Florence Nightingale Wants You!

By Anastasia Toufexis

To recruit nurses, hospitals are boosting pay and perks

The scene outside two Massachusetts hospitals last week has become distressingly familiar at hospitals across the nation: nurses on a picket line. At Cape Cod Hospital in Hyannis, a walkout by 300 nurses last weekend resulted in a virtual shutdown of the facility, with only emergency room services being provided.

Across the state in Pittsfield, the Berkshire Medical Center was struggling to get along with only a supervisory staff and 15 nurses; 425 nurses had been on strike for three weeks. "Money and benefits are the obvious complaints," says Denise Sullivan of the Massachusetts Nurses Association. "But more important is the fact that nurses are the lifeblood of any hospital. That is what is not being recognized."

Dissatisfied with the low pay, grueling hours and inferior status that have been their lot in the past and faced with expanding job opportunities for women, many nurses have left the field. About a quarter of the nation's nearly 1.5 million registered nurses are no longer practicing, and only two-thirds of those working do so full time. The number of new nurse graduates is decreasing. That has created 100,000 nursing vacancies in the U.S.--or 72 full-time positions at an average hospital. Says Tina Filoromo, president of the National Association of Nurse Recruiters: "As long as there were herds of us at the front door, no one cared how many went out the back door. Now hospitals are feeling the pinch."

To cope, some institutions have had to import nurses from the Philippines, the United Kingdom and Canada. By next year, 20% of the 5,600 nurses in New York's municipal hospitals will be Filipino. And still the city will be short 1,000 nurses. Many more use temporary nursing employment agencies that have proliferated, particularly in California, where the nurse shortage is acute. Some Southern California hospitals rely on such agencies for as much as 60% of their staff, but the solution is hardly ideal. Agency fees can cost a hospital millions of dollars each year. Staff morale suffers because temporary nurses set their own schedules and are better paid than full-time members of the hospital staff. More disturbing, agency nurses are not familiar with a hospital's specific procedures, which can lead to confusion and dangerous mistakes. Georgia Sobiech, staff director at St. Joseph Medical Center in Burbank, Calif., says flatly that registry nurses are often incompetent and that some agencies are no better than "pimps." As proof, she cites the case of a reporter from the Los Angeles Herald Examiner who posed as a nurse, passed a registry exam and was sent off to a job. Says Sobiech: "You have no way of evaluating registry nurses until they do something stupid--and then it may be too late."

Many hospitals are redoubling efforts to recruit new nurses and keep the ones they already have. Through newspaper advertisements and job fairs, institutions hawk themselves with the zeal and in genuity of used-car salesmen. At Rush-Presbyterian-St. Luke's Medical Center in Chicago, nurses willing to work nights for six months get a $1,200 bonus plus an extra week of vacation. At Iowa Methodist Medical Center in Des Moines, nurses on the night shift can take a leased car in lieu of a pay differential. In apartment-tight New York City, Beth Israel Med ical Center has offered subsidized hous ing. Says Rose Hauer, director of nursing services: "If I had more apartments, I'd have no nurse vacancy problems." Park way General Hospital in North Miami Beach pays a $300 bounty to employees for each nurse they help recruit -- if the nurse stays for one year. The hospital also gives out-of-state nurses $1,000 to help de fray moving costs, but that was not enough for one husband-wife nurse team who took jobs with another hospital because it paid for the move and offered free day-care facilities as well.

Nurses' salaries now average $14,800 a year. But last month Pennsylvania Hospital in Philadelphia began offering newcomers almost $19,000 a year, more than double what it paid in 1974. At Hollywood Medical Center in Florida, nurses on the night shift can earn up to $35,000 a year, about twice what many medical residents make. Flexible work hours are being introduced as well. One plan allows nurses to work a 24-hour weekend and get paid for a 40-hour week, full benefits included. At some places, weekend shifts can be avoided altogether.

Says Joyce Alt, director of nursing at Houston's M.D. Anderson Hospital and Tumor Institute, which offers 30 different schedules: "Absenteeism has been reduced by 50% and turnover by 55%." One contented M.D. Anderson nurse is Laurie Hendley, 36, who now works two 16-hour shifts on a weekend. Before, she says, "I was working 10%-hour shifts, sometimes four days at a stretch. I couldn't get enough rest.

I wanted to go back to school and finish work on my degree, but there wasn't time. I was getting depressed."

Hospitals are also beginning to redesign nursing's career pattern, which traditionally led to administrative jobs.

"In the past, if you didn't become a head nurse, there was nowhere to go," Filoromo says. "Now a nurse who chooses to remain at the bedside can get more money and the recognition she needs."

A5 welcome as these changes are, they do not address one of the main causes of nurse dissatisfaction.

Traditionally, nurses have been physicians' handmaidens, often unable to make even minor decisions on patient care. Nurses say they want more responsibility and more autonomy and not to be treated simply as someone who is there to empty bedpans. Says Burma Garrett, a Florida operating-room nurse who quit after 16 years: "All the money in the world is not going to compensate for the abuse we take from doctors. Once the new nurses have been in the field a while, they'll discover that those advertisements don't mean a thing."

But others are more hopeful. Says Hauer of Beth Israel, where a committee of doctors and nurses meets regularly to discuss hospital practices: "All the publicity about the nurse shortage is paying off. Physicians are beginning to think, 'We may need nurses,' and their attitude is changing. I never thought it would before."

-- By Anastasia Toufexis. Reported by Joseph Pilcher/Los Angeles and Janice C. Simpson/New York, with other U.S. bureaus

With reporting by Joseph Pilcher, Janice C Simpson

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