Ask hospital administrators about the biggest challenge currently facing Nevada’s hospitals and the reply is nearly unanimous — recruitment and retention of qualified nurses to staff their institutions. Indeed, according to a recent survey of 20 state hospitals conducted by the Nevada Hospital Association (NHA), a non-profit statewide advocacy group, hospitals are spending literally millions of dollars just to recruit and retain their nursing staffs. The shortage for some institutions has become so severe that they are increasingly being forced to go on what is known as “divert status.” When that occurs, hospitals must send emergency vehicles carrying trauma patients to other area hospitals with the staff to handle the crunch.
While no critically ill patients are being turned away at any of Nevada’s hospitals, some medical experts familiar with Las Vegas’ emergency room situation regard it as one of the worst in the country. And the state’s nursing shortage — which includes registered nurses, licensed practical nurses and certified nursing assistants — is expected to worsen in the coming few years. By 2006, it’s projected that the number of nurses needed to adequately staff hospitals throughout the state will soar to 16,600. That’s up significantly from about 10,000 in 1996. The demand is expected to result in Nevada hospitals posting more than 700 available nursing positions annually for the next six years. And those job listings will be in addition to hundreds of openings for licensed practical nurses and certified nursing assistants.
Hospital administrators cite a number of reasons for the current shortage, including the fact that fewer women, who still dominate the profession, are choosing nursing for a career. “Essentially, over the years, there have been more professional possibilities for women in our society. That’s been happening at the very same time that the healthcare industry has been expanding,” said Jim Miller, president and chief executive officer of the Washoe Health System in Reno, which serves as an umbrella group for a consortium of healthcare services in Northern Nevada.
Historically, nurses couldn’t look much beyond the traditional hospital setting for employment, but the growth and technological advances that have occurred in the healthcare industry throughout the past decade have produced new job opportunities for nurses outside of hospitals. These include home healthcare, hospice programs that treat the terminally ill, outpatient clinics and diagnostic imaging centers. Most of these positions enable nurses to work more flexible hours than hospitals, which must provide round-the-clock patient care seven days a week. The care that nurses are providing in the traditional hospital setting has become much more intense, due in part to the health insurance industry’s push to get hospitals to cut costs and provide more services in outpatient clinics. “That means the patients who are admitted [to the hospital] are much sicker than they were in years past, and they require more nursing staff who have to provide a much higher level of care,” Miller said.
Nurses are not the only professionals hospitals find in short supply. A. Allan Stipe, president and chief executive officer of Sunrise and MountainView hospitals in Las Vegas, says the industry also needs more qualified pharmacists, lab technicians and diagnostic imaging specialists. “It’s definitely going to be the leading challenge for all of us in the next several years,” he said. According to Jeff K. Bills, president and CEO of St. Mary’s Hospital in Reno, “Hospitals are a community resource — and people are the most important part of that resource.”
At the same time hospitals have been scrambling to find qualified nurses and other professionals, the state’s population has been soaring. Washoe’s Miller said Northern Nevada’s growth has been less troubling for hospitals in that region since growth has been occurring at a slower pace than in Southern Nevada. “It’s made it easier for us. And we’ve been very fortunate that people who move to our community stay here. You rarely find a hospital in Reno diverting patients,” Miller said.
Meanwhile, Las Vegas and Henderson have consistently ranked as two of the fastest-growing areas in the country. Clark County’s population has soared from about 1.2 million people a few years ago to nearly 1.4 million today. That population surge includes a larger percentage of retired persons who tend to utilize healthcare systems more frequently than younger residents. All of this growth has resulted in a huge influx of new patients for area institutions. At the University Medical Center of Southern Nevada (UMC), for example, the hospital’s outpatient and inpatient services combined are annually serving some 800,000 people. That’s up from 250,000 people seven years ago when William Hale took over as chief executive officer of UMC. Since his arrival, Hale estimates that daily hospital admissions have jumped from 340 per day to about 450. At the two campuses of St. Rose Dominican Hospital, which serve the southeast portion of the Las Vegas Valley, emergency room visits are expected to reach 60,000 by this June, double the number from June 2000, before its Siena campus opened.
In an effort to keep pace with the explosive growth, Nevada hospitals are spending hundreds of millions of dollars to expand current operations and build new facilities. In Reno, Washoe Health System is embarking on a $3 million to $5 million expansion of its pediatric intensive care unit, Northern Nevada’s sole intensive care facility for children. Saint Mary’s is building Galena Health Center, an outpatient hospital, and is planning a major renovation and expansion of its Regional Medical Center.
In Southern Nevada, Sunrise and MountainView hospitals recently spent more than $70 million to expand numerous departments and add another 72 beds to their Las Vegas operations, which now boast more than 800 beds. Valley Health Systems Hospitals, which include Desert Springs, Valley and Summerlin hospitals, recently spent $95 million for the construction of Summerlin Hospital and additional beds at Desert Springs. St. Rose Dominican Hospital has invested $150 million to build a new hospital campus and expand its medical operations as well. HealthSouth, a Birmingham, Ala.-based healthcare concern, has spent about $40 million the past two years building two additional rehabilitation hospitals in Las Vegas where it will soon have three institutions. Hospital administrator Richard Knowland said it’s likely Southern Nevada’s growth will prompt HealthSouth to build several more hospitals to serve the Las Vegas Valley in the future. Meanwhile, UMC is expected to spend more than $100 million in the coming few years to upgrade and expand its operations. “I don’t think there is any other community in America that is building hospitals as quickly as we are in Las Vegas,” said Karla Perez, chief executive officer and managing director of Desert Springs Hospital. Other hospital administrators say Nevada institutions will continue to be pressured to expand operations in the coming years as well. “We will have to [expand] if we want to meet the demands of a growing community and the new fields in specialized healthcare,” Stipe said.
As if the state’s growth isn’t a big enough headache, hospitals are also feeling the financial pinch from providing care for a larger number of uninsured patients. Currently, it is estimated that nearly 18 percent of the state’s entire population, about 350,000 people, have no health insurance. “Nevada’s uninsured rate ranks as one of the top five or six in the nation,” noted UMC’s Hale, who worries that an economic downturn could cause those numbers to grow substantially. “A lot of smaller employers in Nevada are already unable to provide health insurance to their employees because of costs. And the economy is sound.” According to a state study, hospitals spent more than $125 million in 1999 providing services for Nevada’s uninsured. Desert Spring’s Perez said the uninsured population is just one variable in hospitals’ increasing “cost-of-caring” equation.
Technological advances in healthcare are also pushing up costs. New and safer methods used to process blood, for instance, have caused costs to jump 40 percent. Still, hospital administrators say they welcome the technologies since they ultimately benefit patients. New surgical techniques, for instance, allow doctors to perform less invasive operations that allow for a much quicker recovery period. Today, some open-heart surgical procedures can be done by making just a small incision, and the patient can be discharged within a matter of several days. Years ago, that would have been unthinkable. Improvements in technology are also making it possible for many surgeries to be performed on an outpatient basis. “I really think that 10 years from now, only the acutely ill will be admitted to hospitals. They really will be operating as large critical care units, which will also result in higher costs,” Perez said.
Hospitals’ coffers are also being tapped by recent federal legislation that mandates that institutions upgrade and improve the systems used to compile and maintain patient records. “We are going to have to implement a new level of discipline in the way we manage patient information,” said Rod Davis, president and chief executive officer of St. Rose Dominican Hospital. “We will have to have new tracking mechanisms in place to ensure patient privacy, which is good. But again, it’s going to be very expensive.” According to the American Hospital Association, the government’s Health Insurance Portability and Accountability Act will cost hospitals anywhere from $10 billion to $20 billion in the coming five years. “Many of the new systems that we are putting in place require a lot more paperwork and are very labor-intensive,” Perez said.
While the cost issues facing Nevada hospitals may seem daunting, administrators say the state’s growth has helped to keep hospital occupancy rates high and bring in much-needed revenue. “In a lot of markets, the population has been decreasing and hospitals are facing financial troubles due to low occupancy rates. That’s definitely not the problem here,” Stipe said. “We generally have an occupancy rate as high as 99 percent,” added HealthSouth’s Knowland. “In fact there’s a waiting list to get into our facilities,” he said.
Nevada hospitals are also getting some financial relief from the federal government’s recent decision to increase certain reimbursement rates for services hospitals provide to patients insured by Medicare. Several years ago, hospitals were adamant in their complaints that reimbursement rates were so low they often failed to cover actual costs incurred. “A consortium of hospitals nationwide got the government to take another look at the reduction in rates, and it has taken steps to improve the system,” Stipe said.
Meanwhile, it’s critical that hospitals work with public agencies and private community groups to help solve the state’s nursing shortage, says Bill Welch, NHA’s president and chief executive officer. Most institutions already have aggressive recruitment and retention efforts in place. “Recruiting and retaining skilled employees is our lifeblood,” said Bills of St. Mary’s Hospital. “We continually ensure that we offer exceptional wages and salaries as well as benefit and paid-time-off plans.” Other efforts include domestic and international recruitment programs in which hospitals routinely offer to pay for relocation costs, provide sign-on bonuses and other perks to lure nurses to their institutions. Several Nevada hospitals also provide scholarships to local high school students interested in pursuing the profession. Hospital personnel frequently visit Nevada schools where they try to encourage more people to enter the profession as well. Welch says that hospitals need to seriously examine what changes need to be implemented to make nursing a more appealing profession for young people.
In addition, adequate funding needs to be provided to state schools that offer nursing programs. It is estimated that the state’s eight nursing programs will graduate just 353 registered nurses in 2001, while Nevada hospitals will have openings for more than 700 nurses. According to Welch, “This is not just a perceived shortage. It’s very real. And everyone, including the community, will be impacted unless we come together and work collaboratively to ensure these things happen.”
