Steamboat Springs When Carrie Marshall graduated last May, she had her pick of jobs. While the rest of the work force was going through layoffs, Marshall got to decide which package of benefits including signing bonuses, paid moving expenses and the opportunity of quick advancement best met her needs.
Welcome to the world of nursing and health-care professionals.
At 24 and as a certified registered nurse, Marshall is a rare commodity in a profession where the average nurse is nearing 50 and hospitals have resorted to recruiting tactics such as calling competitors' nurses during working hours.
Nation-, state- and countywide, hospitals and health-care offices are suffering from a nursing shortage. And it's a problem local health administrators fear will only get worse.
Jan Fritz, the director of home care and hospice for the Visiting Nurse Association, sees her staff growing older and fewer younger nurses available. That leaves her to wonder what the landscape will be like in the next few decades.
"We always joke about who is going to be taking care of us when we need nursing. We'll all be nursing at 82-and-a-half, just trying to take care of each other," Fritz said.
A native New Yorker, Marshall decided to move to Colorado after graduating last spring. She searched for jobs on the Internet and was hired by Yampa Valley Medical Center as a labor and delivery nurse.
Despite the high cost of living, Marshall said she came to Steamboat for its outdoor life and the medical center's patient-to-nurse ratio.
Those two factors help keep Steamboat's nursing shortage less severe than other rural areas around the state, medical center CEO Karl Gills said. Steamboat is in the five-county Northwest Colorado region that has the lowest ratio of nurses per capita in the state.
"In comparison to other rural areas as well as nationally, we're in very, very good shape," Gills said. "We live in a beautiful area and that is a big draw. And we feel like we have a safe and good (patient-to-nurse) ratio."
Medical center nursing director Linda Casner said about 4 percent of the center's nursing staff's 108 positions are vacant and it could take up to a year to fill them.
Fritz has similar problems filling positions for nurses. As the second-biggest nursing employer in the county, the VNA has 25 nurses and advertises as far as Grand Junction and Denver when vacancies come up.
"It could be six months to a year to fill a vacancy. We just know it is going to take a long time," Fritz said.
Not only nurses are in high demand. Finding other health-care professionals such as pharmacists, radiation technicians and lab technicians can be difficult.
Bill Moore, who came from Denver three months ago, wanted to move his family out of the urban area and Steamboat seemed like a good fit. But as the director of the respiratory therapy unit, he has been unable to fill two of five positions open since his arrival.
"We've had very little response to any ads. And the little response we have gotten just about everybody has walked out the door once they understand what we pay versus cost of living," Moore said.
Casner said competition for nursing and other health professionals has turned "cutthroat," particularly in urban areas. Gills told tales of hospitals calling their competitors' nurses at work and offering 70 cents more per hour if they would come work for them across town.
With signing bonuses, paying agencies to contract nurses for three months at a time and attracting the competitors' employees, Casner said hospitals are putting short-term fixes on complex problems.
"Trading short term for long term is not the best idea. It costs a lot of money and eventually, they'll not be able to support it," she said.
The medical center's base salary for an RN ranges from $38,000 to $59,000, a figure that is comparable to the Front Range, Gills said. Unlike other hospitals, the medical center does not offer specific signing bonuses to attract nurses. But it does pay for relocation costs and assists in finding housing.
The task of offering incentives is compounded for hospice and homecare program administrators like Fritz. Almost 70 percent of VNA patients are on Medicare.
Fritz said it's not just the lack of signing bonuses VNA has to combat, but lower salaries, expensive health-care benefits and Steamboat's high cost of living.
"Cost of living, wages and insurance, those are the big questions," Fritz said. "About a year ago we had a manager's position open. We had a lot of calls. But after I would answer those three questions, it was 'thank you very much' and they didn't want the job."
Nursing supplies have been cyclical in the past 30 years with heavy demand in the early 1980s and a surplus in the early 1990s. But administrators say they see the demand only worsening in the next decade.
The average age of a nurse in Colorado is 47, and as the baby boomers begin to retire, the population of older patients needing care will keep increasing. The average age of the nurses at the medical center, Casner said, is 43.
A study from the National Careforce Consulting Group estimates that by 2010, 40 percent of all RNs will be 50 or older and RNs under the age of 30 dropped 41 percent between 1983 and 1998, compared to a 1 percent drop in the total work force.
"It's not going to get better in the foreseeable future," Casner said. "With the retirement of the baby boomers, there'll be a much older population. It'll be a big inverted pyramid with fewer younger people (in health care) and the older populations' health-care needs increasing. There is going to be a need for more medical care in general."
Just a decade ago, nurses were in lower demand as hospital restructuring began. When managed-care programs increased, patients' stays in hospitals decreased, more outpatient surgery was done and care shifted to lower-cost nursing facilities and home care.
The number of beds used in community hospitals decreased by 15 percent from 1985 to 1994. The result was nursing layoffs, fewer nurses hired and eventually declining enrollment in nursing schools.
Marilyn Bouldin, the VNA's director of community care, believes now is the time for more nursing programs.
The closest nursing school is in Glenwood Springs. Bouldin said Colorado Northwestern Community College is in the beginning stages of looking into creating a facility in Craig that could train nurses from Meeker to Oak Creek. Bouldin said the college agreed about a month ago to put some money into exploring the possibility of starting a nursing school.
But creating such a program could be difficult.
"One of the problems that we are having in training and educating new nurses is the ability to keep faculty to educate them. There aren't enough new people in the work force to replace (the instructors)," she said.
Nursing and teaching were traditional career paths for women in the 1950s and 1960s, but the women's movement progressed and so did job opportunities with bigger pay scales.
As the bulk of women who began their careers as nurses prior to 1970 begin to retire, the younger generations are not following in their footsteps.
Like many young females, Marshall almost did not take the nursing path. She spent her first years out of high school in a New York state college studying to become a physicist. "I wanted to say I was a physicist. I didn't want to say that I wanted to be a nurse," Marshall said.
But after three years of physics, Marshall decided she wanted to work with people, not with math problems, and she enrolled in the Crouse Hospital Nursing School.
"I was studying physics and realized I was doing it for the wrong reasons," Marshall said. "I wanted to just make enough money doing whatever I enjoyed doing."
Local and state nursing agencies have begun to institute programs that target high school and middle school students. VNA had a booth at the local Girls to Women, Women to Girls, career fair to encourage the nursing. And the Western Colorado Area Health Education Center has a program that takes juniors and seniors in high school on a two-day trip to shadow nurses.
Changing a younger generation's perception of nursing is one way of solving the shortage, Bouldin said. It worked for Marshall. "Everybody told me not to be a nurse because nurses are over worked and underpaid," Marshall said. "I knew that coming into it. But, there are so many other benefits."