Condition Critical: Georgia's Nursing Shortage

Despite aggressive efforts to ensure nursing gets the professional respect it deserves, the state's nursing shortage is dire. A look at the myths and realities impacting the profession, and efforts by leading institutions to transfuse new line into nursingas a career.

by Dianne Bernez

June 1, 2006

According to Barry Hawthorne, Chief Nursing Officer for Piedmont Hospital, these and other challenges are ones he and his colleagues all grapple with. "We need to keep the level of interest [in nursing] growing as a profession so that we have [sufficient] people entering ... we have an aging population across the nation ... and it's critical that we continue to attract and retain people who are interested in nursing."

But stereotypes of nursing as a 'female' profession (of the approximately 2.9 million RNs living and working in the United States, just under 6 percent are men), or as a profession for those who couldn't make the grade as a doctor, are hard to overcome.

"The myth is that nurses just pull bedpans out from underneath patients and change beds," says Hawthorne, who became a nurse in 1983 and has held his current position at Piedmont for seven months. Previously, he was Chief Nurse Executive in a hospital in Concorde, NC. "[The public] sees the role of the general hospital nurse as a low brain, low task function. The truth is, we contribute greatly."

It's a statement that's echoed consistently by nursing administrators across the city.

"Our nurses are the quarterbacks of the healthcare system," says Rhonda Scott, PhD, chief nursing officer (CNO) for Grady Health System for the past two years and a 21-year veteran of the profession. "They're involved in every facet [of patient care] from admissions to discharge." Grady has worked aggressively to enhance the image of nursing as a profession, from its "Celebrating the Visibility of Nursing" initiative launched two years ago, resulting in a return to white uniforms for all Grady nurses, to involving nurses in decision making through a "Shared Governance Model for Bedside Nursing," to a deliberate focus on investing in recruiting nurses instead of depending on contract labor. Grady spent approximately $2 million in 2004, and $1.8 million last year hiring nurses, versus the $20 million to $25 million that had been spent on contract labor by the time Scott took up the CNO role.

"There was a time when I was coming out of graduate school when there were many nurses [applying] for one position," says Scott. "There are now many other opportunities out there ... and [healthcare facilities] are competing for those [applicants]. Look at the number of women in business today, and who are CEOs. You just didn't see that 20 years ago, and even within the nursing profession there's competition for other opportunities such as working for legal firms, or in risk management departments, or in private clinics. The need [for Grady] is in acute care at the bedside, caring for the patient [because] ... nursing practice and nursing care truly does dictate patient outcome."


The perception that nursing is an 'also-ran' profession in healthcare is troubling to Susan Chambers, vice president and chief nurse executive for Gwinnett Medical Center (GMC) who's been in the profession for 21 years. Recently, Governor Sonny Purdue appointed her to the Georgia Health Strategies Council.

"One myth I'd like to dispel is that the really smart people become doctors and the ones that are not so smart become nurses," Chambers says. "People don't choose nursing because of a lack of intelligence. They choose it because they want to focus on the hands-on caring of the patient ... the nurse is the first to know if something is going wrong with a patient and notifies the doctor. Nurses have an independent responsibility to do the right thing - they're not just following orders."

Aside from debunking myths, equally challenging for Chambers is managing workplace issues, such as the patient-to-nurse ratio. "Our nurses feel they are required to care for too many patients each, and [acute care] ... has become more complicated, as have regulatory requirements to document things. Charting takes a tremendous amount of time," she says.

A unique issue at Gwinnett Medical System, which includes GMC, is the rapid growth of its medical facilities to keep up with the growth of the county. Chambers says the hospital system is frequently at or beyond capacity. Additionally, GMC grapples with providing care for a growing number of patients whose primary language is not English. The facility currently offers a specialized 'Spanish for Healthcare Professionals' course, has bilingual patient representatives on staff, and uses a computer-based language line for interpretation where necessary.

Without doubt, the demands on nurses are tremendous and there is continual need for nurses to keep up with changes in healthcare practice, regulations, new technologies and treatments. Yet, while pay scales have improved over the years, nurses still don't make the sizeable salaries that are expected of such a demanding profession. According to the 2004 National Sample Survey of Registered Nurses, the average national salary is approximately $57,784 for all levels of practicing nurses. New graduates can expect to start out with an annual salary of approximately $36,000 to $38,000, while nurses with advanced degrees and specialists can earn upward of $75,000 annually, or more.

The need for ongoing training of nurses, and especially for nurse educators, is part of the Georgia University System's $5 million commitment that will encompass 21 University System institutions that produce new graduates with associate, bachelor and doctoral degrees in nursing.

Institutions such as Mercer University are already testing new approaches to nurse training programs. Mercer is currently the only school in the southeast that offers a three-year clinical nurse program - an associate's degree is the typical entry route into the nursing profession. Mercer is piloting the Piedmont Scholars Program with 12 students this year for subsequent employment at Piedmont Hospital (that facility closed its nursing school in 1983).

"Piedmont approached us recognizing the need to do more with clinical training," says Susan Gunby, dean of Georgia Baptist College of Nursing of Mercer University, and a 38-year veteran of the profession. "Our strength is the clinical program and we offer six semesters of nursing courses with a clinical component. We started with 12 students, and have just selected 32 more rising juniors and seniors for placement at Piedmont for the practical, hands-on experience. We also became the first program in Georgia to require that students become members of the National Students Nurses Association because we are committed to building the professional nurses of the future."

Gunby says key to attracting more women and men to nursing is getting the interest of students as early as the middle and high school years. Twice yearly, Mercer conducts a 'tour' of select schools, working with admissions counselors to help recruit students to a nursing career.

"I think it's the greatest career anyone can have," Gunby says, "but there are limitations we didn't have when I started my career. Now we can place ads repeatedly across the U.S. and we're fortunate if we get 10 to 15 people responding. We have a severe nursing shortage ... and a wide-open field for anyone wanting to enter the nursing profession. Conditions have improved, pay has improved ... and if I had to do it all over again I would. Nothing is more gratifying than caring for people who are at their most vulnerable."

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Nursing Shortage
• In 2005, some 32,617 applicants to U.S. nursing schools were denied due to a lack of capacity and shortage of instructors.
• As of October 2004, 72 percent of U.S. hospitals were experiencing an immediate shortage. We would need more than 126,000 nurses to fill the need immediately.
• By 2012, the country will need more than 1.1 million new nurses to accommodate for the growth and replacement needs.
• Georgia hospitals have a vacancy rate of approximately 8.7 percent. The national average is 6 percent.
• More than 75 percent of all hospital vacancies are for RNs.
• Georgia's RN population is the largest single professional group in the state totaling some 97,000, and Gallup polls rate nurses as the most trusted and honest professionals.

Source: Georgia Nurses Association