Bedside challenge

Finding workers has gotten a little easier in Orange County in the past year-unless you're a hospital looking for nurses.

The economic downturn and higher unemployment has done little to curb demand for registered nurses at OC hospitals. To find nurses, hospitals are offering sign-on bonuses or payments to their own workers who refer nursing candidates.

Training programs, flexible schedules and even housing help also are being used as lures.

OC's nursing shortage-and the state's. for that matter-is nothing new. But unlike technology's engineer crunch of two years ago, the nursing imbalance hasn't eased at all.

The shortage has become worse in the past two years, according to Marni McCartney, a registered nurse and director of Tenet Healthcare Corp.'s career center, which recruits and trains nurses for Santa Barbara-based Tenet's 10 OC facilities. Tenet counts some 2,500 registered nurses in OC.

"There are still not enough spots in nursing schools to graduate enough nurses to meet the needs, and the work force is much older," McCartney said. "And it's not just nurses retiring, but nurses who decide to cut back on their work time opening up vacancies. It will continue to get worse for several more years."

Tenet is offering sign-on bonuses averaging $3,000 as well as internships and relocation assistance, according to McCartney. The hospital operator also is training nurses from doctors' offices and elsewhere who want to come back to hospitals and is offering flexible work hours, she said.

The shortage is pushing up nursing salaries. Figures from the California Employment Development Department show OC registered nurses earned a mean annual wage of $53,462 in 2001, up from $50,810 in 1998.

Last fall, Children's Hospital of Orange County gave registered nurses who work with patients a 7% across-the-board raise, said Suzie Reinsvold, the hospital's vice president of patient care and chief nurse executive.

CHOC employs around 400 registered nurses at its main facility in Orange and at its satellite facility in Mission Viejo.

Another issue that could have an impact on the nursing shortage: the tentative contract pact between the University of California's medical centers, including UCI Medical Center in Orange, and the California Nurses Association.

Nurses represented by the association emerged with several concessions, including the end of the university medical centers' merit pay system, which the association argued relied on subjective evaluations of nurses' performance.

"I think this will encourage nurses to look at (the association) as an organization that protects their interests," said Maureen Berry, a registered nurse at UCI Medical Center and union representative.

UCI Medical Center, which employs some 800 registered nurses, is the only OC hospital that has California Nurses Association representation.

"During a competitive market, other organizations always are concerned about what the next person's doing," said Lisa Reiser, UCI Medical Center's associate director of acute care services and chief nursing officer.

As for recruiting, UCI uses sign-on and referral bonuses, works with nursing schools, runs a mentorship program for graduates and dispatches nurses to conferences, Reiser said.

"Our own nurses are our best recruiting tool," she said.

Back in November. when the California Nurses Association reached pacts with five Los Angeles-area Catholic Healthcare West hospitals, some predicted that other hospitals could end up anteing up-- whether they were union or not.

But some OC nursing managers downplay the recent union pacts.

"We don't feel additional pressure based on the UCI settlement," said Dale Vital, vice president of patient services and chief nursing officer at Orange Coast Memorial Medical Center, Fountain Valley. "I have a lot of loyal nurses here, they like working for Orange Coast. We have a lot of long-termers here, so I haven't felt that pressure (from) the UCI decision."

Orange Coast Memorial is one of three local hospitals owned by Memorial Health Services of Long Beach, and employs around 250 registered nurses.

Orange Coast Memorial's recruiting tools include salary increases, continuing education and scheduling, Vital said. The hospital pays bonuses to its own nurses who recommend candidates and to those who work extra shifts, rather than using temporary labor, she said.

Tenet's McCartney said her company continually looks at benefits to stay competitive.

"What's interesting is that our salaries have always been better than UCI and continue to be," she said.

But McCartney also offered this take on unionization: "I went to nursing school in Oregon, where just about every hospital is a union hospital. I'm very disenchanted with it from my early days in nursing, so that's my own perspective."

McCartney said if management listens to the needs of its nurses, "then the need to organize isn't really there."

The UCI issue "will not have a major impact on us," said Rick Martin, vice president of patient care services at Hoag Memorial Hospital Presbyterian in Newport Beach. "We have good pay and a very high staffing level. We want to be ahead, not do things as a knee-- jerk push from the market."

Hoag employs some 900 registered nurses. As for recruiting, Hoag uses referral bonuses for employees who refer a qualified registered nurse. Any hospital employee is eligible for the bonus, Martin said.

"We'd rather give (bonus money) to our own employees" than give it to "job-hoppers," he said.

Hoag has hired 60 to 70 registered nurses in the past year under the referral plan.

"I think all hospitals, whether they are unionized or not, are finding themselves in a position of constantly having to evaluate their salary, benefits, work environment," CHOC's Reinsvold said.

The pediatric hospital's tactics for nurse recruitment and retention include launching a graduate internship program later this summer, with room for up to 20 people and meeting staffing ratios suggested by Gov. Gray Davis.

CHOC also offers sign-on bonuses of $2,500 for nurses who work day shifts and $3,000 for night-shift nurses, Reinsvold said. Finding pediatric nurses, according to Reinsvold, is more challenging because only 6% of the some 260,000 registered nurses in California work in that area.

But, Reinsvold said, "We are actually trying to see if there are nurses who work in the adult setting who might be interested in coming into pediatrics."

At St. Joseph Health System, "what's going on at UCI doesn't necessarily impact us-a nursing shortage is a nursing shortage," said Cindra Syverson, senior vice president of human resources for the Orange-based system with three local hospitals.

St. Joseph employs 1,400 registered nurses at St. Joseph Hospital-Orange, St. Jude Medical Center in Fullerton and Mission Hospital Medical Center in Mission Viejo.

Nursing shortages have put "significant pressure" on St. Joseph, Syverson said, particularly when it comes to base salaries.

Market wages are moving quickly, she said, and because of that, "it seems like every time we turn around, we've got to do some equity adjustments to make sure our nurses are paid competitively."

At St. Joseph, nurse recruiting includes sign-on bonuses or getting into a housing lease, Syverson said, describing the situation as "like a menu."

St. Joseph also is piloting a program that allows people who are studying nursing or other health-related occupations to work and go to school at the same time at Mission, she said.