A severe shortage of RNs has already plunged many hospitals and nursing homes into chaos. And there's no easy fix in sight.

Arkansas is starving for registered nurses. The demand far outstrips the .supply, the most experienced nurses are retired or nearing retirement, and Linda C. Hodges, dean of the University of Arkansas for Medical Sciences' College of Nursing, worries that the dearth of new RNs could mean a catastrophic shortage in coming years.

In Connecticut, the state's RNs are taxed to the max, says Mary W. Hickey, executive director of the Connecticut League for Nursing. Local hospitals and nursing homes couldn't handle a sudden influx of patients. "A flu epidemic would overwhelm our health system right now," she says.

New Jersey families are learning that having a relative or private duty nurse at a loved one's bedside 24/7 is a must if they want to assure good care. Since August 1999, the New Jersey Department of Health and Senior Services has fined 14 hospitals-about one in seven-for not having enough nurses on the floors.

Things are no better in California. "We've had hospital patients call 911 just to get someone to answer their light:" says Kay McVay, president of the California Nurses Association. "It's a very sad state of affairs:"

WWI as aft Is Wd s1 ClI, hk Ii IIW ICS According to the American Nurses Association, the RN population is sparsest in California, Florida, Minnesota, Missouri, Tennessee, and Texas. Atlanta; Columbus, OH; and Denver are among the hardest! hit urban areas, but the problem is spreading nationwide.

What does it mean to you? "The shortage may jeopardize a hospital's ability to provide timely access to nonemergency services," says Dianne Anderson, president of the American Organization of Nurse Executives (AONE). "Some facilities have pared down hospital services, closed beds, put emergency rooms on divert status, delayed elective surgeries, or transferred patients to other hospitals-all for lack of nurses:'

Quality of care is plummeting as well. Two out of five RNs who responded to an ANA survey last year said they were so concerned about the care provided in their facilities that they wouldn't recommend them to a family member.

What's worse, starting in 2011 the first of 77 million baby boomers will become eligible for Medicare. By 2020, with geriatric boomers flooding hospitals in record numbers, the RN workforce-at an estimated 2.7 million-will be nearly 20 percent below projected requirements, an article in JAMA reported last year. "There's growing doubt throughout the health care industry that market forces can bring about a timely adjustment," AONE's Anderson warns.

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Reports of regional nursing shortages emerged about seven years ago, when the Clinton administration was trying to win congressional approval for its health plan and health care costs were soaring at twice the rate of inflation. Hospitals and other health care facilities responded in part by downsizing nursing staffs-which typically consume 20 percent of operating expenses-or substituting less skilled (and less costly) care providers for RNs. At the same time, with managed care restrictions on hospital admissions, inpatients were sicker, requiring more intensive nursing care. Horror stories of bungled care began making newspaper headlines. Connecticut's Hickey allows that 20 percent of an RN's workload can safely be shifted to unlicensed staff in some units. Even so, she adds, 80 percent of the nurses in acute care units and 100 percent in critical care units still need to be RNs, because only RNs are trained in the sophisticated technology used to stabilize and monitor severely ill patients.

Adding fuel to the fire, in 1997 Congress passed the Balanced Budget Act, which slashed Medicare and Medicaid payments to hospitals, nursing homes, and home health care agencies. "BBA eliminated some $700 billion in reimbursements, forcing us to be significantly leaner," says Brandon Melton, vice president of human resources for Catholic Health Initiatives in Denver, which manages 68 hospitals and 50 long-term-care and retirement housing facilities in 22 states. …