Nurse shortage likely to continue

By: Joe Ferguson, Special to The Independent

04/07/2006

PHOENIX - It has been almost a year since the Arizona Legislature approved an ambitious plan to double the number of nursing school graduates to 2,000 a year by 2010, but limited clinical training opportunities may thwart efforts to meet that goal.
      Arizona currently has a health care crisis, as the state is well below the nursing per capita average for the nation. The state has 606 nurses per 100,000 residents, compared with the national average of 784 nurses per 100,000, according to the Department of Health and Human Services.

      As the state's population continues to expand and the residents grow older, the demand for trained nurses is expected to skyrocket. About two years ago, when legislation was crafted to address Arizona's nursing shortage, the state's colleges? and universities were graduating only about 1,000 nurses each year.
      The Arizona Legislature set aside $20 million to fund a five-year program to increase the number of nurses practicing in the state. The program created Arizona's Partnership in Nursing Education, designed to double the state's nursing education program enrollment by hiring additional nursing faculty.
      But nursing officials say the Legislature's ambitious plan contains a serious flaw that may prove to establish a ceiling on how many nurses Arizona colleges can train in any given year. The program fails to address how to increase the capacity for clinical rotations of hospitals, required to obtain a nursing degree.
      In addition to classroom instruction, students are required to perform a set number of hours in clinical rotations. For clinical rotations, students learn under the direct supervision of experienced registered nurses who serve as preceptors.
      Hospitals, however, have a limit to how many student nurses they can offer shifts in clinical rotations, said Bridget O'Gara, the vice president of
communications for the Arizona Hospital and Health Care Association
      "It's a catch-22," said O'Gara. As colleges and universities increase the number of students they serve, neighboring hospitals have to become creative on how to accommodate more students, she said.
      "With more students, we have to use creative scheduling and offer shifts at non-traditional times," said O'Gara.
      The executive director for the Arizona State Board of Nursing, Joey Ridenour, said hospitals are exploring different ways to accommodate needed clinical rotations. She said schools are considering using complex simulations in a classroom setting to offset some of the clinical rotations necessary for graduation.
      She said the state has already increased the number of nursing school graduates to 1,600 a year, but is still short of the goal set by the Legislature. For some rural hospitals, capacity for clinical rotations is not an issue.
Programs in rural community colleges are usually small, so even if a nursing program doubles in its size, the hospital is not overwhelmed with students.
      The director of development and public relations for Kingman Regional Center, Jamie Taylor, said the hospital can accommodate the 35 nursing students enrolled in Mohave Community College.
      "We will take the whole bunch," said Taylor.
      Roland Knox, the chief operating officer for the Mount Graham Regional Medical Center, said the nursing crisis was so dire at the hospital that it occasionally had to fly patients to other hospitals because it didn't have enough nurses on its staff.
      He said those trips are no longer necessary as Eastern Arizona College has increased more students training at the hospital, many whom stay at the
hospital after graduation.
      Eastern Arizona College President Mark Bryce said the college has a strong relationship with the local hospital and had an easy solution to bring more nurses in to the community hospital: "We doubled our program in one year. It was real simple; we just let 20 more students into the program."
      In Tucson, clinical rotations at University Medical Center have almost reached a point of saturation, where the hospital cannot accommodate students even with creative scheduling.
      Carol Mangold, the clinical affairs coordinator to the UA's nursing program, said the program had used creative ways to find shifts for students, including introducing clinical rotations during the summer session. While the UA offers some in-class simulations, she warned against relying on simulations in lieu of hands-on experience.
      "You can't learn nursing through simulations," said Mangold.

* * * Joe Ferrguson is the Don Bolles Fellow in the University of Arizona Journalism Department. He is spending spring semester of his senior year covering rural and suburban issues at the state Legislature for the journalism department's Community News Service.