Nevertheless, the work can be intense.

“There is something different every day,” Ms Summo said. “It’s not boring.”

 Ms Summo works per diem, three days a week, from 7 am to 3 pm. “I have to do a shift, but pick the days I work.” She receives no benefits, vacation, or sick time.

She said many per diem CNAs work full time or take two shifts by choice. They are also offered overtime. “All shifts need extra hands,” she said. Because of that, she noted, “We work harder to make sure people’s needs are met, and they’re comfortable.”

She said it is important to attract more people into nursing. “The more people you have, the more you can give to the residents and each other,” she said.

What she originally found appealing about the job was the evening shift. “When my husband got home, I could go to work. The position could appeal to young moms looking for part-time work or students looking for a job,” she said. “It pays better than minimum wage. I don’t know how many young people know about CNAs.”

Ms Summo said being a certified nursing assistant is a “tough job with a lot of responsibility,” but noted that many of the CNAs at Ashlar have been there a long time.

Mae Schmidle, president of Newtown’s Visiting Nurse Association (VNA), said the local group could do more if it had more people available.

“The whole nursing field has been hit hard,” she said.

Mrs Schmidle said some of the shortage has to do with increased options nurses now have, with fewer nurses being available for hands-on patient care.

At one time, nurses took a two-year course, she said. “Then nurses wanted to upgrade, to be fully degreed nurses. They wanted administrative jobs so there were fewer nurses with associate degrees.”

The Newtown VNA offers scholarships each year to high school seniors interested in studying to be nurses, Mrs Schmidle said.

 In addition to nurses who visit recuperating or ill patients in their homes, the VNA also offers home health aides, who provide hands-on personal care, and homemaker helpers, who assist with light household chores.

Home health aides are required to receive training through the Bethel or Danbury VNA offices, Mrs Schmidle said. VNA offered a scholarship program for people interested in obtaining the training, but it did not provide much incentive, she noted.

“Home health aides help keep elderly people in their homes,” Mrs Schmidle said. “Just having a person that comes in once a day is helpful to them and also brings them companionship.”

Promoting The Profession

Judy Mallen, director of the Bethel VNA, agrees the nursing shortage has reached crisis proportions. “Most of the nurses are in the mid- to late 40s. There are not many younger people out there. They’re not going into the profession,” she said. There won’t be enough people to replace retiring nurses, she added.

“Nursing needs to be promoted as a profession,” she said. “If you want to provide hands-on patient care, nursing is the place to be. I’ve never regretted going into nursing. The pay could be better, but it’s better than when I started.

“It’s physically, mentally, and emotionally hard work, but it’s also very rewarding,” she said. “You don’t stay in it for the money.”

Ms Mallen said enrollment in nursing schools is down. Hospitals are also looking for ways to cut their budgets, she noted. “They don’t acknowledge the expertise and education of nurses.”

Technicians are hired to do certain tasks so the number of nurses can be reduced, she said. “I never thought that nursing is where to cut costs. Nurses are the eyes and ears for the physician, and can give meaningful reports back to the doctor. I’m not putting technicians down, but they are not a replacement for nurses.

“The people we’re seeing are sicker,” she said. “People don’t get better in the hospital. This is very different than how it was. We work much more hand and glove with the hospitals now. Home care is a neat place to be.”

However, more people are needed who are willing to do hands-on care, she said.

The state needs to make money more available to nursing students, such as forgiving loans taken for education, and to make more scholarship money available to nurses beginning their training, she said.

Job shares and split schedules would be helpful in hospitals, nursing homes, and other health care facilities, she said. Subsidies should be offered for childcare or on-site childcare facilities provided.

She said health care facilities should not make nurses be the first cuts in cost reduction efforts because “there are shortages out there.”

 Because fewer and fewer people are going into nursing, Ms Mallen said she believes the nursing crisis is going to be drastic.

 “We are only seeing the tip of the iceberg,” she said. “It will be very serious shortly.”