An acute shortage of nurses in hospitals and
nursing homes has added billions of dollars to the nation's
escalating expenditures for health care.
Of the nation's 1.9 million registered nurses, the most ever, at
least 1.5 million are currently working in the profession. But
hospitals and nursing homes still need at least 150,000 more nurses.
Hospitals will spend $3.1 billion this year to recruit and train
nurses, said Carolyne K. Davis, head of a federal commission that is
studying the situation for the secretary of health and human
services, Dr. Otis R. Bowen.
In Boston, where the shortage is especially acute, employment
agencies are asking hospitals to pay commissions of $8,000 to $10,000
for each nurse hired. And Southern California hospitals are paying
the equivalent of $85,000 a year for temporary nurses provided by
For the lack of nurses, many large hospitals, especially in
large cities, have had to take beds temporarily out of service,
forfeiting revenues. For example, the University of Michigan
Hospitals system estimated that it had lost more than $2 million in
net income since October after temporarily leaving 66 beds empty.
There have been cyclical nursing shortages for years. The last
one, in 1979 and 1980, was remedied when nurses' pay scales were
raised, on average, 13 percent. But experts say the current
shortage will be harder to solve because of changes in the health
As the federal system of paying pre-set fees for Medicare
patients took effect in 1983 and 1984, hospital beds were left empty
and some nurses were dismissed. The hiring soon resumed as
hospitals cut payrolls, eliminating medical technicians and aides
while seeking to maintain standards by giving additional duties to
As a result, hospitals are using more registered nurses - about
80 for each 100 patients - than ever before. Nurses are helping to
operate high-technology devices and to monitor the increasing
proportion of patients in intensive-care units.
Davis and other experts have proposed various remedies, starting
with raises, flexible benefits and child-care services for nurses.
New York-area nurses won double-digit increases in recently
signed contracts, raising starting pay to $29,000 - higher than that
of police officers and firefighters. The national average for
beginning nurses is about $22,000.
In the past, most nurses have not received the kinds of rewards
for experience and education that teachers and other professionals