Winter
2002
Critical Care
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There
are also concerns that cost might not be the only problem in the
future. Keeping experienced nurses on hand to train younger nurses
in the complex cases seen at UCLA is becoming increasingly difficult
as many of these veteran nurses approach retirement with an inadequate
number of newcomers following behind, Karpf notes. Certain nursing
specialty areas are hurting more than others, including stressful
units that require high skill levels, such as neonatal intensive
care, pediatric intensive care and the psychiatric wards.
“We
think we’re at the beginning of the crisis part of the nursing
shortage,” says Mark Speare, UCLA Medical Center’s senior
associate director for patient relations and human resources. “Right
now we consider ourselves lucky to be able to spend our way out
of this, to pay what it takes to get very talented people here.
But there are other places that don’t have that opportunity,
and some of them will close. It’s going to get worse before
it gets better.”
THE
TRENDS AREN’T ENCOURAGING. For 20 years, cost-containment
efforts and improved treatments have resulted in more outpatient
care and shorter hospital stays for inpatients. Construction of
new hospitals stopped, and smaller ones were forced by their low
census numbers to shut down. But the aging population has begun
to figure more heavily than these trends: Hospital admissions, which
had declined from the mid-1980s to the mid-1990s, began to increase
in the second half of the last decade and are expected to continue
that climb into the foreseeable future. And given the higher bar
that has been set for admission, today’s hospital patients
are much sicker than patients of the past.
Why,
then, aren’t there more nurses to take care of them? Several
reasons have been proposed, including the expansion of opportunities
for women (who continue to make up the vast majority of nurses)
in medicine and other higher-paying professional fields. Nursing
salaries, adjusting for inflation, rose slightly in the 1980s and
then reached a plateau in the ’90s. (In 2000, the average
salary for a full-time RN was $46,782.)
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