In 1983, the Institute of Medicine sent a special report to the Congress that forecast there would be plenty of nurses for the rest of the decade.
The prediction, virtually everyone now agrees, was wrong.
Anyone who picks up the want ads of this newspaper any weekend can see that nurses are very much in demand and that there apparently aren't enough of them--at least at the salaries currently being offered.
"There very definitely is a shortage in the nurse arena," said Alan Ewalt, senior vice president of human resources for Los Angeles-based National Medical Enterprises, a company that employs 15,000 nurses in 500 facilities around the country.
"We feel this very definitely in the recruiting process, where we have a number of vacant positions we are unable to fill," he said. It takes the average hospital 60 days to recruit one new medical-surgical nurse, he noted, and 90 days to recruit a critical-care nurse.
Boom and bust, gluts and shortages. It has happened with teachers, it has happened with engineers, and it is certainly a situation that nurses have come to know well.
And at the same time that nurses are in demand, the job of nursing itself has become more demanding.
One reason has been the federal government and its efforts to reduce hospital costs. New regulations seek to limit hospital stays to only the minimum time necessary for treatment. As a result, hospital patients tend to be sicker, they need more care and the pressure on nurses is more intense.
And as hospital nursing has become more intense, the alternatives for nurses have increased. There is a greater need for home health care, and more nurses work through so-called nursing registries, which are in essence personnel brokers for hospitals.
Ewalt of National Medical Enterprises said he is particularly concerned about the growing use of registry nurses. "If it continues at the present rate," he said, "it will be disastrous for the industry."
But one labor expert suggests that hospitals can--to some degree--blame themselves for what is happening. Daniel J. B. Mitchell, director of the Institute of Industrial Relations at UCLA notes that hospitals have traditionally been the predominate employer in the market. As a result, he said, it has been in their interest to hold down wages.
"Hospitals are a monopsony in the labor market," he said. A monopsony is the word economists use to describe a situation in which there is only one buyer for a particular commodity or service. As a result,he said, the buyer--in this case, hospitals--have abnormal ability to control wages. "If you're a nurse, there's not that many kinds of alternative employment," Mitchell said. "It's not like the market for secretaries."
Ewalt of National Medical Enterprises acknowledged that "we need to get the income levels up so people find a nursing career financially attractive over other alternatives."
But he also said the pressures from government to keep wages down is a significant impediment to improving salaries to the point where a significantly greater number of people would want to become nurses. He would not try to predict when those conflicting pressures would be reduced.
Richard Belous, an economist with the Conference Board, a business research organization, said the changing situation of women workers and other so-called "external factors" also have been causes of the shortage.
"All of a sudden, women have other occupational choices, not just becoming teachers or nurses," he said. "You're seeing the supply going down."
There are other significant causes, as well, said Ewalt. In the early part of the decade, he said, there was "an abundance of nurses, and we dropped our guard, the nursing profession dropped its guard." He said there were some inaccurate forecasts about future supplies of nurses, a reference to the Institute of Medicine study. The institute is part of the National Academy of Sciences in Washington, D.C.
The study said no specific federal support was needed to increase the supply of registered nurses because the aggregate supply and demand would be in reasonable balance the rest of the decade, Ewalt said.
"This resulted in a major decline in support for nursing education," Ewalt said. "Federal funding support for nursing education fell from $150 million in 1973 to $53 million in 1987," he said.
By 1986, he said, a new study predicted that requirements for full-time nurses with bachelor's degrees would be about twice the projected supply for 1990 and 2000.
On the demand side, Belous said employers are now faced with spending reduction pressure from government agencies concerned about the costs of Medicare, prompting hospital administrators to try to hold down wages.
To attempt to respond to the problem, some employers have endeavored to increase supply by hiring people with fewer skills than normal, starting them at a lower rank and then trying to train and upgrade them over time, Belous said.