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If only Mount Sinai were the exception. But across the country, hospitals are in the grip of a nationwide nursing shortage that promises to grow even worse. In a 2001 study by the SEIU Nurse Alliance, a national nursing union, two-thirds of RNs reported there are too few nurses in their hospital to provide high-quality care. Nearly all experts agree this shortage could soon become severe enough to cripple our entire health care system -- and lead to more preventable deaths. "It's going to hit us hard," says Peter Buerhaus, senior associate dean for research at the Vanderbilt University School of Nursing, "and it's just around the corner."America has faced some nursing shortages before, two of the worst stretches being in the early and late 1980s. Yet the one unfolding now is "much more severe and long-term than those of the past," according to Gary Mecklenburg, president and CEO of Northwestern Memorial HealthCare, a 750-bed hospital in Chicago. Managed-care companies helped kick off the shortage by cutting tens of thousands of nursing jobs in the mid-1990s to trim costs. Now this shortage threatens to become far worse due to simple demographics. First, the nursing work force is aging rapidly. Between 1983 and 2000, the number of registered nurses under age 30 dropped 41 percent, compared to a drop of only 1 percent in the entire American work force. Today, the average age of RNs is 43. Tens of thousands of them will be retiring in the next few years, and the U.S. Bureau of Labor Statistics estimates that by 2010 -- just seven years from now -- more than one million new nurses will be needed.
Now consider the aging baby boomers. They will start turning 65 in 2011, and by 2020, tens of millions of them will be in their 60s and 70s. Even as they deluge the health care system, the shortage of nurses is predicted to grow to 200,000 by 2010 and 400,000 by 2020.
Dr. Dennis O'Leary, president of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), says, "If nothing intervenes, the whole system could melt down." In the worst case, some hospitals will shut down whole units, people will experience longer waits for elective surgeries, and a growing number of patients will suffer needless complications and deaths.
Why can't hospitals simply add staff to prevent this scenario? There's a far more intractable problem than costs: a deepening crisis of morale in nursing. According to a 1999 survey conducted by the University of Pennsylvania School of Nursing, 40 percent of hospital RNs say they are "dissatisfied" with their job. That's four times the average rate for American workers. It gets worse. A recent study of 10,184 nurses published in the Journal of the American Medical Association found that one in five nurses said they would quit the profession within a year.
Their grievances are rarely about the paycheck. Instead, they complain chiefly about the job stresses and the environment in hospitals today, according to Barbara Blakeney, president of the American Nurses Association. Hospitals didn't help matters when they began requiring RNs to work overtime to fill staffing gaps, leading to shifts of 16 hours or more. In one national survey, more than two-thirds of registered nurses reported working some kind of mandatory or unplanned overtime every month. On average, nurses work an extra eight and a half weeks of overtime a year.
"We are being put in situations where we are set up to fail," says Julie Semente, 45, an RN from Staten Island, New York. "After a 12-hour shift, you can't see straight. You stand there looking at this medication sheet and then at the patient and you're saying, 'May God help me. Please don't let me make a mistake with a decimal point.' "
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