Faced with growing pressures to keep adequate staffs of nurses at work, healthcare institutions in the region are following time-tested strategies.
They're trying to keep their existing nurses so satisfied that they don't want to leave their jobs.
They're sharpening their recruitment efforts to draw new nurses to northern Nevada.
But the ultimate solution training enough nurses to meet the needs of a fastgrowing state is out of the hands of hospital executives and instead rests with legislators.
Already, Nevada ranks dead last among the 50 states in the number of nurses that serve residents.
It has 520 registered nurses per 100,000 population; the national average is 782.
And the shortage is expected to grow.
The U.S.
Department of Health and Human Resources say staffing shortages, which stood at 11 percent in Nevada in 2000, are expected to grow to 15 percent by 2005 and 28 percent by 2020.
That puts a premium on efforts by administrators to keep current nurses happy.
"We focus more on retention than recruitment," said Norma Brown, chief nurse executive at St.
Mary's Health Network.
"Our philosophy has been that if we establish a great working environment for nurses, they're not going to want to leave."
Retention efforts start with pay, and the average annual wage of a nurse in Nevada $51,200 in 2000 ranks seventh of the 50 states.
But pay alone isn't enough to solve retention issues.
"If they wanted to do just anything, they could be in the computer business," said Jean Lyon, chief nurse executive at Northern Nevada Medical Center in Sparks.
Ensuring that hospitals maintain a professional culture in which registered nurses are respected as part of a health-care team is a key part of the retention effort, said Brown.
So is the willingness of hospital administrators to customize work shifts to meet the needs of individual nurses.
Brown starts with a statistic: Registered nurses these days are most likely to be in their late 40s, and they're unwilling to work the 12-hour shifts three or four days a week that have been the norm in nursing.
At NNMC, Lyon said, flexible staffing means that a registered nurse with two young children at home now works a shift from 5-10 p.m., the hours her husband is home to provide child care.
"She is a good nurse," Lyon said.
"We try to be creative."
Turnover is particularly high among fresh graduates of nursing schools, and that led Washoe Health System to hire a registered nurse specifically to mentor young nurses.
"She's an emotional support.
She's a clinician.
She knows a lot about nursing," said Kaylene Opperman, a registered nurse who manages recruitment for Washoe Health.
But even with the medical industry's stepped-up retention efforts, Opperman noted that the average U.S.
nurse changes jobs every 18 months.
That translates into higher levels of recruiting.Washoe Medical, for instance, devotes three fulltime employees to recruitment for clinical positions.
They bring high school students into the hospital for career days in an effort to light the spark of interest in a medical career.
"It's not just a matter of recruiting for your needs today," Opperman said.
At the same time,Washoe Medical has sharpened its advertising pitch.Working with its ad agency, the medical center learned more about the psychographics of medical specialists what do critical-care nurses like to do in their leisure time? What are their professional desires and shapes recruitment advertising accordingly.
The recruitment campaigns have paid off as Washoe Medical in the last year doubled the number of nurses it brings on board.
Medical executives in Nevada recognize, however, that the long-term solution is education of more nurses.
That's not as easy as it looks.
Schools in the state graduated 364 nurses last year but turned away 255 qualified candidates because they didn't have available slots.
UNR this year has slots for 48 new students, but received applications from 97 qualified candidates.
That led state legislators in their last session to tell colleges and universities to come up with a plan to double the number of nurses they train.
That effort got some quick help from NevadaWorks, a program that funnels federal job-training dollars into the state.
Through NevadaWorks, the Orvis School of Nursing at the University of Nevada, Reno received $233,000 to fasttrack 24 nursing students.
The students, who already hold a bachelor's degree in another field, will graduate as nurses this December after only 15 months in nursing school.
"Without this program, they wouldn't have become nurses in Nevada," said Tom Fitzgerald, chief executive officer of NevadaWorks.
"And we know that if they have to leave the state to become a nurse, chances are that they won't come back."
NevadaWorks, he said, continues its search for federal funds to jump-start nurse training efforts.
Dr.
Jane Nichols, chancellor of the University and Community College System of Nevada, cautioned lawmakers during a recent hearing, "Nursing is an intensive, expensive program."
The university and college system estimates it needs $12 million for each of the next two years to ramp up production of nurses.
Among the costs, Nichols said, are these:
* Doubling the number of faculty, which will prove difficult because nurses with doctorates can make substantially more in clinical settings than they can as teachers.
* Providing more tutoring in science and math to nursing students who otherwise might wash out.
* Running nursing education as a yearround program so more graduates get into the field more quickly.
* Figuring ways that students interested in nursing careers can begin knocking off some of their coursework even while they're seniors in high school.
Fitzgerald, who notes that the state's population growth includes large number of retirees who will need medical services, said he can't see any low-cost way to resolve the nursing shortage.
"I have serious doubt that we're going to get it fixed unless there's some massive infusion of capital," he said.
