JACKSONVILLE’S CRISIS IN NURSING
John W. Cowart
Guards armed with shotguns enforced a quarantine around northeast Florida during the yellow fever epidemic of 1888. Fear of contagion was so great that some other cities offered a $100 reward to anyone capturing or killing an escapee from Jacksonville.
A contingent of 18 Red Cross nurses from New Orleans took a train to come relieve suffering in Jacksonville, but the train engineer refused to stop in the plague zone.
It was after midnight in a torrential downpour when the nurses jumped from the moving train in MacClenny in order to reach the sick who needed them.
They stayed in this area for 79 days often working shifts of 72 hours without sleep. Some carried patients on their backs for miles to seen help. These nurses earned $3 a day.
Apparently, eight of them died of the fever.
Red Cross founder Clara Barton wrote of their sacrifice, “Warm appreciation and grateful acknowledgement of the faithful hands that toiled and the generous hearts that gave”.
Where do you find that kind of dedication today?
The same place you found it back then – among the nurses who care for Jacksonville’s sick.
The problem today is not yellow fever, quarantine or armed guards; the problem is finding nurses just like the ones we already have – only more of them.
A Bureau of Labor Statistics study shows that there are 1.5 million registered nurses and 6,000 hospitals in the U.S. Projections say that nationally the need for nurses, “will rise much faster than the average for all other occupations through the mid-1990s”.
While the need for nurses rises, the number of new nurses declines.
Nationally, enrollments are down in nursing schools by 50% over the mid-1970s. A UCLA study found that 10.4% of the women entering college expressed interest in becoming nurses in 1974; today, only 5.1% express interest. Less than 3% of all nurses are male.
Jacksonville is doing considerably better than the national average in drawing new nursing students.
“Our enrollment is strong right now, and we are considering expanding the program,” said Dr. Patricia H. Foster, interim director of the division of nursing at the University of North Florida.
“From my reading, I know that enrollment is down in nursing schools around the country, but ours is stable. The number of nurses here who are advancing their education to the bachelor’s lever is increasing,” she said.
In 1986, UNF admitted 24 new nursing students – called generic nurses.
“This year we admitted another 24. The word got out and 60 people applied; 50 met the requirements, and we could be selective choosing those with the highest grade point averages,” Dr. Foster said.
Applicants needed to be strong in disciplines such as chemistry and microbiology.
“Hospitals prefer to staff with the best educated people available, people who are clinically competent and well-educated,” she said. “They hire the bachelor’s-prepared nurse first, then RNs with experience. LPNs are not faring as well in the job market”.
“Nurses are handling multiple roles in work, family and education. They are students, nurses and homemakers. They feel the need to be excellent in all three. So one other benefit of coming here is that as a student they get peer support from others who are dealing with the same multiple demands,” she said.
UNF sends recruiters to high schools and junior colleges to talk with students about coming to Jacksonville to earn a nursing degree.
“What we want to do is to motivate people in high school to consider nursing as a profession they would like to go into as a rewarding career. This is a crisis time, but we are coming out with some good decisions for health care. We do have a commission for the future of nursing around the state. It’s devoted to the retention, education and control of decision-making in nursing,” Dr. Foster said.
The wave of generic nurses is encouraging, but can local nursing schools supply the demand?
A Sunday Florida Times-Union classified section in June carried 138 ads for registered nurses; these ads represent virtually every area hospital as well as many hospitals from out of state.
There are now 4,000 registered nurses in Jacksonville.
We need more.
“The pattern of nursing seems to go in five-year cycles, and right now we’re in the greatest shortage we’ve been in,” said Bruce A. Barber, director of Consolidated Staffing Services.
“We need to pay attention to the wave from the west. Shortages from California to Texas to Florida are critical, and it does not look like it’s letting up,” he said.
Jacksonville nurses are taking heroic measures to see that patient care remains optimal. They are working extra shifts and overtime to insure that the patients do not suffer because of staffing shortages.
At the same time, local nursing recruiters are initiating innovative programs to attract more nurses to Jacksonville hospitals.
While each hospital hopes to attract the highest caliber nurse, they avoid stealing each other’s sheep. Their recruiting efforts focus more on cooperation in drawing nurses to Jacksonville than on competition for existing employees.
Every local hospital is represented in the Jacksonville Coalition of Nurse Recruiters, said Jo Ann Grover, one of the group’s organizers.
“We don’t loose by cooperating; if we pool our resources to increase the pool of available nurses in the community, we all win,” she said.
Grover is an RN working as professional recruiter at Memorial Medical Center.
“We are definitely competitive, but what we realize is that Memorial has something different to offer from University or Baptist or St. Vincent’s. Each of them has something different to offer from us, so our coalition’s emphasis is not stealing employees from each other. A nurse will be drawn to a specific hospital as its reputation, location, benefits and advantages suit her own requirements”.
Cooperative endeavors of the coalition include distributing a glossy brochure to attract out-of-town nurses to Jacksonville. The pamphlet outlines outstanding qualities of each individual area hospital so a nurse can apply to the one best suited to her interests.
“Our brochure will make applicants more aware of choices and make our time as recruiters more effective,” Ms Grover said.
Coalition members save on expenses at nurse’s conventions and seminars by car pooling. They have also placed nurse appreciation ads during Nurses Week.
“Essentially, the group is committed to making it possible for people relocating to the South to choose Jacksonville as the place to work, in preference to other cities.
“Nationally there is a 16 per cent shortage of nurses. Locally, we do a little better – at least Memorial certainly does. Here we don’t have every position filled, but none of the other hospitals in Jacksonville does either.
“Our group is meeting lone-term needs as well as the staffing needs of today,” she said.
“But, we are in a crunch. You have to do something to keep from being trampled by the people leaving the profession.
“A nurse covers a hospital 24 hours a day, seven days a week. We don’t close the hospital for Christmas or holidays… But say a nurse goes to an insurance company, they get holidays and weekends off. They only work during the day like regular people do, and she would be able to re-enter the mainstream of society. But, when they do, it takes the edge off their skill,” she said.
Ms Grover sees the multiple career opportunities nurses have as a major drain on the supply of hospital nurses.
“Most nurses are working; the thing is they’re just not working in hospitals,” she said.
Legal issues also deter nurses from hospital settings.
“The individual nurse’s license is on the line every time she acts – even making an entry on a form… We don’t all feel like Florence Nightengale, but we made a decision to help other people. But we spend 50 per cent of our time doing paper work to0 stay out of legal problems. Many jobs take nurses away from the bedside when that’s what she got into nursing to do,” Ms Grover said.
“Florida has the most stringent license requirements of any state. They require continuing education to renew the license. That shows a standard of practice throughout the state. And everything needed for that education is available her in Jacksonville,” she said.
Many Jacksonville hospitals offer tuition reimbursement at state rates according to grades. Some give scholarships to rising nurses. National scholarship groups like the Business and Professional Women offer scholarships at both national and local levels.
“There’s literally millions and millions of dollars of scholarship money available,” Ms Grover said.
Jacksonville’s overall quality of life also attracts nurses.
“Quality leisure time is more and more important to career oriented people like career nurses. And here we have the symphony, the Riverwalk, the ocean beaches, and Disney World is not all that far away. Jacksonville is a wonderful place to live and work; I came here from north-east Tennessee 14 years ago, and I’m not ready to go back,” she said.
Jacksonville hospitals also offer nurses opportunity for advancement and prestige in the medical community.
“Most hospitals encourage internal transfers without flack and most encourage internal promotions… Jacksonville has medical prestige. You may have heard there’s a Mayo Clinic in town? Well, there’s also our Joslin Diebetes Clinic, and for a lor of nurses, that’s our drawing card. It’s been identified as one of Memorial’s centers of excellence and draws other people especially from the Northeast and Mid-west because of our new concept of treatment for diabetic patients,” Ms Grover said.
Nancy K. McKoy, an RN who works as nurse recruiter at St. Vincent’s Medical Center, is also one of the organizers of the Jacksonville Coalition of Nurse Recruiters.
She sees the shortage of nurses as the result of an abundance of opportunities for women. She defines her job as showing qualified nurses that hospital nursing—particularly at St. Vincent’s – is one of the best opportunities available.
In December she spoke at a seminar on Alternate Career Choices For Nurses at Jacksonville’s Park Suite Hotel. A hundred nurses with experience ranging from three to 40 years attended.
“Most wanted to get out of hospital nursing for a variety of reasons,” Ms McKoy said. Therefore, creating job satisfaction for nurses ranks high among her priorities.
“The problem is that women have more opportunities now than ever before,” she said.
The opportunities in home care nursing, opportunities with insurance companies, opportunities with pharmaceutical companies, with bio-medical supply houses, in hospital administration, in doc-in-the-box facilities, opportunities in doctors’ offices – all lure nurses from hospitals to other areas of nursing.
Besides all that, opportunities also abound for people of nursing caliber in fields unrelated to healthcare.
With all those chances to go into some other field, why do hospital nurses stay on?
Dedication seems to be a large part of the answer.
“When you’re sick, the doctor does not take care of you. The hospital does not take care of you. The nurse does,” Ms McKoy said.
Much of a nurse’s job satisfaction comes from hands-on patient care. The initial vision of a woman considering nursing as a career involves being bedside a suffering person soothing his fevered brow with a cool cloth, Ms McKoy said.
That’s the vision. The reality is that paperwork and similar duties bog nurses down away from the hands-on care aspects of their job as much as 50 per cent of the time they are on duty.
Area hospitals are taking steps to remedy this.
“At St. Vincent’s we have a new documentation system to put nurses back at the bedside. And we hire ancillary personnel to do more things so nurses can do what it si they are trained to do, what they want to do,” she said.
She described some other innovative St. Vincent’s is taking to encourage present nurses and recruit new ones:
“We have 400 nursing positions on the staff, and right now I could hire 25 – a lot in specialized areas like OB, OR and oncology. We train but prefer experienced people who are sharp and motivated,” Ms McKoy said.
Ms McKoy taavels to nurse conventions in other states where she sets up displays and tells prospective nurses about the advantages of working in Jacksonville—especially at her hospital.
Does this work?
“I get calls everyday from nurses wanting to relocate to Jacksonville,” she said.
“There is a limited number of nurses and we all need them,” she said. “Eighty per cent of the nurse population works, the largest work force of any profession,”
But a linear projection of current figures indicates that by the year 2000 there will be a nationwide deficit of a million bedside nurses.
“I care very much about nursing and would like to see nurses take a more active role in being professionals. There are things that need to be changed than can only be done by nurses ourselves. Our opportunities are just starting,” Ms McKoy said.
So many opportunities exist that in march St. Vincent’s initiated an associated staffing agency, Consolidated Staffing Services. Bruce A. Barber directs the agency which was set up by St. Vincent de Paul Stewardship Community Services, Inc.
“Because of the shortage of nurses, there is a growing active business in temporary staffing,” Mr. Barber said. “Our primary responsibility is to work for St. Vincent’s, but in the last few weeks we do a lot of outside work for St. Catherine’s Nursing Home, seven other nursing homes and four other hospitals”.
Because the patient census in each hospital varies, the demand for nurses varies also. Vacations, continuing education, and personal schedules call for replacement nurses.
“Nurses are the workingest people I’ve ever met,” Barber said.
Some work one full shift at one hospital but come to his agency to find work for a different shift at another hospital. Some who hold administrative positions hone their RN skills by working staff positions periodically.
“A nurse can work when she wants,” Barber said. “She’ll call us and say she wants to work 3 to 11 Mondays, Wednesdays and Fridays, and we go to work to find her employment those days”.
Barber has even drawn a traveling nurse from as far away as Puerto Rico to temporarily fill in a highly specialized slot in Jacksonville. The deal included a place for her to live for the three months she would be working in town.
The work load for nurses in Jacksonville is tremendous. The opportunities are tremendous. The dedication called for is tremendous.
Where today are you going to find a nurse willing to jump from a moving train to do her job?
In Jacksonville, of course.
Before Jo Ann Grover began work at Memorial, she cared for employees of Family Line Rail Systems – now CSX.
To evaluate employee needs, she spent time in the rail yard doing what they did, including swing aboard moving trains.
“Well, you have to be called of God, or crazy to be a nurse,” she said.
This article appeared in the September, 1987, issue of Jacksonville Magazine.
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