As detailed in the previous Statehouse, if current trends continue Ohio will need 30 percent more nurses than it will have in 2020.
To retain nurses already working and to attract others to the profession, hospitals, industry organizations and lawmakers must address the underlying problems. Chief among these are overwork, stress and the perception among nurses that their profession isn't respected. Another significant problem is that, due to a lack of qualified instructors, nursing schools are forced to reject eligible candidates.
In the private sector, the competitive battle among hospitals to hire nurses can benefit the profession by increasing its attractiveness to those who are deciding upon a career. Micro-level retention initiatives can also be macro-level recruitment initiatives.
The Dayton Heart Hospital, a 48-bed cardiovascular facility, offers a clear example of this. To reduce turnover that had resulted in 30 percent of its nursing positions being unfilled, the hospital created a retention committee and included nurses among its members. Because of this committee, all nurses now have significant input into creating their individual work schedules. Mandatory overtime, which is prevalent in many hospitals and which registers as a major cause of job dissatisfaction on nursing surveys, is a thing of the past at Dayton Heart Hospital. The retention committee, annual satisfaction surveys and suggestion boxes that are taken seriously also give employees a voice, thereby eradicating another often-cited complaint on nursing surveys -- lack of appreciation and respect.
The news of Dayton Heart Hospital's positive working environment has spread via word of mouth to the local nursing community, and the hospital now maintains a waiting list of applicants for nursing positions.
The Ohio Psychological Association has spread the message further by naming Dayton Heart Hospital the winner of its 2003 Psychologically Healthy Workplace Award.
Most hospitals, especially larger institutions whose dynamics would render scheduling initiatives and direct employee input cumbersome, retain and recruit nurses by offering bonuses, tuition assistance and other benefits. For example, the Health Alliance of Greater Cincinnati offers sign-on bonuses, tuition assistance and limited flexible scheduling to nurses at its six area hospitals. The Health Alliance also offers incentive packages, which include a car lease and a home decorating allowance, to new nurses who relocate to the area.
Yet even as such initiatives draw potential nurses to the profession by making it an attractive career choice, nursing schools must reject many qualified applicants.
"Everyone in the city is turning away eligible candidates," said Lou Ann Emerson, associate dean of the University of Cincinnati College of Nursing. "I have a clinical group that starts in a week, and I am still searching for someone to teach it."
Nursing professors in Ohio, as in most states, must possess a master's or doctoral degree. But there are few advanced-degree nurses willing to accept relatively low-paying jobs in academia, according to Emerson. The university is attempting to ameliorate this shortage by creating a certificate program that will encourage such nurses currently working in clinical settings to teach part time.
But it's clear from the scale of these problems that governmental involvement is necessary and eventually inevitable. To date, Ohio lawmakers have done little to address the nursing shortage. In the current General Assembly, they have introduced only two applicable bills and one budgetary provision. House Bill 382, introduced by Rep. John Widowfield (R-Cuyahoga Falls), pending before the House Health Committee, would prohibit hospitals from forcing nurses to work overtime.
Passage of this bill would bring nurses back to hospitals, filling the vacancies that make mandatory overtime necessary, according to Jan Lanier, health policy director for the Ohio Nurses Association.
"Many nurses left hospitals for doctors' office and other settings because of mandatory overtime," she says. "A bill that prohibits this will bring nurses back to bedside care."
State Rep. John Boccieri (D-New Middletown) introduced House Bill 46, which would exempt from state income tax the salaries of nurses employed full time in an Ohio hospital or nursing home. The exemption would last only for the first five years of such employment.
"We were trying to make it more attractive to our graduating nurses to stay in Ohio, to go into bedside care," says Lyn Falk, Boccieri's legislative aide.
HB 46 has garnered only two co-sponsors, but Boccieri is eager to consider any viable solution from either side of the aisle.
"We are open to ... whatever (lawmakers) want to do," Falk says. "This is all of our problems. It is not a partisan issue."
In the state's 2004-05 operating budget, the General Assembly created a nurse education grant program to increase the enrollment capacity of nursing schools. The program will fund the hiring of additional faculty and the development of clinical training partnerships between nursing schools and health-care facilities. But instead of immediately and significantly funding the program, lawmakers merely directed $10 of each nurse's license renewal fee to the program. It will be years before meaningful funds accumulate.
Not only have Ohio's political leaders anemically addressed the shortage, they have also reduced state funding of nursing schools in recent budget cuts. The ONA's Lanier would like nursing schools to be exempted from further reductions.
"Nursing programs can't afford to take any more financial cuts," she says. "They need to expand, not cut back."
Such spending cuts demonstrate that the General Assembly doesn't understand the soon-to-be critical shortage of nurses in Ohio. If not addressed through cohesive, intelligent action, this shortage will certainly impact the health of Ohioans, probably within the next 10 years. Except for representatives Boccieri, Widowfield and a few others, it appears lawmakers have a difficult time focusing on anything beyond the next election cycle.