Steamboat Springs On her first day as an intern in the emergency room at Yampa Valley Medical Center last week, Steamboat Springs High School senior Brienna Combs stood back and watched as nurses tried to revive a man who had gone into cardiac arrest.
"He didn't make it," Combs said. "I wasn't expecting something like that to happen so quickly. I thought I'd just get a tour of the ER or something. But having witnessed it, I'm pretty sure this is what I want to do."
That's good news to those who are seeing the impacts of a lack of nurses.
"We definitely are experiencing the nursing shortage," local registered nurse Julie Alkema said. "We have several openings. Even if there are nurses who want to work here, and even if the salary is decent, there's the whole affordable housing thing."
A unprecedented worldwide nursing shortage, predicted by a federal report 20 years ago, has a unique face in rural resort communities such as Steamboat, where attracting experienced nurses collides with some of the socioeconomic dynamics of Routt County, to which Alkema referred.
"The standard of living is 42 percent higher in Steamboat than the national average," Northwest Colorado's Visiting Nurse Association Director Sue Birch said. "That makes it awfully difficult for a young single woman to work as a nurse in Routt County."
Combs isn't phased.
"I love interacting with people," she said. "I love sciences: physiology, biology. I've always wanted to be in the medical field and my aunt is a nurse. I decided to do a work study here through school to try it out."
Despite the fact that most of her peers are planning to pursue careers in technology, because, Combs said, that's where all the money is, she said she thinks it's important to stay human and keep in touch with each other.
Combs is an example of what some health care leaders are calling, quite simply, hope.
The state of health care, worldwide, is forcing first-world countries such as the United States to decide what kind of country they want to be, said Pat Uris, a Ph.D. and program administrator of the Colorado Board of Nursing.
"This is our greatest moral crisis," she said. "What kind of human race do we want to be? What do we want to value? Our cars, or the person next us that we love?"
It is anticipated that by 2020, the United States will have a shortage of about 400,000 nurses; that is 20 percent below the projected requirements, according to Patricia Hinton Walker, Ph.D., dean of the University of Colorado School of Nursing.
Although causal factors include graying of the profession the average age of a registered nurse is 41 to 43 as well as declining enrollment in nursing schools and increased salary and benefit issues now available to women, the global shortage of care-givers is reflective of a cultural disease surpassing the scope and framework of modern medicine.
"It'll go to an extreme," said Kathy Yeager, Visiting Nurse Association of Denver's vice president of human resources. "Eventually people will realize not everyone can have a dot-com company. Years ago, all those people that went into nursing school and social work were there for doing good. Now everyone's going to business school. Everybody's in e-commerce."
Uris agreed with Yeager.
"I look on the front page of the paper and see 20-something multimillionaires gone high-tech, drinking champagne in downtown restaurants so expensive I can't even go near them," she said.
"It's a sad commentary on our society," Yeager said. "Does everything have to be 'Net-speed? Couldn't we pause, appreciate quality and care for other people?"
Said Uris: "(The nursing shortage) is reflective of our bigger societal and cultural values. I don't personally agree when people say we can't afford the cost of health care. This country can afford anything it wants. We've chosen to not make health care something we want to pay for. If we have high health care costs, something else has to go."
The phenomenon is by no means exclusive to metropolitan areas. Robin Bragg, a registered nurse at Mercy Medical in the Four Corners area, said the nursing shortage is in part due to young people planning to work for IBM to make $60,000 a year starting salary.
The starting salary for a registered nurse is about $14 to $15 an hour.
Some fast-food workers, Target stores employees, zookeepers, toll-takers and manicurists earn more in spite of the rigorous, challenging education behind a degree in nursing, not to mention a master's or a Ph.D., according to an article in The New York Times in February.
Nor is the phenomenon exclusive to the United States.
Until recently, some Colorado hospitals were hoping to recruit nurses from Europe.
"I think not," Uris said.
Uris, who recently returned from a conference overseas, said she was inundated by media recruiting nurses within the EU.
"Diabetic Made to Sleep on Floor: Fears Over Lack of Nurses," Uris said. "That was the headline in a London paper. And in Ireland, they're telling people over the radio, "We've drastically changed working conditions. If you're an RN, come back.' They're even advertising free re-entry courses for RNs who have quit but are considering work again."
Recruiting nurses from Europe became out of the question, Uris said, when Denver hospitals started receiving requests for verification of Colorado nursing licenses from facilities overseas.
Watching the global picture has made a few things clear to health care professionals such as Uris.
"Europe doesn't talk around the issue of salary," she said. "Nurses have to be paid more."
Kristina Wenzel, project coordinator of the Area Health Education Center in Denver, agreed the most attractive aspect of a position to nurses right now is salary.
"Several hospitals in Denver are in the process of diverting their clients because they don't have the availability of staff or services or beds to serve that individual," Wenzel said. "The shortage right now is really starting to heat up, as is demonstrated first by the increased use of temporary personnel, like traveling nurses."
The second and more severe symptom of a crisis is when facilities can't get traveling nurses and thus can't offer services.
"It's starting to happen in Denver," Wenzel said.
Local registered nurse Alkema said it hasn't gotten to that point in Steamboat.
"We've definitely been on the brink," Alkema said. "But so far it hasn't materialized into diverting clients."
Nevertheless, Alkema said local nurses are being asked to work extra shifts, and that reality means three shifts per pay period.
"Extra shifts and longer shifts is another sign and symptom of the crisis," Wenzel said.
YVMC Director of Nursing Linda Casner said that in spite of how busy the current nursing staff is, the nurse-to-patient ratio is excellent and patient care has not been compromised.
"As a profession, nursing is a very physically demanding and emotionally challenging job," Casner said. "The hospital never closes. Locally, we've experienced some difficulty with recruiting and retaining as has the rest of the country."
It's estimated to cost $20,000 to advertise for, recruit, orient and hire each new nurse, Casner said.
YVMC is advertising for nursing positions throughout the country on Web sites, is trying to keep its pay competitive, offers housing assistance and in the past three to four years has been hiring more new nurses with less experience, and investing time, effort, mentoring and training to increase their knowledge and skill levels.
Given the sheer demographics of baby boomers, especially in a pseudo-retirement area such as Steamboat, Birch said, the nursing crunch is going to get a lot worse before it gets better.
"It's a special calling," she said.