Sometimes, after a grueling 12-hour shift dispensing medicine to AIDS patients, pumping lifesaving blood into yet another gunshot victim, offering her hand and her ear to critically ill elderly patients, Marian Grant thinks back on her former life.
This always lifts her spirits and reaffirms her decision four years ago to abandon her career as a marketing executive and study to become a nurse in the emergency room at Johns Hopkins Hospital for a fraction of her previous salary.
Her epiphany came during a marketing strategy session at Procter & Gamble, where she worked in the Hunt Valley office. She kept thinking about the Govans AIDS hospice where she volunteered weekly, and how she had marveled at the nurses' compassion and, more than that, what it meant to their patients.
"It was one of those life-changing experiences," the 46-year-old Reisterstown resident says. "We're sitting there for hours debating the name of some lipstick, and I suddenly sat back and I thought, 'I just can't do this with my life.' "
Grant's mid-career move to nursing is the sort of story hospital officials love to hear - and wish they heard more often. The traditional pipeline of young women fresh out of nursing school has dropped precipitously as women pursue other careers. So increasingly, hospitals are looking to non-traditional candidates like mid-life career changers, men and minorities to help ease a critical shortage of nurses.
The face of nursing is changing, and more often, it's looking like that of Doug Phelps. The former businessman became a nurse at age 50, and now works in the emergency room at St. Joseph Medical Center in Towson. He works alongside a former high school teacher and a former cafeteria worker, both training to become nurses.
Nationwide, the American Hospital Association says, 126,000, or 12 percent, of all nursing jobs at U.S. hospitals remain unfilled, and the U.S. Bureau of Labor Statistics projects the gap will mushroom by 2010 to nearly 500,000, leaving one of five nursing jobs unfilled.
At the same time, demand for care -- and nurses -- will soar as the population ages and baby boomers retire.
Heightening the sense of urgency, Harvard researchers reported in a recent New England Journal of Medicine results of a study showing the shortage of registered nurses at hospitals has led to more complications among patients, longer hospital stays and even deaths from treatable conditions.
"We are standing on the precipice of an unprecedented nursing shortage," says Mary Foley, president of the American Nurses Association. "Let there be no doubt about it: The current and emerging shortage of RNs poses a real threat to the nation's health care system."
The shortage already has forced hospitals to cut back on available beds and sometimes close entire units, postpone elective surgery and even temporarily close emergency rooms, sending patients to other hospitals.
Moreover, as the pool of potential nurses dwindles and demand continues to grow, overworked nurses at understaffed hospitals are abandoning the profession in record numbers. According to the American Nurses Association, nurses now leave hospital employment for good after an average of only four years.
The dire prognosis has prompted hospitals and other health care providers, nursing schools, national health organizations and corporations to launch an array of unprecedented efforts to attract and retain nurses. Among them: national recruitment drives, financial incentives like signing bonuses for new nurses, slick national advertising campaigns, tuition reimbursement and scholarships, paid professional development courses and more flexible working hours.
Johns Hopkins Hospital, for example, pays the tuition for courses Grant is taking to earn a master's degree at the JHU nursing school. To lure nurses, Hopkins also airs radio and TV ads, offers to pay moving expenses for nurses who relocate to work there and provides furnished apartments at reduced rates for those searching for permanent housing.
But recruitment alone won't fill the gap, nursing advocates say, without equal emphasis on retention through, among other things, increasing salaries and banning mandatory overtime, as some states have done. Nurses also demand more say in decision-making and say they're too often treated like second-class citizens.
"If we don't start addressing that work environment, it's not going to make a hill of beans how many we recruit," says Diana Mason, editor in chief of the American Journal of Nursing.
Expanding applicant base
Nationwide, a push to attract nontraditional candidates reflects fundamental shifts in demographics and the dynamics of the work force.
While women still comprise more than 90 percent of all registered nurses, the average age of RNs has climbed to 45, and those under 30 represent only 10 percent of the work force, according to the American Association of Colleges of Nursing. So when nurses leave, there's nobody to replace them.
"In the past, we've had nursing shortages and could say, 'This will pass,' but this one's different and will require new solutions," says Barbara Heller, dean of the University of Maryland School of Nursing. Because of all the new career possibilities for women, she says, the traditional pipeline for nurses "just isn't big enough."
To expand its base of applicants, the nursing school created ads and brochures two years ago featuring men and minorities in nursing.
"Diversity had to become a cornerstone of our marketing plan," Heller says. Gains in enrollment of men and minorities contributed to a 37 percent increase in enrollment last fall, she adds, ending a five-year decline.
In New York, academia and labor have joined forces to bring free college nursing education to a poor section of the Bronx in hopes of attracting Hispanics to the profession. City University of New York, which developed the nursing program with a major city health care union, will open the school this fall to about 500 union members.
The college also will offer remedial math and science classes to help students prepare for nursing school as well as free child care and after-school programs for students' children.
Antonio Perez, chairman of the university's nursing task force, says the health care industry, nursing schools, corporations, foundations and governments must band together to broaden efforts to train people to become nurses. Filling the widening gap in nursing ranks, he says, will require diversifying a profession that is about 87 percent white.
"We really need to reinvent nursing and redefine how we view it and how we fill the jobs," Perez says.
In other efforts to diversify the nursing work force:
* The nursing school at the University of Texas Health Science Center in Houston created programs tailored to the needs of career changers and men. Both succeeded. Career changers comprise 29 percent of this year's entering class; men, about a third. This year's nursing class includes business executives, lawyers, accountants, engineers, even a priest.
* Johnson & Johnson Health Care Systems Inc., a Brunswick, N.J., health care company, launched the biggest campaign ever to attract nurses with a series of commercials that began airing in prime time during the Winter Olympics last year. Along with national TV ads starring nurses, the two-year, $20 million "Campaign for Nursing's Future" includes recruitment brochures, posters and videos, a Web site and scholarship funds.
It's no coincidence that nearly half the TV spots feature men.
* Tenet Healthcare Corp., which operates 30 hospitals in southern California, awarded a $1 million grant to cover tuition and other expenses for Latino nursing students in local colleges.
More than a job
While other hospitals recruit throughout the nation and even beyond, St. Joseph in Towson has found solid nurse prospects in its own emergency room. There, volunteers assist staff and comfort patients and their families, and four of 10 volunteers who have worked in the ER over the past few years decided to become nurses.
Doug Phelps traded his briefcase and high-paying executive job for blue scrubs and a stethoscope to volunteer, and then to become a nurse. When he hears the anxiety in his patient's voices and sees the fear in their eyes, he can empathize.
After taking early retirement from his job as a vice president at Carroll Independent Fuel, he came to St. Joe in May 2000 for a hip replacement. A routine X-ray revealed a brain tumor, which he had removed in an operation at the hospital.
"I remember what it was like, how scary it can be, and I really try to think about what it was like to be a patient," he says. "A lot of people come in and they've never been in an ER before, and for them, if you can spend a couple minutes just reassuring them, let them hold your hand, that can be a big difference."
Phelps thrives on the adrenaline buzz he never got working as an executive at the air conditioning and heating company. "Working at Carroll was making a living," he says, "but I had a longing for something else. I found it here."
So, you want to be a nurse?
It's a job-seeker's market for nurses. Hospitals, hard hit by the nursing shortage, typically offer signing bonuses and other incentives such as tuition reimbursement and day care for nurses' children. In Maryland, starting annual salaries for new registered nurses range from $31,000 to $42,500, according to the Maryland Hospital Association.
Many registered nurses in hospitals make considerably more because of regular overtime. Salaries increase with experience and specialization. Mid-level nursing managers, for example, earn about $65,000; nurse anesthetists, about $72,000.
About half of Maryland nurses work in hospitals. The others choose from a range of options, including long-term care centers, medical offices and home care.
Registered nurses must graduate from an accredited school of nursing. A bachelor of science in nursing is a four-year, university-based degree. The associate degree in nursing is a two-year program, usually offered through community colleges. Graduates with either degree must pass a national licensing exam to become an RN. A master's degree is required for advanced specialties including nurse practitioner, nurse anesthetist and nurse midwife.
For more information on nursing opportunities and requirements, check out these Web sites:
American Association of Colleges of Nursing: www.aacn.nche.edu
American Hospital Association: www.aha.org
American Nurses Association: www.nursingworld.org
Discover Nursing: www.discovernursing.com
Maryland Health Careers: www.marylandhealthcareers. org