The shortage of registered nurses in the Bay Area will worsen in the next decade, as baby boomers continue to age - leading to more people needing care - and as aging nurses retire.
A report released in June by San Francisco-based Health Workforce Solutions predicts that by 2020, the Bay Area is expected to need nearly 14,000 extra RNs to handle the additional work load.
According to the California Department of Aging, one in five Californians will be 60 years of age or older by the year 2010. Meanwhile, the California Nurses Foundation reports that 55 percent of currently practicing nurses plan to retire between 2011 and 2020.
A 2006 report by the California Board of Registered Nursing included a forecast for 2030 predicting that California will need an additional 100,000 to 120,000 nurses. East Bay hospitals and nursing schools are working together to fill the gap.
To offer new nursing graduates support and additional training in a complex clinical environment, hospitals, including John Muir Medical Center in Walnut Creek and Eden Medical Center in Castro Valley, have started offering their own clinical nurse residency programs. Recent estimates from the Journal of Nursing Administration show the average turnover rate for first-year nurses ranges between 35 percent and 60 percent, and these programs are designed to bring that rate down.
"For nurses who have just graduated from school, going to work in a hospital can be a difficult transition," said Jan Hunter, director of work force planning and development for John Muir.
The nurse residency programs give new nurses confidence by combining classroom work with clinical experience. Each new nurse is paired with a nurse manager who serves as the new nurse's mentor and coach, guiding, directing and supervising the new nurse within a designated unit.
The residency programs also give the medical centers the opportunity to place nurses in hard-to-fill specialty areas, including the operating room.
"Our nurses who enter the clinical residency program for the OR complete a two-year residency as opposed to nurses who work on a medical/surgical unit who have a six-week residency," said Lori Collett, nurse educator for Eden Medical Center. "It's a significant investment of time, but our nursing retention rate is 75 percent."
Hospitals including John Muir in Walnut Creek and Washington Hospital in Fremont are also working with local college nursing programs to help alleviate such problems as shortages of qualified faculty.
"Some of our nurses also work as adjunct faculty at local nursing schools," Hunter said. "We pay their salary two days a week to offset a college's costs of hiring additional faculty. It's a fabulous opportunity for our experienced nurses to share their clinical knowledge with students."
At Washington Hospital, non-nursing staff members are encouraged to attend nursing school as part of the hospital's clinical-ladder program, said Martha Giggleman, senior director of clinical work force development.
"If one of our employees expresses an interest in attending nursing school and has met the prerequisites for the program, we will pay their salary while they attend nursing school and offer them tuition reimbursement," she said. "We also offer an onsite teleconferencing program with Holy Names College for our nurses who have two-year RN degrees and want to go on to earn their bachelor's degree in nursing."
Hospitals and colleges are also focusing on bringing back to the profession nurses who may have left to raise their children or change careers. Eden recently paired with Chabot College in Hayward to offer a summer RN refresher program.
"This is a way for nurses who have been out of the field for a while to update their skills if their current nursing license is inactive or lapsed," Collett said.
While the state has made headway in encouraging more students to consider nursing careers, educators say there is still a long way to go.
In May, the state's Labor and Workforce Development Agency reported that nursing programs around California were projected to graduate 10,391 RNs in the 2007-08 academic year, a 68 percent increase over the 6,158 who graduated in 2003-04.
"Hospitals need to hire a mix of both new and experienced nurses," said Arlene Sargent, associate dean for the Samuel Merritt School of Nursing in Oakland. "When people hear nursing schools have a waiting list, they often think the nursing shortage is over, yet the reality is we haven't even begun to meet the shortage."
Sargent said Merritt has also begun to emphasize gerontology in its nursing curriculum to prepare students to care for residents over the age of 85, the state's fastest-growing population segment. A "healthy aging" class is now a mandated course in the school's nursing program.
In 1990, one in 99 people were in the state's "oldest old" age group (those 85 and over). By 2040, this population is expected to increase to one in 34. In most hospitals, the percentage of patients over age 65 approaches or exceeds 50 percent and continues to rise.
"Many nurses have not received specific education about the ways in which older adults differ from younger patients, in terms of symptoms and appropriate treatment," Sargent said. "Taking courses in gerontology can prepare nurses to successfully care for older patients with complex medical conditions such as dementia, and comorbidities including heart disease and diabetes."
Who the nurses are
The National Sample Survey of Registered Nurses (NSSRN) - conducted every four years since 1976 by the Health Resources and Services Administration of the U.S. Department of Health and Human Services - is the nation's most extensive and comprehensive source of statistics on all RNs currently licensed to practice in the U.S., whether or not they are actively employed in nursing.
Distribution of the 2008 survey began on June 1, and the findings are expected to be released by the end of 2009.
A total of 50,691 RNs were estimated to be eligible to participate in the last NSSRN survey in 2004, with a total of 35,724 individual RNs responding to the survey request, or a final response rate of 70.47 percent.
Here are some of the highlights from the 2004 report:
- The average age of the RN population was 46.8 years of age in 2004, compared with 45.2 years in 2000, and 44.3 years in 1996.
- Of the estimated 2,909,357 RNs in the U.S., 168,181 - or 5.8 percent - are men. This represents a 14.5 percent increase over the 2000 NSSRN estimate, when 146,902 RNs were male, and a 273.2 percent increase over 1980, when 45,060 RNs were male.
- Seventy-five percent of all RNs were married; 18.1 percent were widowed, divorced or separated; and 9.2 percent were never married. Roughly 42.5 percent of all RNs had children under the age of 18 living in the household, including 14.8 percent who had children less than 6 years of age.
- Of all RNs employed in nursing, 56.2 percent worked in hospital settings in 2004, compared with 59.1 percent in 2000 and 68.1 percent in 1984. This percentage decline reflects the growth in nurse employment opportunities in other sectors.
- In 2004, 11.5 percent of RNs were estimated to be employed in ambulatory care settings, including physician-based practices, nurse-based practices, and health maintenance organizations, compared with 9.5 percent in 2000.
East Bay nursing programs
Eleven East Bay colleges and universities have nursing programs. Here is what they offer:
- Cal State East Bay, Hayward and Concord: Cal State offers a B.S. in nursing degree at both of its campuses.
- Chabot College, Hayward: Chabot College offers RN, LVN to RN, and RN summer refresher programs.
- Contra Costa College, San Pablo: Contra Costa College offers an RN program.
- Holy Names University, Oakland: Holy Names offers a nursing program in conjunction with Oakland's Samuel Merrit College. It also offers a M.S. in nursing, a joint M.S.N./M.B.A. program and a M.S.N. with a certificate in business program.
- Los Medanos College, Pittsburg: Los Medanos College offers both registered nursing and vocational nursing programs, as well as a LVN to RN program.
- Merritt College, Oakland: Merritt College offers RN and LVN to RN programs.
- Mills College, Oakland: Mills College offers a nursing program in conjunction with Samuel Merritt College.
- Ohlone College, Fremont: Ohlone College offers an RN degree program at its new Ohlone College Newark Center for Health Sciences and Technology.
- St. Mary's College of California, Moraga: St. Mary's offers a nursing program in conjunction with Samuel Merritt College.
- Samuel Merritt College, Oakland: Samuel Merritt College offers a B.S. in nursing program in partnership with Holy Names University, Mills College and St. Mary's College of California. An accelerated B.S. in nursing for those who have B.A.s in other fields is offered in Oakland, San Francisco, San Mateo and Sacramento. Samuel Merritt also has a graduate program offering an M.S. in nursing with specialties in case management, family nurse practitioner and nurse anesthetist.
- Solano Community College, Fairfield: Solano Community College offers an RN nursing program.