Ophthalmology and the Nursing Shortage
How to cope with the situation, which might get worse before it improves.
BY LOUIS PILLA

For the past 10 years or so, nursing has been a profession in flux. The roughly 2 million professionals who make up the nursing workforce have had to deal with significant shifts.

In the 1990s, as hospitals restructured to cut costs, nurses found themselves the recipients of pink slips. Women (nursing is still very much a female profession) who thought their occupation provided them career security found themselves without a job.

Now, however, the wheel has turned -- and with a vengeance. Nurses are in high demand, with hospitals and other settings battling for fewer professionals.

Ophthalmology too finds itself influenced by the nursing shortage. In this article, we'll describe how some ophthalmology practices have been affected by the shortage and offer practical steps for coping. But first, let's do some numbers.

Dire Statistics

In virtually every place you look, the statistics tell a tale of woe. Updated estimates from the government's Bureau of Health Professions reveal a national shortfall of 110,700 registered nurse (RN) full-time equivalents in 2000, according to an article in the journal Health Affairs (Sept./Oct. 2002).

What's more, the article says, the Bureau of Labor Statistics identifies nursing as one of the top 20 occupations to be affected by baby boomer retirements. Employers will need to replace about 331,000 RNs between 1998 and 2008.

And these conditions collide, the article notes, with a three-decade gradual decline in interest in nursing as a career. Today, women have more access to occupations in business, for instance.

Complicating matters is the graying of the nursing workforce at the same time the baby boomers start to age -- and need more healthcare. The average age of employed RNs, says another article in the same issue of Health Affairs, is 43.3 years, with more than 60% older than age 40. The average age is projected to rise another 3.5 years by 2010, when more than 40% of the RN workforce will be older than 50.

"Absent effective interventions," the article warns, "the magnitude of the projected RN shortage not only will decrease access to care but could cripple the healthcare system. If future hospital nurse staffing levels fall, then more patients will face a greatly increased risk of serious adverse complications."

Adding to these woes is the shortage in nursing faculty. In spring 2002, the National League for Nursing (NLN) surveyed 1,419 institutions that had nursing programs (exclusive of LPN programs). The NLN found that the estimated number of budgeted unfilled full-time positions nationwide is 1,106 with 682 of those vacant positions in baccalaureate and higher degree programs and an additional 373 in associate degree programs, according to Theresa M. Valiga, EdD, RN, FAAN, chief program officer at the NLN.

These numbers, Valiga says, represent a 6% vacancy rate in baccalaureate and higher degree programs, 5.1% vacancy rate in associate degree programs, and 3.6% rate in diploma programs. The South, she says, has the largest number of unfilled positions, though the West has the highest vacancy rate. Anything over a 5% vacancy rate, she notes, is baseline to define a nursing shortage in healthcare settings such as a hospital.

ILLUSTRATION: ROY SCOTT

What About Ophthalmology?

Nursing shortage statistics focus mainly on the hospital, not on settings such as ophthalmologists' offices or ambulatory surgery centers (ASCs). Still, those venues also feel the effects of the shortage.

The experience of Eye Centers of Tennessee illustrates the difficulty. Headquartered in Crossville, Tenn., the practice has five locations, including one ASC.

Late in 2001, the practice recruited nurses for its new ASC, says Ray Mays, administrator. The practice, which treats about 35,000 patients/year, advertised in the newspaper for three RN spots: one nurse administrator and two RNs to work in the ASC operating room. The ASC opened in April 2002.

In response, the practice received a whopping one resume in one month. Adding insult to injury, the one respondent wasn't even qualified for the position.

Reviewing the classifieds, the practice realized that nurses were in high demand in East Tennessee. They wound up recruiting their present nurse administrator away from another ASC.

Still needing the two nurses to work in the ASC OR, the nurse administrator again advertised in the paper and received not even one resume. Ultimately, they found the nurses through networking. It's "just a war around here to get nurses," Mays says.

Further north, another ophthalmology practice offers a similar tale. Five to seven years ago, one open nursing position would draw 30 to 40 responses, says Maria Tietjen, RN, vice president of clinical services at American SurgiSite Centers, based in Somerset, N.J.

Now, she may place an ad in the newspaper and get no responses. The situation is the worst she's seen says Tietjen, who heads a staff of 30 to 35 RNs and two LPNs. With locations in New York and New Jersey, American SurgiSite Centers has six cataract surgery centers and five LASIK centers.

To find qualified nurses, Tietjen may still use the newspaper and Internet. But she'll also network with colleagues and contact nursing schools.

The experience at Eyecare Medical Group, Portland, Maine, however, suggests that not all ophthalmology practices feel the nursing shortage with the same impact. During the past year, Gloria Neault, RN, BSN, CRNO, CNOR, clinical director, has hired two nurses for her group's ASC. She's been able to locate candidates through local newspaper ads.

Ophthalmology practices may not feel the strain of the nursing shortage as readily as some other settings, suggests Jean Hill, RN, MSN, CRNO, nurse manager at the ophthalmology clinic of the University of Iowa Hospitals and Clinics in Iowa City. Hill is also president of the 1,000-member American Society of Ophthalmic Registered Nurses (ASORN).

That's because for the past 10 years ophthalmology practices have tried to decrease labor costs through hiring technicians, she says. Still, they may feel the shortage in ASCs and LASIK centers, she notes.

ASCs Have Some Recruiting Advantages

In recruiting nurses, ASCs have enviable qualities to offer compared with hospitals. Such amenities may make it easier for ophthalmology practices with ASCs or refractive or cataract centers to attract nurses.

For instance, nurses at ASCs generally don't have to contend with shiftwork, including nights and weekends. Instead, ASCs can provide a "good daily regimen," says consultant Michael D. Brown, Health Care Economics, Indianapolis, Ind.

Nursing in an ophthalmology ASC, says San Diego, Calif.-based consultant John Pinto, represents a perfect job for part-timers looking to escape the drudgery and stress of hospital floor nursing. Most, he says, are even willing to take a modest pay cut to work in an ASC.

Nurses at his ASC, says Mays, get to try new things, talk to patients, and receive immediate feedback after surgery. In short, they "get the chance to be nurses," he says. His environment doesn't have the "doom and gloom of the hospital."

Despite these enticements, however, ASCs still face competition from hospitals for nurses. Hospitals can offer more in tuition reimbursement and higher salaries, says Tietjen.

Her practice will hire nurses right out of school, she says. And if nurses leave to have families, her group will hire them back to work per diem. Another attraction: full family healthcare coverage with no out-of-pocket expenses for the employee.

Words to the Wise

With this background, how can you cope with the nursing shortage? One step is simply to do what you can to retain nurses now on staff, says Hill.

Replacing a nurse isn't cheap. A press release from the National Institutes of Health notes that estimates indicate that the cost of replacing a hospital specialty nurse can amount to $64,000.

If you have to find a nurse, don't delay. "Start 3 months earlier than you think," says Mays.

Flexibility also is key. You'll need to offer nurses spots that are going to fit their needs. You have to "start looking to tailor these positions to what people are looking for," says Tietjen.

Also keep up to date with the salary levels that hospitals and ASCs offer, says Neault. And maintain continuing education opportunities for nurses as well.

To limit RN hiring, consultant Brown encourages his clients to hire one RN who supervises ophthalmic technicians and assistants. "One's a lot easier than a dozen," he says.

What the Future Looks Like

Without a doubt, the nursing shortage has caught the nation's attention, and government and others are taking steps to address the issue. In September, for instance, Department of Health and Human Services Secretary Tommy Thompson announced 34 grants worth more than $8.4 million to expand the nation's nursing workforce and increase diversity in the profession. This follows other HHS efforts.

For the past 2 years, says Mays, technical schools in his area have pushed nursing programs, and in June he expects RNs to come out of those 2-year programs. Tietjen spots older students attending 2-year community college nursing school programs while working a full-time job. And Hill notes that schools of nursing are targeting men and older students that already have a degree in another field.

Big Needs

And yet, Hill, from what she has been told and heard expressed, doesn't believe that the shortage is likely to turn around as fast as previous nursing shortfalls. The need for nurses, she notes, is escalating faster than the pool of candidates to fill the slots.

Likely, you'll be coping with the shortage for a while, as exemplified by Eye Centers of Tennessee. Mays says that if one of his nurses were to leave, he'd be stuck. "Our pool of potential nurses," he says, "is zero."

Pilla (pilla@netreach.net) is a freelance healthcare journalist based near Philadelphia, Pa.