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A clearer path to nursing

Published Sep. 2, 2005

At Tampa General Hospital, newly hired nurses can earn a signing bonus of $1,000, as can staffers who recruit them.

At Morton Plant Hospital in Clearwater, nurses can opt for shifts that mirror the school calendar _ including summers off _ so parents will find it easier to work. And at Bayfront Medical Center in St. Petersburg, pay was raised to encourage highly trained nurses to stay.

A persistent nursing shortage has forced hospitals into creative and expensive ways to find and keep nurses in the past three years.

Now the state Legislature is poised to add money and remove roadblocks _ including some of its own making _ in an effort to train and recruit more nurses.

The Nursing Shortage Solution Act unanimously passed the state House on Tuesday, and it's expected to pass the Senate today or Friday. Gov. Jeb Bush has indicated he will sign it.

Florida hospitals have about 9,000 unfilled nursing spots, a vacancy rate of 15.6 percent. The wide-ranging legislation would remove state-imposed limits on how many nurses colleges could train, and make it easier for licensed nurses from other states to practice here.

It also would increase scholarships and loan forgiveness programs for nursing students who practice in Florida, and provide recruitment grants for hospitals with the most dire shortages.

"It is a monumental step forward," said Dr. Patricia A. Burns, dean of the college of nursing at the University of South Florida.

State Rep. Sandra Murman, R-Tampa, introduced the bill (HB 0519) after meeting with nurses, doctors, hospital administrators and educators. Her bill has rare support from all major interest groups, including colleges of nursing, the Florida Medical Association, the Florida Nurses Association and the Florida Hospital Association.

Without action, the state would be short 34,000 nurses by 2006, the hospital association warned.

The Legislature created some of the problems it's now trying to fix: The state has long limited the number of nursing spots at most four-year universities.

At USF, that meant turning away 200 applicants each fall, about half of whom were qualified, because the school only could take 70, Burns said. The school petitioned the nursing board to increase those spots to 120 for the 2001-2002 school year.

Under the new law, the school can add all the students it wants without seeking prior approval, as long as it maintains enough instructors and its graduates perform well on national tests.

"We've had a great deal of pressure from the institutions in the area to increase enrollment, and they weren't aware that we were a limited-access program," Burns said.

State Sen. Burt Saunders, R-Naples, said many schools chafed at the limits. "A lot of universities want to increase their nursing student body," he said. "They have a demand for it, and their local communities need it."

Administrators say Florida law also made it cumbersome for nurses to come here from other states. It often took one to four months for out-of-state nurses to obtain a license to work here, and hospital administrators hope Murman's bill will provide quick relief.

If the new law passes, nurses simply must be licensed, have passed a national nursing exam and pass a criminal background check. They can work while their Florida license is approved.

"We do target all those cold weather states, and historically have brought people down," said Deborah Menendez, director of human resources at Bayfront. "But their biggest complaint is how long it takes to get through the process. It's a hassle."

Nursing shortages have plagued hospitals before, most recently in the late 1980s, but supply has always returned to meet the demand. That isn't happening now, hospital and nursing executives say.

And, they add, it will take more than legislative action to turn things around.

"The unfortunate part is the nursing shortage is a very complicated issue, and it's not one that's going to have a single solution," said Lisa Johnson, a registered nurse and the vice president for patient services for Morton Plant Mease Healthcare in Clearwater. "We can do everything right, and it's still going to take awhile for the nursing shortage to end. This is long term."

The reasons are many. The average age of RNs increased from 39 in 1989 to 46 in 2000, meaning more RNs are retiring or quitting. And the number of newly licensed RNs dropped by 50 percent from 1994 to 1999, from about 8,000 to 4,000.

The annual turnover rate for nurses at Florida hospitals is 18.2 percent _ almost one in five.

Layoffs at many hospitals in the early and mid 1990s scared away many potential nurses, while the hungry job market gave young people more options, experts said. Women, who still make up nine of 10 nursing students, also have more career choices.

But for career and aspiring nurses, at least, the shortage has had a silver lining. Starting pay for medical and surgical nurses in Florida has increased by more than 11 percent between 1995 and 2000, to just over $30,000, the hospital association reports.

At most hospitals, it's easier to work family-friendly schedules. Concerns about working conditions are being heard.

At Morton Plant, North Bay, Mease Dunedin and Mease Countryside hospitals, nurses can work and still be home when their children are home. A special schedule mirrors the Pinellas County school district schedule, including Easter, Christmas and summer breaks, said Johnson, the vice president of patient affairs, who also is a registered nurse.

At Tampa General, nurses who agree to work two extra shifts for 13 weeks can get an extra $6,000, in addition to their regular and overtime pay. Tampa General and other hospitals also have implemented new career tracks that allow experienced nurses to advance in pay and responsibility while staying at the bedside, rather than moving to management.

"If we didn't listen, we would be foolish," Johnson said. "Our job as nursing leaders is to create an environment where people can do what they went into nursing for, and that's to care for people and make a difference in their lives."


The Nursing Shortage Solution Act:

Removes limits on the number of students who can enroll in Florida nursing colleges. Schools including the University of South Florida in Tampa could enroll as many students as they have resources and staff to adequately teach.

Allows licensed nurses from other states to work while their Florida licenses are being processed and streamlines that procedure. Qualified nurses must have practiced for two of the past three years, have passed the national nursing exam and be in good standing. They also must pass a criminal background check.

Provides $1-million for matching grants to hospitals for nurse retention and out-of-state recruitment programs. Eligible hospitals must have vacancy rates of at least 20 percent.

Expands the Nursing Scholarship Program to include students who are seeking an associate's degree, not just those seeking upper-level degrees. The program will pay up to $8,000 per year for qualified undergraduate applicants, provided they complete the course of study and work in Florida. Registered nurses seeking graduate or faculty degrees can get up to $12,000 per year.

Increases the Nursing Loan Forgiveness Program. The program would be able to payprincipal payments of up to $4,000 a year for up to four years for selected graduates of accredited nursing programs who continue to work in Florida. Before, the program paid a percentage that was based on how long the nurse had been working.