Which hospital is this? It may become a local one if the increasing nursing shortage is not taken seriously.

According to Julie Clayton, chief nursing officer at Good Samaritan and Mission Oaks hospitals, "the nursing crisis that is hitting us is the worst in the history of our country."

Clayton explains that many nurses are retiring and fewer are getting into the field. The average age of a nurse is 42, and many will be retiring from the nursing profession when our country is hardest hit by the shortage. Between 1995 and 2000 there were 26 percent fewer nurses graduating from nursing programs, which means fewer nurses are coming in.

"In truth, we feel the nursing shortage now," says Clayton, who explains that the demand for nurses in the year 2000 was 2 million when the actual number of nurses was closer to 1.89 million. That demand is projected to grow yearly, reaching a demand for 29 percent more nurses by 2020.

Clayton explains that the lack of nurses is not the only problem—there is also a growing pool of patients that will need care in the future. By 2010, there will be a substantially larger number of patients over age 50 and especially over age 65 who will need nursing care. This is due partially to the maturation of the baby boomers—all 76 million of them—who will soon enter the age of retirement and also have the need for increased health care.

Pam Pirzynski, a Los Gatos resident and a registered nurse in the neonatal unit at Kaiser Permanente's Santa Clara Medical Center, is also concerned that the type of patients needing care is changing. "Years ago, people stayed in the hospital for more minor conditions. Today, if they are hospitalized, they usually have a more serious condition, which means nurses are working harder than ever," says Pirzynski.

Nurses today carry greater responsibility and suffer from patient overload. These are the two major reasons that nurses are giving up and leaving the field. In order to make up for the lack of nurses, hospitals may be forced to work nurses harder, with some hospitals forcing them to work double shifts or mandatory overtime. This, in turn, results in tired nurses who are not functioning at peak performance. Nurses worry about making mistakes and even endangering their patients, feeling an overwhelming pressure to avoid errors. When tired or overworked, these concerns are magnified.

Chris Owen, who worked as a nurse in the Los Gatos and San Jose areas for more than 20 years, explains just how hard this could be on a nurse. "Most nurses get out of the field after two to five years because of the tremendous amount of responsibility. There is always the looming threat of 100 percent accuracy as they perform their job or someone can die or end up with a permanent disability," explains Owen, who adds that the amount of stress on a nurse can be overwhelming. "Early in my career, I had a couple of seconds to take the right action or someone's baby wouldn't live—this is stressful."

Photograph by George Sakkestad Loretta Woods administers eyedrops to Eileen Walker, a Saratoga Retirement Community Health Care Center resident.

"They don't tell you in nursing school that you will have to work night shifts or mandatory overtime. They also don't tell you that you work most of your holidays and every other weekend. You give up so much and you get no 'thank you'—you are not really appreciated."

Owen explains what the job of nursing can be like. "Imagine yourself as a nurse. You just worked an eight-hour night shift. You are exhausted, and the boss comes up and says, 'Guess what? You have mandatory overtime,' " explains Owen, who says this can be a common scenario.

Missy Scudder, a registered nurse at Community Hospital of Los Gatos, also understands just how hard nursing can be. "Nursing can be frustrating because you want to give the best care possible to the patients, but it can also be a rewarding career," says Scudder. "I have been a nurse for 27 years, and I would do it again." Scudder finds "being able to help people in their time of need" the best part about being a nurse.

The nurse shortage is a direct result of several factors. Years ago, women had fewer options for a career other than nursing, but that has changed.

"Our area has been impacted by the computer industry in regard to nursing. Students wanted larger, more attractive wages out of school," says Clayton. These goals pointed them in the direction of computer science and other areas instead of the nursing field.

Another reason for the nursing shortage is that nursing programs don't have the capacity to take in more students, mainly because there are fewer instructors to teach them. Good Samaritan stepped up to the plate in this area by sponsoring faculty at San José State University. Community Hospital of Los Gatos also helped, recently donating $36,000 to assist in funding a new nursing faculty post.

Good Samaritan is also working on educating students about career choices in nursing. The hospital has been involved with the Johnson & Johnson campaign "Celebrating Nursing," which is presently running commercials that show the benefits of a nursing career. Through this campaign, Johnson & Johnson is hoping to attract new candidates to the nursing profession.

According to Clayton, Good Samaritan is also beginning to educate high school students about the nursing field. "Many have the misconception that it is caregiving only. We stress the fact that nurses have the need for technical and mathematical skills," says Clayton.

Photograph by George Sakkestad Taking a much-needed break, Brenda Laws pours herself a soda in a break room at Good Samaritan Hospital.

A lack of nurses can cause a series of problems, according to Harvinder Sijher, director of nursing at the Saratoga Retirement Community and Health Center. "In the future, safety issues could come because of a nursing shortage. Patients will receive late treatment. Nurses are rushed and won't spend enough time with the patients. There could also be patient neglect with medications along with poor assessment and charting," says Sijher.

Her projections support the findings of a recent study published in the New England Journal of Medicine that shows a direct link between patient fatalities and nurse staffing. The study shows that increased nurse staffing results in a 2 to 25 percent reduction in adverse outcomes such as shock, cardiac arrest and pneumonia. This is the first study of its kind that confirms that a nursing shortage could prove deadly. It's estimated that more nurses involved in patient care could save thousands of lives each year.

California lawmakers understand this, which is why in 2004 hospitals will be required to institute a nurse-to-patient ratio—one of the first states to mandate the ratio. The ratio bill states that one nurse can adequately take care of five to six patients. The problem lies with trying to secure enough nurses to fill those positions. Some hospitals are making up for the limited staffing with team nursing, where a registered nurse oversees a licensed vocational nurse and they divide the patient responsibility between them. This allows the registered nurses to supervise in the care of more patients.

Dr. Joseph Walters, a Saratoga physician, speaks highly of the nursing profession and the work that nurses do. He also feels that although the shortage is not at the point of resulting in serious consequences, it could get there. "Nurses are very hardworking and really dedicated," says Walters. "They juggle a lot of balls. A lot of them get burned out and are not staying [in the profession]. They are also nervous about making errors." When asked what would be the best way to recruit new nurses to the area, Walters laughs and retorts, "With the cost of living out here?"

The cost of living is a major factor in bringing nursing talent to the area. Although the nursing shortage will hit hard across the country, our local area may feel it even more due to the high cost of living in the Bay Area.

Jamie Maure, who is a Bay Area recruiter for a company called Nurse Finders, has his work cut out for him. He explains that it is getting harder to find good nurses, even with higher pay and assignment completion bonuses. "It is definitely more difficult to get R.N.s to come into the Bay Area with our housing costs. They often get more money, but it still doesn't make up for the cost of living here," says Maure.

To combat this, hospitals have had to bring in travelling nurses to make up for the demand. These nurses, sometimes called "flyer nurses," are brought in from other parts of the country to fill short-term nursing positions. They receive a housing allowance and also Silicon Valley wages, which makes it lucrative for them to come here and take the positions. This helps to replace nurses when there is a shortage for various reasons, including leaves of absence and vacation periods.

Photograph by George Sakkestad Nurse Brenda Laws handles phone calls in Good Samaritan's intensive care unit.

To make up for this, Good Samaritan and Mission Oaks hospitals engage in international recruitment. "This can be difficult to achieve because other countries are also experiencing shortages and do not want to let their nurses go," says Clayton, who explains that Good Samaritan has recruited nurses from India, the Philippines and Canada. "The problem with this is the length of time it requires to get nurses from out of the country, which can be a process that takes up to two years. Not only are there licensure requirements and visas to obtain, these nurses sometimes require work with their language skills, even though they can write and read English well," says Clayton.

Clayton's main worry is that people will take action regarding the nursing shortage too late. "I am worried that it will be like the power crisis—the concern will not be there until 2010, when it's too late and there is already a major problem," says Clayton.

That problem? When the call buttons are pushed, the nurses may not come.