More are in nursing than ever, yet states still can’t lure enough to practice

There is a structural problem with the job of nursing across the country, and states are trying a number of ways to address and stem the shortage.

"In 1998 and 1999 there was an increase in those asking for licenses, and a reduction in people going into nursing programs," said Georges Benjamin, secretary of the Maryland Department of Health and Mental Hygiene. "But people are not finishing the programs. Where did they go? They have left nursing."

Maryland created a commission on the crisis in nursing, with 46 members that meet four to six times per year. The state may not have the answers to the problem, but it has outlined why the nursing situation has become what it is.

Among the reasons cited in a recent Maryland study:

  • Nursing schools are expensive and that scares off potential students.
  • Curriculum at the schools do not keep up current practices.
  • There is a lack of qualified faculty.
  • There are no incentives or reimbursement for continuing education.
  • There is a lack of mentoring.
  • There is insufficient clinical experience for students.
  • There is a poor image of nursing among the public.

What to do? The state has introduced bills among the legislature for nursing scholarships, increased Medicaid funding by $20 million per year, and discussed workplace concerns with hospital CEOs.

But there is still going to be trouble. "Until we fundamentally change the workplace, you’ve got nothing going for you," Mr. Benjamin says. "We need more federal action."

Edward Salsberg, director of the Center for Workforce Studies at the State University of New York, says his state also has taken steps to get more people back into nursing. New York has expanded grants; capitation funding and/or mandates for educational programs; state funding for training and training initiatives; scholarships; and marketing for health careers, he says.

The Medicaid reimbursements would help to increase wages and improve benefits, such as health insurance for workers, and portability of benefits within the industry, Mr. Salsberg explains.

Lack of diversity among nurses is also a common concern. In California, Hispanics, African-Americans, and Asians comprise only 21% of the total nursing population. "As a policy analyst, I think we must look at broad issues," Mr. Salzburg adds.

"More RNs are employed than ever. But there are underrepresented minorities in the nursing work force. We must look at the issue of job design and re-engineering, and we must bring nurses into the process," he says.