Blame the economy, if you want. Or the aging population. Or the Internet. Or the feminists who paved the way for more women to become doctors, medical researchers, lawyers and scientists.

Whatever the cause, the reality is this: There is an immediate need for 5,000 nurses in Los Angeles County, that need is growing, and there's no relief on the horizon.

Should we be worried? You bet. In 10 years, the nursing shortage in Los Angeles will grow so severe there may not be enough nurses to staff all the local hospitals. Meanwhile, the demand for nurses will expand exponentially as the baby boom generation ages.

All across the nation, the nursing shortage is severe. But Los Angeles County is headed for the intensive care unit.

Nationally, there are 798 nurses for every 100,000 patients. In California that ratio is 566 nurses per 100,000 patients. In Los Angeles County, it is 464 nurses per 100,000.

The shortage is already taking a toll. "Mandatory overtime runs rampant in many facilities," said one intensive care nurse who wished to remain anonymous. "When it is time to get off your shift, there is no one to relieve you. Sometimes they disguise the overtime as voluntary. The hospital says it needs five nurses for the next shift and there are only three sched-uled. They'll ask, 'Who wants to stay?' and you'll say, 'OK, I guess I'll stay,' because you feel you should."

When did nurses become such a scarce commodity? Health care experts said nursing shortages are nothing new; they occur every decade or so, typically during the later stages of economic expansions. In the early 1990s, there were nurses begging for jobs. Now the hospitals are begging for nurses.

"There is definitely a crisis in nursing. And the No. 1 crisis is the shrinking workforce," said Linda Burnes Bolton, chief nursing officer at Cedars-Sinai Medical Center.

Nationwide enrollment at nursing schools has declined for the fourth straight year.

World of opportunity

Women, who still comprise 93 percent of the nursing workforce in California, used to have fewer career choices. Now they are opting for higher-paying professional jobs they wouldn't have even considered a generation ago. Women interested in health care are becoming doctors, not nurses.

At UCLA Medical School, 47 percent of the students are female. In 1980, only 29 percent were women. The graduating class of 2003 will have 97 female doctors and 80 male doctors.

Most of the women college students who aren't attracted to the medical profession are becoming lawyers and business executives, who earn higher salaries without having to listen to complaining patients and work odd hours.

"There are so many opportunities to go into other professions, such as the computer field and the Internet, that not as many people are going into nursing," said David Milovich, vice president of human resources at Good Samaritan Hospital near downtown Los Angeles.

Others point to the frustration factor that is being experienced by nurses. "A lot of nurses feel increasingly that their work is not really valued," said David Johnson, a representative of the California Nurses Association. "They feel that decisions are made based more on increasing the bottom line (for hospitals) as opposed to improving the quality of the patients' care."

With fewer students entering nursing schools, California is producing only 50 percent of the nurses needed to adequately staff the state's medical facilities. So hospitals are sending recruiters out of state and even out of the country to find good health care workers. And with Los Angeles' growing population diversity, more nurses are needed who speak Spanish, Chinese, Korean and Vietnamese.

"We are looking to recruit nurses from states that have a large number of Hispanic or bilingual nurses," said Brenda Kuhn, chief nursing executive at White Memorial Medical Center in East Los Angeles. "Texas is one state we're targeting. Also, being an Adventist hospital, we are looking at an Adventist college in Mexico."

Aging workforce

With fewer students graduating from nursing schools, the nursing workforce is aging. The average age of a nurse today is 46, which means about half will retire in the next 10 years.

At Kaiser Permanente hospitals in Southern California, 48 percent of the operating-room nurses will retire in the next five years, according to a recent study. Because it takes 18 months to train an operating-room nurse, hospital administrators are extremely concerned there won't be enough skilled nurses to staff that area.

"We need to put some educational programs in place to train the O.R. nurses soon," said Inez Tenzer, assistant director for divisional patient care services for Kaiser Permanente California.

Another factor contributing to the nursing shortage is the booming economy. With better salaries and jobs, nurses who are part of a two-income family are working fewer hours or retiring early.

If that weren't enough, Gov. Gray Davis signed a law that mandates a certain ratio of nurses per 100 patients. The size of that ratio is being discussed right now; it will go into effect at the beginning of 2002.

Faced with a critical shortage, Los Angeles hospitals are using their imagination to lure nurses to their facilities. But it's a tough task. While nurses' salaries increased 43 percent from 1990 to 1997, to an average of $45,073 per year, there is still a perception that nurses are underpaid.

"We haven't gotten to bribery yet," quipped Tenzer of Kaiser Permanente, which has 1,000 nursing vacancies in California.

Kaiser is offering sign-on bonuses as high as $5,000 for experienced specialized nurses. Referral bonuses are $3,000.

Enticements abound

St. John's Hospital and Health Center in Santa Monica, which has 91 nursing vacancies at its 233-bed facility, is offering sign-on bonuses that vary from $1,000 to $5,000. The facility's referral bonus is $2,300.

At Cedars-Sinai Medical Center, there are no referral bonuses for new nurses. But there are referral perks, such as free maid service or an all-expenses paid professional trip. Those who have referred nurses have their name entered into a raffle. The most recent prize was a trip for two, plus spending money, to any place in the United States.

At Good Samaritan Hospital, administrators have decided to take an aggressive attitude and have created a new position: director of nurse recruitment. The yet-to-be hired director will attend nursing symposiums, have close contact with nursing schools and try to retain the nurses already employed at the medical facility.

Meanwhile, hospitals are busy building closer relationships with nursing schools and setting up internships to attract recent nursing graduates. White Memorial Medical Center is giving scholarships to nursing students if they promise to work at the medical facility after graduating. "We are looking at new strategies, like providing scholarships to employees' children," said Kuhn. "You make your employees happy, and you have people in the pipeline."

But finding a good nurse is only one hurdle. The next trick is to keep them on staff. Most nurses, if they are going to leave, quit within two years after arriving. So hospitals are trying to create a nurturing environment.

White Memorial is now giving salary increases after the first six months on the job and then again after the first 18 months. "We are encouraging our staff to go into different disciplines and work in other parts of the hospital, such as the emergency room or rehabilitation. We tell them, 'We are happy to train you and keep you here,'" Kuhn said.

Cedars-Sinai Medical Center has a crisis-intervention team that provides immediate help to nurses going through a family crisis or difficult work situation. "The quality of work life is an important piece for us," said Burnes Bolton, chief nursing officer.

Only time will tell whether all this will work. The nursing shortage might not be resolved until the next economic slump.

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