Not enough nurses

Since October, DCH Health System has hired about 44 nurses as it seeks to replenish its ranks while competing with peers in Alabama and nationwide amid a shortage of nurses.

“Like other hospitals in Alabama and the nation, we are experiencing a nursing shortage,” said Peggy Sease, vice president of human resources for the DCH Health System. “This is caused by lots of different reasons.”

During the fiscal year that ended in September, the system hired 237 registered nurses. The system expects to hire another 200 this fiscal year as it tries to maintain its staff of bedside nurses, Sease said. The system has about 170 vacancies right now. It’s a deficit the system has learned to live with by using overtime, special pay and traveling nurses to fill shifts.

The turnover follows retirement and nurses leaving for other opportunities.

“That has been typical for us for about a year and a half or two years,” Sease said of the vacancies. “It is what it is, and we are hiring.”

A few years ago, the rate was between 110 and 115 vacancies, she said. The system has about 4,800 employees and sees similar challenges at other positions as well, Sease said.

“It is hard to hire a lot of positions, because there are so many positions open in our area,” she said.

There is no single factor responsible for the shortage in West Alabama, according to Sease and the heads of local nursing colleges. The problem is cyclical, and supply and demand are influenced by factors including pay and working conditions, the increasing needs of an aging population, national health care policy shifts, as well as the capacity of nursing programs to provide graduates as the demand increases.

Health care delivery models are also continuously changing, said Gladys Hill, associate Dean of Health Services at Shelton State Community College.

“What we needed five years ago may be something totally different than we need today,” Hill said.

Hill noted the current debate about repeals or reforms to the Affordable Care Act.

“I am not sure where we are going to land,” Hill said.

A cycle of shortages

The cycle of shortages occurs every 10 years or so, Hill said. Demand increases. Programs respond by producing more graduates. The demand lessens, and fewer nurses are hired or hours are cut.

Shelton State Community College is on track to graduate about 150 nurses in 2018, Hill said. The University of Alabama graduates about 500 total annually from the Capstone College of Nursing’s undergraduate and graduate programs, Dean Suzanne Prevost said.

“Our graduates are mostly local folks who live and work here in the city because this is their home,” Hill said. “We generally supply the lion’s share of the nurses in the West Alabama area.”

About 80 percent of the UA graduates get their license and take their first job in Alabama, Prevost said. However, about 55-60 percent of students in the program come from out of state.

“We are importing nurses,” Prevost said.

UA is also developing a plan to increase its size and expand its facilities in the next few years, Prevost said. The college is also working to increase endowments for scholarships and research.

The patterns of nursing shortages nationwide tend to be regional, according to the U.S. Department of Health and Human Services, Health Resources and Services Administration, National Center for Health Workforce Analysis, which published a report earlier this year on the projected demand for nurses during the next 15 years.

According to the report on supply and demand projections for the workforce from 2014-2030, the demand for nurses differs from state to state, with an inequitable distribution of workforce. Some regions are predicted to have a surplus of nurses, while others are projected to face deficits.

The demand for nurses in Alabama is projected to grow from 68,000 to 79,800 from 2014 to 2030. The supply in the state is projected to grow to 85,100. The supply of licensed practical nurses nationwide is expected to fall short of demand in the same period, including states such as Alabama, though LPN demand can be met more quickly because of the shorter training period.

The supply figures are calculated based on factors such as the number of graduates entering the workforce and the number of nurses who leave or see work hours cut. Demand is estimated based on current health care use, staffing patterns, demographic changes, changes to insurance and Medicaid or Medicare.

Recruiting season

DCH and other hospitals do most of their recruiting as students graduate from nursing programs, typically during the summer, according to Sease. But DCH is in the midst of recruiting right now because there are December graduations, she said. DCH representatives have been at nine colleges and universities recruiting.

“We are able to recruit most of our new grads from community colleges," Sease said. “It is hard to recruit from larger colleges because half come from out of state. Some want to stay and some don’t.”

DCH typically attract individuals from the region or those who are attracted to living here, Sease said.

The Health Resources and Services Administration report said nurses tend to practice in the states where they have been trained.

DCH is also doing several things to help recruit nurses to its facilities and students into the profession, Sease said.

“We are going into the high schools,” Sease said.

DCH works with the World of Work career expo at Shelton State, which introduces eighth-graders to future job possibilities.

DCH also offers a program for second-year nursing students allowing them to work as patient care assistants to experience work in different units, Sease said. The students receive tuition assistance as part of the program. Tuition assistance is also available for DCH employees who go to nursing school, she said.

DCH hires lots of new graduates, Sease said.

Citing competition among employers, Sease declined to provide a specific salary amounts but said the rates were competitive.

The average salary for registered nurses in the Tuscaloosa metropolitan area is $58,160, according to U.S. Bureau of Labor Statistics data. For the nonmetropolitan area of northwest Alabama the average was about $53,000. The average in the Birmingham metro area was $59,810.

While its rates are competitive, sometimes the system finds itself competing against lifestyles rather than salaries, Sease said.

“What we find is as they get experience ... they can go travel and be a travel RN,” she said.

It’s a chance to see the world, according to Hill and Sease.

“They want to live in an area where they can snow ski,” Sease said. “They want to see the world and have a different style of life.”

Some University of Alabama students who did their initial clinical work in West Alabama would go to Birmingham or Nashville for their final preceptorships, Prevost said. The students would return impressed by the difference in the work environment.

Prevost agreed the Tuscaloosa area currently faced a shortage, but argued there are more nurses in the region than people may think. Some live here but travel outside the area, drawn by better salaries or work environments.

“I think the challenge is ours to really invest to produce healthy work environments to stay in,” Prevost said.

DCH wants to be the employer of choice for its nurses, Sease said.

“We do a lot of things to incentivize our employees,” Sease said.