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Making a Mark
Making a Mark is published bi-annually by the CHOC Foundation. It features CHOC and children?s healthcare news, patient highlights, hospital updates, board member spotlights, and community involvement stories and is mailed to donors who support CHOC with a gift of $250 and more.

CHOC Takes Proactive Steps to Cope with National Nursing Shortage

It?s been described as a perfect storm: an aging nursing workforce coupled with an aging population with increasing healthcare needs. Throughout the country, hospitals are facing a shortage of registered nurses like never before in our nation?s history.

The demand for full-time, registered nurses is projected to increase by 41 percent by the year 2020. To meet this need, U.S. nursing schools must boost graduation rates by 90 percent. But if current trends continue, only 64 percent of that projected demand will be met.

The shortfall of nurses has hit California particularly hard. In a 2000 survey, the U.S. Department of Health and Human Services ranked California as the 49th lowest state providing registered nurses per capita, second only to Nevada. A more recent study cited by the University of California, Irvine, shows that California has fallen to last place.

CHOC is an organization that is committed to being creative and innovative. We are developing strategies that will create a pipeline of well-qualified, registered nurses for our patients.

DANA BLEDSOE, R.N., M.S., M.B.A., C.N.A.A.., B.C.,
Vice President, Patient Care Services / Chief Nursing Officer Children?s Hospital of Orange County

THE IMPACT ON ORANGE COUNTY

The reality of the national nursing shortage has also impacted care close to home. Orange County received a ?D? from the California Registered Nurse Regional Workforce Report Card, based on 2004 data comparing registered nursing jobs per capita in all 50 states and the District of Columbia. The ?D? meant that the number of nursing jobs in Orange County was one-to-two standard deviations below the national mean.

The report card showed that 46 states and the District of Columbia received a ?C-? or better. The state of California, as a whole, received only a ?D.? Between 2000 and 2025, California?s population is projected to grow by 52 percent.

Nursing Schools Need Strengthening

If only the solution were as easy as simply training more nurses to fill the gap. Until recently, enrollment rates in nursing school programs were on the decline. As a result, schools cut back their nursing programs, and faculty members who left or retired weren?t always replaced. Salaries did not remain competitive, and replacing those master?s and doctorate-level faculty positions with qualified nurses has been difficult. Now the student demand is there, but the shortage of nursing faculty is making it difficult for the schools to keep pace with it. The average waiting list for a Southern California nursing school offering a two-year associate degree is two-to-three years long. Essentially, it takes longer to get into the nursing program than it does to earn the actual degree.

Students pursuing a four-year bachelor?s degree in nursing must leave Orange County to do so. Traditional four-year nursing programs are not offered at the University of California, Irvine; California State University, Fullerton; Chapman University; or Concordia University. However, the University of California, Irvine, is considering the possibility of opening an undergraduate nursing program. Farther north, the University of California, Los Angeles, has begun accepting freshmen applicants into its recently re-opened four-year nursing program.

Proactive Strategies to Ensure Well-Qualified Pediatric Nurses

Nursing shortage or not, CHOC will soon be opening, and staffing, a 30-bed pediatric intensive care and cardiovascular intensive care unit on the sixth floor in addition to other hospital expansions. For quite some time, CHOC has had proactive strategies in place to recruit and retain highly qualified registered nurses. One strategy has been to develop partnerships with local nursing schools.

Four years ago, CHOC implemented a six-month registered nurse residency program to support new nursing school graduates. After the first year, CHOC hired 28 nurses from the program. This year, CHOC anticipates the nursing residency program to bring in 80 new registered nurses who will benefit from the extensive residency program. ?The amount of time nursing schools typically allow students to spend exploring pediatrics as a possible career is very limited. We have only a short period of time to capture the students? interests, and we must actively court them during the brief time they are here,? says Dana Nicholson Bledsoe, chief nursing officer and vice president of CHOC Patient Care Services.

The CHOC Padrinos recently committed $72,000 to fund four scholarships to support registered nurses working toward a bachelor of science degree in nursing at the newly developed ?RN to BSN? program at Vanguard University in Costa Mesa. These scholarships are inclusive of all student expenses, including books and fees.

Did you know CHOC was recognized as the #1 place to work and volunteer by the Orange County Register readers poll, and as one of the best places to work by OC Metro magazine? CHOC is dedicated to being an employer of choice by creating a high-performance culture that attracts, engages, develops and retains healthcare?s finest professionals.Nurse retention is equally important. In a recent national survey conducted by the American Association of Critical Care Nurses, nurses ranked ?a healthy work environment? and ?enduring optimal workforce development and staffing? as the two most important workplace issues. ?Nurses want to work for hospitals that value their abilities and practice, and that are willing to support them in expanding their knowledge in a profession and science that is rapidly changing,? says Judy Verger, R.N., Ph.D., a pediatric nurse practitioner at Children?s Hospital of Philadelphia and a clinical lecturer at the University of Pennsylvania.

As past chair of the AACN Certificate Corporation, Dr. Verger has seen a dramatic increase in nurses seeking professional certification.

?In the last year alone, we have seen a 50 percent increase in the number of nurses taking our certification exams. And the number of nurses who renew their certifications has climbed significantly from 78 percent to over 83 percent,? Dr. Verger says. ?According to a recent survey published in Nursing Management last year, almost 60 percent of the nurse managers surveyed reported that certified nurses have a higher performance level.?

Certification validates a nurse?s specialty knowledge, skills and abilities, and is therefore a mark of excellence that many nurses and hospitals invest in to provide their patients added assurance that they will be well cared for. CHOC works very hard to create the professional environment nurses are looking for.

?CHOC is committed to a culture of ongoing learning and professional development, which is consistent with the correlation between certification and an increase in patient safety,? Bledsoe says. ?We strongly promote nursing certification within the areas of specialty, such as pediatrics, critical care and oncology. Additionally, we have a shared governance council that ensures our staff nurses are involved in making decisions that affect their clinical practices. At CHOC, every nurse has a voice.?

With the nursing shortage, salaries are understandably volatile. High Orange County housing costs also make it difficult to keep younger graduates in the area and to attract well-qualified nurses from outside of the county. CHOC is committed to offering competitive salaries and benefits in order to attract and retain the best talent.

With these strategies well in place, CHOC is confident about facing the growing nursing shortage in the years ahead. Bledsoe says some of the best nursing referrals come from other CHOC nurses. It takes a special kind of nurse to work in a pediatric hospital, and CHOC nurses know what qualities to look for.

?We are committed to further strengthening our reputation for providing high quality care and being an ?employer of choice.? Our dedication to excellence, education, professional development and collaborative relationships provides a practice environment that is both rewarding and exciting for nurses at CHOC,? Bledsoe concludes.

Sources: U.S. Department of Health and Human Services, Health Resources and Services Administration; Healthcare First Study Group, VA Long Beach Healthcare System, University of California, Irvine; Nursing Subcommittee of the Health Sciences Committee, University of California; California Institute for Nursing & Healthcare; and American Association of Critical-Care Nurses

CALIFORNIA NUMBERS

Per Capita Registered Nursing Jobs per 100,000 Population

  • National mean: 787
  • California received a ?D? with an RN job ratio of 622
  • Orange County received a ?D? with an RN job ratio of 611

Source: California Registered Nurse Regional Workforce Report Card

Age

  • Average age of a nurse: 47.7 years
  • Mean age of faculty in four-year colleges and universities: 50.5 years
  • Average age of assistant professors: 50 years
  • In 1997, fewer than 10 percent of all RNs were under the age of 30

Sources: American Association of Colleges of Nursing; University of California, 2004 Survey of Registered Nurses in California, CA Board of Registered Nurses

Nursing Turnover by Region

  • National (mid-size hospitals like CHOC) 10%
  • Statewide 16.4%
  • Southern California 15.3%
  • CHOC 8%

Sources: Hospital Association of Southern California, American Society of Healthcare Human Resources Association

CHOC CHILDREN'S PUBLICATIONS
PHYSICIAN CONNECTION ENEWSLETTER
KIDS HEALTH MAGAZINE
ANNUAL REPORT
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chocChildren's Hospital of Orange County | UCI University of California, Irvine

Children's Hospital of Orange County is affiliated with UC Irvine Healthcare and UC Irvine School of Medicine

CHOC Children's - 1201 W La Veta Ave, Orange, CA. Phone: 714-997-3000. .