COLUMBIA, S.C. - As hospitals expand across South Carolina to serve a growing number of patients, officials worry about a looming shortage of nurses to care for those patients.
South Carolina already is behind in the number of nurses per capita. The state has 70 nurses per 1,000 residents, compared with a national average of 78 per 1,000.
Nationally, numbers of nurses have crept up for the last two years. There were 993 more South Carolina nurses working in 2003, compared with 2002. And many hospitals are attracting nurses with improved working conditions and pay.
But large numbers of nurses are nearing retirement age, raising questions about who will care for 76 million baby boomers.
"For now, we're OK.... Shortages in nursing are cyclic," said Gayle Heller, dean of nursing at Greenville Technical College. "But if we don't do something, in 10 years when the baby boomers retire, we're going to be in big trouble."
Gail Stuart, dean of nursing at the Medical University of South Carolina, said a statewide effort is needed.
"We're a small state... not resource-rich, but also with lots of incentive to work together," she said. "But if there's no infrastructure to support it, we're all just paddling as fast as we can."
Peter Buerhaus of Vanderbilt University has studied the national nurse shortage. His most recent study found that even with the addition of nearly 185,000 hospital RNs nationally since 2001, there is no evidence the nurse shortage is ending. Yet it can be hard to convince decision-makers that this one is serious, said Buerhaus, who is senior associate dean for research and professor of nursing at Vanderbilt's school of nursing and chief author of several studies of the nursing labor force.
There are about 41,617 nurses in South Carolina. That includes more than 9,000 licensed practical nurses, over a third of whom are employed by nursing homes, as well as more than 32,000 registered nurses, 64 percent of whom work in hospitals.
Nurses also work in public health jobs, such as caring for mental patients and visiting low-income families with new babies. State officials say South Carolina has about 700 fewer public health nurses than it did 10 years ago.
Even when students are attracted to the nursing profession, there aren't always enough people to teach them.
South Carolina has nine bachelor of science nursing degree programs, 13 associate degree programs, 23 practical nursing programs, three master's programs and two doctoral programs.
Statewide, there are about 32 faculty vacancies now and 62 more projected over the next five years, said Renatta Loquist, who directed a study by the Colleagues in Caring task force and is retired from the University of South Carolina College of Nursing.
"Each one of those faculty positions prevents eight students from getting into the system," she said, and thousands are on waiting lists already.
Thus, almost 100 faculty vacancies means almost 800 potential nurses may end up doing something else.
In March 2002, the Colleagues in Caring task force - people from health care, business and education - issued a report urging action that included:
- A permanent center for nursing, accountable for analyzing and dealing with the shortage.
- Aggressive nurse recruitment, scholarship and loan programs, and funding for nurse education.
- Incentives for hospitals to adopt strategies successful elsewhere, such as seeking magnet hospital status. The designation establishes the hospital as a great place for nurses to work.
Task force leaders say the project led to enhanced collaboration, a statewide nurses' award program, and a nursing license plate, but not much else.
"We were almost in an election year, and the budget was miserable," Loquist said. "I think the mind-set was, this (crisis) is 10 years down the road."
The situation makes it difficult for South Carolina to recruit from other states. Efforts by South Carolina hospitals and nursing schools yielded 87 more registered-nurse graduates in 2002-03, compared with 1998-99. But undermining the increase was the fact that South Carolina recruited 435 fewer nurses from other states in 2003-03, compared with 1998-99.
Buerhaus said the most important thing states can do now is to help bolster faculties at nursing schools - with supplemental incentive pay, for instance. Otherwise, all those potential nursing students on waiting lists could decide to try something else, he said. "I worry that by the time we get the schools ready to go, it's going to be too late."