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For the week of January 10 through January 16, 2001

Nursing shortage hits valley

Blaine Manor refuses new residents; St. Luke’s hires temps

 "I could admit five more residents, but I wouldn’t do that, because I don’t think I could provide the quality of care I think these people deserve."

Gail Goglia, chief administrator of Blaine Manor

Express Staff Writer

Gail Goglia, chief administrator of Blaine County’s only skilled-care nursing home, says she’s been forced to turn away the frail and sick who seek admission.

True, there’s space available in the county-owned Blaine Manor, but with just six nurses on staff, Goglia won’t risk the unmanageable workload that accepting new residents might create. More work, she said, could jeopardize her staff’s ability to do its job well.

"I could admit five more residents," she said during a tour of the home last Wednesday, "but I wouldn’t do that, because I don’t think I could provide the quality of care I think these people deserve."

Of course, Goglia would like to hire more nurses. Adding just two would allow an increase of residents from 20 to 25 and create additional revenue for the financially struggling facility. However, practically no one is interested in the job. Newspaper ads in Twin Falls and Blaine County have announced the open positions since she became the facility’s administrator Oct. 30, but "mostly, we haven’t had people applying."

Ten miles north of Hailey’s Blaine Manor, the new St. Luke’s Wood River Medical Center is experiencing a similar problem. Since it opened its doors Nov. 19, the hospital has been searching nationally for nurses to fill six positions in management, critical care, surgery and obstetrics. So far, the hospital has received few applications and has yet to fill the vacant positions.

Both Goglia and St. Luke’s Wood River Medical Center director of human resources Maureen Askew believe the valley is feeling the effects of a major nationwide nursing shortage that appears to be demographic in nature.

Nationally, the nursing workforce is aging, and fewer young nurses are replacing those who retire. At the same time, aging baby boomers—those born between 1946 and 1964—are needing more and more healthcare.

Nurses for a Healthier Tomorrow, a coalition of nursing and healthcare organizations, attributes the shortage to an 11-year baby bust that followed the baby boom. Fifteen years after the bust, in 1990, there were 77 million boomers compared to 44 million Generation Xers, creating the smallest pool of entry-level workers since the 1930s. While the older generation grows, the younger generation shrinks. The U.S. Census Bureau predicts that the boomer-to-buster ratio may fall from 1.74 in 1990 to 1.6 in 2010.

That ratio’s effect on the nursing workforce gained nationwide attention on June 14 when the Journal of the American Medical Association published a study predicting that the demand for nurses would be 20 percent greater than supply by 2020. The average age of nurses had increased by 4.5 years to 41.9 between 1983 and 1998, the study discovered. Its principal author, Peter Buerhaus, and his two co-authors predicted that within 10 years, 40 percent of registered nurses will be at least 50 years old.

While demographics are shifting, enrollment in nursing schools is down. The American Association of Colleges of Nursing attributes that to media stories in the mid-1990s about the falling numbers of inpatients, downsized hospitals and nurse layoffs.

Whatever the cause, in the fall of 1999, undergraduate enrollments fell by 4.6 percent, dropping for the fifth year in a row, the association reports. Moreover, because many nurses get their two-year degrees from community colleges, which typically have a higher average student age than four-year colleges, the average nursing graduate is 31. At that age, they’ll have a reduced number of years to work.

Prominent news stories of the shortage began in 1999, too recent to boost graduation numbers of students who may have decided to enroll, the association’s Web site argues. Furthermore, college and high school counselors might still be discouraging students from entering the profession.

Other factors that may be contributing to the shortage include a trend toward specialization, creating a higher demand for nurses prepared in baccalaureate programs that emphasize leadership, health promotion and case management.

St. Luke’s human resources director Askew said, for example, she has particular difficulty finding a qualified obstetrics nurse. She believes that’s because the job is so highly specialized.

Then there’s the American Nurses Association president Mary Foley who argues that one of the real problems contributing to the shortage is poor working conditions such as mandatory overtime, unsafe staffing practices and higher patient workloads.

While there’s no evidence those problems exist at Blaine Manor, administrator Goglia said nurses working in skilled-care nursing homes need a "different mindset" to cope with the physical and emotional stress involved.

Attracting nurses to the Wood River Valley has its own problems. Mostly, that’s due to the area’s high cost of living. Blaine Manor’s salary of $12 to $24 per hour and St. Luke’s starting wage of $17.78 may not be enough to persuade nurses to come here.

Also, Askew said, nurses are discouraged from coming here because their spouses have limited employment opportunities.

The effect of all this on healthcare is difficult to determine. Though a 1999 Louis Harris & Associates public opinion poll indicated that more than half of Americans believe the quality of healthcare is affected "a great deal" by a shortage of nurses, Askew said that at St. Luke’s "there is not a compromise to patient care; I can assure you that."

She said the hospital uses up to six temporary nurses to fill in the scheduling gaps. But that creates another problem—because the hospital pays for their travel and housing, temporary nurses can be expensive, especially when used long term.

Meanwhile, St. Luke’s staff nurses have been working more hours, "at their discretion," she said.

For Goglia, not only is hiring qualified nurses important for the frail and sick who need specialized care, and to their friends and families, it may also be vital to the future financial health of Blaine Manor.

Industry experts say reductions in Medicare and Medicaid reimbursements mean that skilled-care nursing facilities with fewer than 40 beds are no longer financially viable. Blaine Manor is currently managed by Hailey Medical Clinic with a subsidy from county taxpayers, but Goglia said the home could definitely use the $20,000 to $25,000 increase in monthly revenues five more residents could bring.

However, Goglia was not optimistic about finding the needed nurses soon. Any qualified local candidates would likely already have applied, she said, and attracting someone from outside the area is "highly unlikely."

Like many hospitals across the country, St. Luke’s is offering a sign-on bonus—up to $3,000 or a 2000/2001 ski pass—and help with relocation costs. The American Nurses Association reports some hospitals offering up to $10,000.

Blaine Manor is not offering any incentives, and in fact, Goglia has had to cope with some dissatisfaction among her staff due to pay cuts that occurred just before she was hired.

Instead, Goglia focuses on the long-term solution of sparking young people’s interest in the profession. Because of our "mobile society," she said, "very few young people have grown up knowing old people." But when the young experience the old through school programs or employment, both groups become interested. She has seen that first hand with the teenagers who work at Blaine Manor. And the interaction is good for the residents. "They just love the young people," she said.



Nurses for a Healthier Tomorrow (,

The American Association of Colleges of Nursing (



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