Sides Differ On How To Address Nursing Shortage

April 12, 2002
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GRAND RAPIDS — Legislation in Lansing to create nursing scholarships as a way to lure more people into the profession should earn easy legislative approval by this summer, the proposal’s main sponsor says.

State Sen. John Schwarz’s bill would amend the state’s Merit Award Scholarship Act — funded with proceeds from the state’s $8.5 billion, 25-year tobacco settlement — to allow funding for nursing scholarships and provide a new financial incentive designed to stem an emerging nursing shortage crisis.

As a practicing physician, Schwarz introduced the measure after seeing the profession’s ranks dwindle over the years. He anticipates the bill, now pending in the Senate Health Policy Committee, will clear the Legislature and go to Gov. John Engler by the time lawmakers break for this summer recess in June.

“It’s one of those places where the government ought to step in and create incentives and that’s what we’re trying to do,” said Schwarz, R-Battle Creek. “I’d be very surprised if the act itself is not on the governor’s desk by the end of the spring session.”

Under the bill, full- or part-time students pursuing a nursing career could receive a scholarship of up to $4,000 annually for four academic years as they work toward a degree or certification. Receiving a scholarship from the state does not preclude a nursing student from obtaining other financial assistance elsewhere.

In exchange for the scholarship, a student would have to obtain their state nursing license within a year of graduation and agree to work full time in the state for one year for every year of scholarship received. If they do not, they would have to repay all or part of the scholarship award, plus interest.

That service requirement is one reason why the state’s largest nursing union does not favor the bill. While supportive of the concept of scholarships to draw more people into the profession and address the nursing shortage, the Michigan Nurses Association refers to the service provision as an “indentured servitude approach” that does not recognize changes in a person’s lifestyle that may occur after they graduate — marriage or childbirth, for example — and prevent them from meeting the requirement.

“The concern is, it’s just not reasonable for them to have expectations where they’re going to be in five years,” said Carol Feuss, the association’s director of communications and marketing.

“The money is good. We just have to lose some of the strings attached,” Feuss said.

Schwarz, however, is unsympathetic to those concerns. Service requirements are common in the business world when corporations help cover the cost of an employee’s continued college education. There’s no reason to structure the state nursing scholarships any differently, he said.

“It seems to me that it is not inappropriate for the state to ask that individual to stay in the state of Michigan,” Schwarz said. “I’m hearing them but I’m not terribly sympathetic. This seems to be a pretty good deal.”

Schwarz previously secured $4 million in funding for the first year of scholarships through an appropriation in the state’s higher education budget for the 2003 fiscal year that starts Oct. 1.

The legislation is the senator’s way of beginning to address the nursing shortage that is expected to worsen over the next 10 to 20 years.

The U.S. Bureau of Labor Statistics forecasts that the nation is facing a shortage of 1 million nurses by 2010, as nurses retire or leave the profession. And, fewer people are expected to enter the profession because of poor and stressful working conditions, as well as new career opportunities that await women — who make up a vast majority of the profession’s ranks. The shortage will come at a time when nurses are needed the most, as baby boomers hit their retirement years and require a higher level of care.

In Michigan, nearly two-thirds of registered nurses are more than 40 years old. Fifteen percent are 55 and older, according to a study conducted and published last July by the Michigan Department of Consumer and Industry Services.

The study states that already more than half of the hospitals responding to a survey were having an “extremely difficult” or “very difficult” time filling nursing vacancies where critical medical care is delivered. The study called for stepped-up efforts for partnerships between nursing schools and employers to improve the working environment for nurses and to recruit talent.

The conditions in Michigan follow national trends of fewer people opting to enter the profession, causing the existing pool to dwindle. Enrollments at state nursing schools have declined steadily in recent years, again mirroring national trends that only just recently showed any hint of abating.

Reflecting a heightened awareness of the national shortage and efforts to address it, enrollments at the 548 nursing schools in the U.S. with bachelor’s and graduate-degree programs increased 3.7 percent last fall over 2000, to 106,557.

While the increase ended a six-year decline, the enrollment level is still well below the 127,683 students of 1995 and “remains insufficient to meet the projected demand” for nurses over the next 10 years, the American Association of Colleges of Nursing reported. More than a third of the schools surveyed reported no change or declines from their 2000 enrollments.

Grand Valley State University’s Kirkhof School of Nursing has been an exception to that trend and saw its enrollment grow by 30 percent last fall to 140 students, Kirkhof School Dean Phyllis Gendler said.

Even with the slight upward trend recorded nationally last fall, Gendler says the profession has a long way to go. She points out that the number of people taking nursing licensing exams fell from 96,438 in 1995 to 71,393 in 2000.

While many parties call for increased public and private funding for scholarships, increasing the capacity for nursing education, and initiatives to improve the profession’s image and working conditions, Gendler believes answers to the impending crisis are far deeper.

The shortage is across all disciplines of the profession, she said. To address it requires health care providers to look at how they deliver care, what role nurses play in the delivery system and how it can become better and more efficient.

“I don’t think we can graduate enough nurses to replace those that are retiring if we graduate them into the present health care system the way it is designed,” Gendler said during the Alliance for Health’s monthly First Friday Forum on April 5 that was dedicated to the nursing shortage.           

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