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As the need for nurses swells, the foreign-born step up

As the need for nurses swells, the foreign-born step up
By Paula Bock

The Seattle Times


TACOMA, Wash. - Of all the differences between hospital life in her native Philippines and here, in Washington state, one in particular has stuck with Maricris Espino, R.N.

It's not so much the salary (though she earns in two days the equivalent of a month's wages in her home country), or the technology (I.V. pumps, fancy electric beds), or the hospital hierarchy in which nurses examine patients and make suggestions to doctors.

What so often strikes Espino when she walks into a patient's room is that they're alone.

In the Philippines, patients are almost never alone. Their bedsides are cluttered with relatives to help with baths, meals, brushing teeth. The hospital wards are filled with the aroma of chicken adobo and pork asado brought in from home or a favorite hawker's cart rather than carefully calculated portions of antiseptic hospital food.

"In the Philippines," Espino recalls, "you don't have someone coming up to the nurses' station to say, 'My mom has to go to the bathroom.' Here, the concept is different. Even if the family is in the room, they won't touch their parents. They're not going to clean up the father or mother. Maybe they're afraid they're going to drop the patient. Or partly it's culture. In the Philippines, (patients) would prefer their daughter is going to see them naked rather than other people. Here, they'd prefer a nurse.

"Here, I do everything. Give them medication. Take them to the bathroom. Give them a bath. I don't mind, but y'know, I feel sorry for the patients who have nobody. ... When my mom was sick, we did everything."

Three years ago, Espino left her homeland and her dying diabetic mother to start a new job and a new life as a nurse at Allenmore Hospital in Tacoma, Wash. She was 31, a wife, a mother of two, the only sibling with the earning potential to pay her mom's medical bills.

"My presence there would have filled up her loneliness," Espino says, "but I could see I have my family to take care of. And I knew she was going to get even sicker eventually and I would have to pay for it."

Espino was one of 47 nurses recruited from the Philippines to relieve staffing shortages at two of MultiCare Health System's hospitals in Tacoma.

"We had a significant nursing vacancy and we were planning for our future as well," says Rita Wilson, who then led MultiCare's nurse-recruiting program. "Our nursing population is getting older. We had to do something so we'd have a steady stream coming in."

Nursing shortages are nothing new. Since World War II, the United States has experienced a nursing shortage every 10 years or so. But this one is different. It's expected to cut deeper and last longer because it's caused primarily by demographics rather than economics, says Linda Tieman, executive director of the Washington Center for Nursing, a private nonprofit focused on making sure Washington state has enough nurses.

Washington has 71,755 registered nurses - 5,160 short of what's needed. Looking ahead is even more alarming. If nothing is done, the state will be down 30,000 nurses by 2020, according to the Washington State Nurses Association.

Nationally, if trends continue, the country will be short 275,000 nurses by 2010. Federal estimates project the nation will need to train or recruit at least 800,000 nurses by 2020 to keep up with nurse retirements and a growing need as baby boomers age and require more medical care.

"The reality is that we aren't going to be able to do that," says Cheryl Peterson, senior policy analyst for the American Nurses Association. "What about funding for nursing education? Better working conditions?" she asks. How does the health-care system need to be reformed to make better use of staff it already has?

During an era of restructuring in the mid-1990s, Peterson says, staffing cuts and belt-tightening in the American heath-care industry drove away nurses who felt overworked and were worried about patient safety as well as their own. By 2005, about half a million registered nurses left the profession.

Consider: The average age of nurses in Washington state is 45. So the bulk of the state's nurses are in their 50s and likely to soon retire. They are the tail generation of American women for whom job options were severely limited.

"Nurses, teachers, secretaries. Those were the career options," recalls 59-year-old Tieman. "Women have unlimited choices now."

No surprise that there was a dip in nurse demographics as post-boomer women chose to become doctors or go into law, business, computers, marine science.

Yet plenty of Americans want to be nurses now, especially given improving salaries. (At Allenmore, for example, base salaries for registered nurses start at $42,000 a year, rising to $83,000 with 28 years' experience. The state average RN salary is $60,000. Nationally, agency and traveling nurses who work as "temps" can earn more than $110,000 annually, without benefits.)

These days, lack of interest isn't what's restricting the flow of nurse grads. The problem is that nursing schools don't have enough teachers. Last year, Washington state's 40 nursing programs turned away 45 percent of qualified applicants. Again, witness the baby-boom effect. The average age among the nursing faculty in Washington is 54. And given relatively low academic salaries, schools find it hard to compete for experienced nurses who want to retire or work in more lucrative industry jobs.

This year, the Center for Nursing raised about half a million dollars to expand the capacity of nursing schools and support training for nurses who want to become nursing educators. Tieman says health-care facilities and nursing schools are starting to talk about how to reform the system so more nurses can be trained. But it's too early to say how many more or how fast.

Meanwhile, across the country, as older nurses age out and burn out and students can't squeeze through the school bottleneck fast enough to replace them, foreign-educated nurses are increasingly filling the gap.

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