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Itinerant Nurses Fill Growing Shortages at State's Hospitals

Institutions must use an expanding industry or turn patients away. For nurses, benefits range from higher pay to rental cars.

October 27, 2002|Carol Pogash | Special to The Times

BERKELEY — The blond, pony-tailed nurse bustled her way through the relatives to the patient's bedside: "How y'all doing today?"

"Y'all"? In Berkeley?

But for the Southern accents and the "y'alls" heard in California hospitals, patients might not know of the migration of nurses from the South to large states like California, and New York.Like thousands of other nurses, Courtney Carruba, who had never been out of the South, is taking advantage of a national nursing shortage.

Having temporarily left her husband, an operating room supervisor, back in Birmingham, Ala., Carruba and her sister have done stints in Merced, Oakland, Chico and Berkeley.

On her days off, she races to Lassen National Park, Lake Tahoe, Monterey or Santa Cruz, which she did after an all-night shift, hitting the beach on no sleep. Having accumulated a lot of loans while in nursing school, the 27-year-old Carruba uses the fatter paycheck to pay them back. In Alabama, she made $19 an hour. In Northern California she earns $30 to $40 an hour. If she headed for Los Angeles, she could make $34 to $43 an hour with the largest company in the business, AMN Healthcare Services. In this burgeoning industry, traveling nurse companies can offer furnished apartments in safe neighborhoods, utilities, health clubs, travel expenses, rental cars, 401(k)s and health benefits.

With an estimated 126,000 nursing jobs going unfilled in the country, and the prospect of that number doubling in 10 years, traveling nurses -- as well as traveling health-care workers such as X-ray technicians -- is a growth industry.

Cross Country Inc. of Boca Raton, Fla., is on NASDAQ; AMN Healthcare Services of San Diego, which went public one year ago and has an estimated 35% to 40% of the market, is traded on the New York Stock Exchange. Its success is based on the premise, expressed by its chief executive officer, Steve Francis, that "it's good to have a nurse rather than a bed not staffed, because there's no revenue coming out of a bed not staffed." The choice is that simple: Hospitals can either hire traveling nurses (or even more costly per diem nurses) or turn patients away. Some nights at Enloe Hospital in Chico, Carruba said, the only other people she worked with were traveling nurses. The agency that hired her, On Assignment Inc. of Calabasas, draws the bulk of its traveling nurses from the South, where salaries are much lower.

And how does a hospital's permanent staff feel about the travelers? Scott Meyerson, an Alta Bates Medical Center critical care nurse, is far from threatened: "You have a pulse? Wow. You want to work? We're thrilled."

"We know if we don't have them," said Denise Navellier, patient care manager at the hospital, "then we don't have anyone."

However, the California Nurses Assn., representing 45,000 registered nurses, believes that quality can be eroded if a hospital staff is not stable.

When the nurses know the staff, the policies and procedures of a hospital, said spokesman Charles Idelson, "the atmosphere is more conducive to reducing medical errors and enhancing the general environment for patient care." Using regularly scheduled staff rather than traveling nurses "is more cost effective and more care effective."

With 585 registered nurses per 100,000 people, California ranks 49th in the 50 states -- only Nevada has a lower ratio, according to Jan Emerson, vice president of external affairs for the California Healthcare Assn. Massachusetts is at the top, with 1,190 nurses per 100,000 people.

With the average California nurse now 47 years old and thinking of retirement, and with state-mandated patient-nurse ratios for all units of all hospitals to take effect in 2004, the shortage will grow.

By 2010, Emerson said, the state will need an additional 109,000 nurses, according to the state Economic Development Department. None of the University of California campuses offers a degree in nursing, and the University of Southern California recently closed its program, she said.

"Nursing programs did not bring it academic prestige," Emerson said. (A USC spokeswoman said the program was too costly and couldn't compete with less expensive programs offered by community colleges.)

Traveling nurses are likely to be essential for meeting required ratios. But the costs are significant.

For the traveling nurses, the offers can be irresistible.

"There aren't unions in Texas," said Annjeanette "Angi" Domasig. After 11 years in Dallas, where she earned $21 an hour at most, she's working for 13 weeks in Berkeley, where she earns $28 an hour and receives a free apartment. The cost of paying a traveling nurse $28 an hour plus the added benefits an agency provides can cost a California hospital from $48 to more than $110 an hour, according to Ginnie Kosmin, manager of patient care resources at Alta Bates Medical Center.

That can be two to three times as much as permanent nurses cost at a time "when 66% of California hospitals are currently operating in the red," Emerson said.

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