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Aging population likely to mean need for more nurses


It was Cynthia Busche’s first day as a nurse in the Mission Hospitals emergency department, but she is no stranger to the nursing world.

The 48-year-old Candler resident has been working in nursing for 25 years, and said she has seen nursing shortages throughout her career.

“The projections are even scarier for three years from now,” she said after she wheeled a patient down the hall. “Those of us who’ve been in nursing so long are getting older, and with the baby boomers getting older we have deals between the nurses about who’s going to take care of whom.”

Western North Carolina’s nursing shortage may not be dire now, but it could get worse as more nurses like Busche reach retirement age. Combined with an aging population, a nursing supply that can’t meet anticipated demand and a lack of nurse educators, experts say the region could face a severe shortage of nurses in the coming years.

Hospitals and other health care facilities will be forced to deliver care despite the shortages, but it may come at the cost of quality, said Brenda Cleary, director of the N.C. Center for Nursing.

“Compared to all other states in the Southeast, North Carolina is doing better, but that doesn’t mean we can just be complacent,” she said. “In terms of the nursing shortage, the thing that keeps me awake at night, is even if we’re doing good, we’re going to need to increase these numbers dramatically in the next few years.”

Nursing shortages are already a reality in WNC, although vacancy rates are not as high as they are in other parts of the country. Mission Hospitals has a 7 percent nursing vacancy, up from 3 percent in 2004. The nurse vacancy rate is about 4 percent at Haywood Regional Medical Center, and Park Ridge Hospital has two open nursing positions.

The average vacancy rate is about 8 percent for hospitals statewide, compared with a national RN vacancy rate of 8.5 percent. North Carolina also has the highest nurse-to-population ratio in the Southeast.

“Fortunately, we’re not as bad as many parts of the country, but it’s still a serious issue,” said Gary Bowers, director of the WNC Health Network. “Even though we’re not at a critical stage right now, there’s a real concern for the future.”

By 2020, North Carolina is expected to need 30 percent more nurses than it projects it will have, according to the N.C. Center for Nursing.

The demand is expected to rise as people have more chronic health conditions, the population ages and the current crop of nurses nears retirement age. In 2006, 31 percent of all licensed registered nurses in North Carolina were older than 50.

WNC may feel the crunch even more because of its large retirement population, which could require more nursing care in the future. Eighteen percent of the population in WNC is 65 years and older, compared with 12 percent nationwide.

“The number of nurses in North Carolina is growing substantially every year,” said Tina Gordon, executive director of the N.C. Nurses Association. “The problem is that our population is growing faster than the number of licenses that are issued, and we’re getting older.”

The supply of registered nurses in the state has increased over the past 20 years and is expected to keep rising. Unlike other states, North Carolina is growing and attracting nurses from out of state, Cleary said.

While there are more registered nurses, there are still not enough, and the current increases may not be fast enough to keep up with the anticipated demand, she said.

The number of licensed registered nurses in North Carolina increased by 29 percent over the past 10 years, but the number of registered nurses per 100,000 residents increased only 7 percent over the same time period.

More nurses are also pursuing nontraditional employment at pharmaceutical companies or in administrative positions, or other jobs less stressful than nursing.

Maria Roloff, vice president of human resources at Mission, said women today have more career choices than they did in the past, and may choose other careers over nursing.

“Traditional women careers are not necessarily as desired,” she said.

Cleary said the biggest problem, however, might not be a lack of interest in nursing.

“Even with all the good news, the problem is that we are turning about half of all qualified nursing applicants away,” she said. “The real shortage issue in North Carolina is around the capacity of our education system.”

Asheville-Buncombe Technical Community College had between 300 and 400 applicants for its 92 associate degree slots this fall, said Ned Fowler, dean for allied health and public service programs at the school.

Fowler said most nursing schools lack the space, clinical sites and most important, faculty, that they need to be able to admit more students. This year, A-B Tech filled all of its 15 nursing faculty positions for the first time in four years.

“The nursing faculty shortage is just as critical as the nursing shortage,” Fowler said.

Appalachian State University started its nursing program last fall in response to the shortages and has about 40 new students enrolled in its associate’s degree to bachelor’s degree program. The school is also developing a master’s program with a teaching focus.

Other schools that already had nursing programs are trying to encourage more nurses to go into education.

Western Carolina University’s master’s degree program in nursing education has 20 students, with room for more, and the school is also offering online and accelerated programs.

“The average nursing instructor is 53, 55,” said Vincent Hall, director of nursing at WCU. “We’re a good 10 years older than the rest of the population of nurses. A significant amount are going to retire soon, and we’re not getting enough people into the profession.”

Betty Gwen Carlton, 53, gave up being a full-time nurse practitioner to teach at WCU’s master’s program. Carlton recently received a $15,000 N.C. Nurse Educators of Tomorrow award, which helps fund her clinical doctorate of nursing degree she is pursuing at the University of Tennessee in Memphis.

Carlton took a more than $10,000 pay cut to teach, something that a lot of nurses are not willing to do.

“It’s just my passion. I love teaching,” she said. “It’s not that people don’t want to do it, but in most households it takes two incomes. To quit working to go back to school is not an option for most of us.”

Information from: The Asheville Citizen-Times,

– Associated Press

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