By HANNAH MILLER
     BUCKS COUNTY COURIER TIMES
      April 21, 2000
 

From packed emergency rooms to the homes of the chronically ill, local hospitals are facing the same problem as hospitals across the country: a shortage of as many as 200,000 qualified nurses in the next five years.  The Robert Wood Johnson Foundation projects that in the next 10 years, demand for registered nurses will rise by 18 percent in hospitals, by 30 percent in nursing homes and by 44 percent in public and community clinics.  On the other hand, enrollment in undergraduate nursing programs fell by 5.5 percent this year, the fourth year in a row for a decline, according to the American Association of Colleges of Nursing.  Lower Bucks Hospital, St. Mary Medical Center and Frankford Hospital have responded by offering bonuses to new hires, internships to lure fresh staff and college loan forgiveness programs.  But more often than not, they're turning to "agency" nurses, those who are contracted through a service which is straining an already overtaxed bottom line.  The problem is part bad press and part increased opportunity for nurses and nursing students.  "Four or five years ago, with a lot of the consolidation of hospitals, a lot of jobs were cut in nursing. That got an awful lot of publicity," said Ann McGinn, the interim dean of the Gwynedd-Mercy School of Nursing in Philadelphia. "The word got out that there's not a lot of jobs around. That's changed. But that word has still not filtered down to the public." According to trade publication "Nurseweek," nurses also have more choices these days. Fields such as home health care, occupational therapy and physical therapy are demanding more nurses. At the same time, health care workers can opt to specialize as nurse practitioners or respiratory therapists.  "Nurses have left for insurance companies, pharmaceutical companies, better-paying jobs and more predictable work shifts," said Sheila Bentzel, director of Bayada's Willow Grove office a nursing agency that serves Bucks and Montgomery counties. "Nursing is like being a fireman or policeman. You're working 24 hours, seven days a week."  And students are looking elsewhere for jobs.  "Women with interests in science or technology can now go into the Internet or research," said Bentzel. "The average age of nurses in this country is over 40. Not a lot of young men and women are going into it. The shortage will probably get worse before it gets better." None of the large acute-care hospitals in the area made money last year. Lower Bucks Hospital lost $7 million in 1998, Frankford lost $6 million and St. Mary's lost $2 million, according to the Pennsylvania healthcare Cost Containment Council. Despite this, they are all leaning on expensive outside contractors to fill the empty shifts. St. Mary Medical Center in Middletown, for example, has been using as many as three agency nurses per shift to fill slots in its new cardiac unit. Often they're paid up to $30 an hour more than the staff nurses according to Margery Seltzer, director of nursing at the hospital.  "(Agency nurses) are very expensive. It's a significant cost." said Seltzer. "They are wonderful, hut they are not here often enough to offer continuity of care." Not only is it a burden on a hospital's budget, but some staff nurses say they feel undermined.  "The morale gets poor because they have to hire a lot of agency. There's resentment that the agency nurses get paid more," said Connie Day, a registered nurse at Lower Bucks Hospital in Bristol Township. "The hospital says they're in all kind of financial straits, but this place is full of agency nurses."  Local hospitals and agencies are also offering training or retraining programs to lure nurses back - Bayada in respirator training, Lower Bucks Hospital in critical care and St. Mary Medical Center in surgical nursing.  Lower Bucks Hospital also started an internship program that yielded seven acute-care nurses, all now employed by the hospital. St. Mary Medical Center is planning a re-entry program, a three-month course that acquaints retired nurses with new developments in the field.  "We're going to offer this to 20 to 25 people this spring," said Seltzer. "The technology has changed so quickly - we're walking them through the rough edges of what's changed."  Despite all these efforts, the nurses on the line say they are squeezed tighter than ever.  "There's always one more thing to do: You can always pick up one more thing, they say," said Kathy Lawler, the president of the Nurses Association of Lower Bucks, which represents Lower Bucks Hospital nurses.  "Nurses are stressed and are leaving the bedside. Politicians and insurance companies have to recognize we're losing nurses. This is a worldwide problem."