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HEALTH CARE WORKERS SHORTAGE UPDATES 
One of the primary forces behind efforts to ease health care immigration rules is the persistent shortage of health care workers in the US. The shortage has gotten so severe that many believe that it will be impossible to ease the crisis without increasing the numbers of foreign nurses, doctors, therapists, technicians, nursing assistants and others from abroad. This month, we have created a new feature that will focus on providing the latest news regarding the health worker shortage. We will bring you the latest information on the shortage itself as well as what efforts are taking place to address the shortage whether the solution be immigration-related or not. 
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Bush Budget Includes Rural Area Doctors Support and Nurse Education Loan Repayment Program 
Health and Human Services Secretary Tommy Thompson announced that President Bush’s 2003 budget will include $191.5 million - a $44 million increase - to strengthen the National Health Service Corps, which supports doctors and clinicians who serve in rural and inner-city areas that lack adequate access to care. The President’s budget also will include a total of $15 million, a 50 percent increase above last year’s funding, to expand the Nursing Education Loan Repayment program to help address the nation’s growing need for nursing professionals. 
With the increased funding, the National Health Service Corps will provide scholarships or loan assistance for approximately 1,800 physicians, dentists and other clinicians to practice in underserved areas. Nearly half of the program’s clinicians currently serve in Community Health Centers, which provide health care to people regardless of their ability to pay and target services in areas where people face financial and social barriers to accessing high-quality care. 
The increase in the Nurse Education Loan Repayment program will support 800 new nursing education loan agreements. The program will repay the education loans of clinical care nurses who agree to work for two years in designated public or nonprofit health facilities that face a critical shortage of nurses. 
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 AHA Report Confirms Severity of  Nurse Shortage 
 The American Hospital Association (AHA) reports that a new study conducted by one of its divisions, the American Organization of Nurse Executives (AONE), finds vacancy rates for registered nurses ranging from 14.6% for critical care to 6.5% for nurse managers. Nurse executives at nearly 700 hospitals participated in the survey, conducted by The HSM Group and based on 2000 data. Respondents said the RN shortage is contributing to emergency department overcrowding (51%), diversions for more than four hours a week (26%), higher costs to deliver care (69%), bed closures (25%), increased waiting time for surgeries (11%), and reduced or eliminated services (6%). They said the most effective recruitment and retention methods include increased and competitive salaries, educational opportunities, improvements in staff satisfaction and input, and bonuses and flexible scheduling.   
For more information, please visit: http://www.aone.org/ 
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Nursing Homes Staff Shortage 
 Yet another set of employers in the health sector is reporting severe staff shortages. According to a new federal study, more that 90 percent of the nation’s nursing homes lack sufficient staff to take proper care of patients. 
 At this time, the Bush administration does not intend to impose minimum staffing levels for nursing homes, mainly due to budget restrictions. 
 The New York Times reports that the Bush administration will not interfere and leave the staffing shortage to free market corrections. Many were hoping that the Administration would support minimum staffing ratios. Others point out that regulatory and legislative obstacles to hiring foreign nurses means that there really is no such thing as a free market in the labor force. 
 The report is expected to be sent to Congress in a few weeks. 
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 California Announced New Staffing Ratios for Nurses 
On 1/22/02 Governor Gray Davis released proposed nurse-to-patient ratios for California’s acute care hospitals, the first of their kind in the nation. The measure is intended to improve patient care in the state. 
Governor Davis signed the legislation (AB 394) in 1999 requiring the California Department of Health Services (CDHS) to establish minimum nurse-to-patient ratios by licensed nurses and by hospital unit. 
The proposed ratios are based on a complex number of factors, including information collected by CDHS specialists. CDHS staff used data from the on-site hospital surveys to determine the staff-to-patient ratios documented at those hospitals. The University of California Office of the President tabulated the information. 
Currently, only intensive/critical care, well-baby nursery, neonatal ICU, intermediate care nursery and the operating room have minimum ratios. The proposed ratios cover all other areas of the hospital, including general medical/surgical wards. The proposed ratios vary from 1:1 in a trauma unit to 1:6 (reduced one year later to 1:5) in medical/surgical. Many hospitals already meet or exceed this standard, depending on the unit. The total number of new hospital staff required to implement the new minimums are estimated to exceed 5,000 when fully implemented. 
While the ratios establish a minimum staffing level, AB 394 also emphasized that hospitals must continue to comply with current statutory requirements to base staffing upon patient acuity, even if that means increasing staff above the minimum ratio. 
However, due to the current nationwide nurse shortage, the number of available nurses is very limited. 
 Nurses and nurse employers are monitoring the situation closely to see how the new staffing ratios will impact the existing nursing shortage in California and the US. 
 The California Healthcare Association says the ratios could exacerbate the state's nursing shortage and jeopardize access to patient services. Other critics say that there should not be pre-determined staffing ratios, but have varying ratios according to the patients needs.
 Draft regulations for implementing the ratios are expected to be published early this spring and final regulations are expected to become effective in July 2003. 
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California Governor Announced Nurse Workforce Initiative Plan to Address Shortage 
Governor Gray Davis announced a three-year, $60 million Nurse Workforce Initiative to address California’s growing nursing shortage. 
The proposed Nurse Workforce Initiative is funded primarily from Workforce Investment Act funds. It includes the following components: 
$24 million over 3 years for 2,400 training and preceptorship positions in hospitals, community colleges or the CSU system; 
$6 million over 3 years to expand the Central Valley Health Careers Training Program to train an additional 300 licensed nurses; 
$24 million over 3 years to expand five regional workforce collaboratives under development and for additional regional collaboratives to train 2,400 licensed nurses through the Community Colleges and CSU system; 
$3 million for on-site health care facility approaches to upgrade training opportunities for Certified Nurse Assistants and Licensed Vocational Nurses to Registered Nurses; 
$1 million to encourage workplace reforms projects designed to improve nurse retention; 
A statewide media campaign to recruit persons to the profession; 
Exploration of strategies to standardize pre-nursing prerequisites and nursing education curriculum; 
Streamlining the nurse licensing process by building a real-time electronic application process and extending the duration of temporary licenses; 
$1 million for research and evaluation of the initiative; and 
Restoration of $800,000 from the Registered Nurse Education Fund to provide additional financial assistance and education support for nursing students. 
There are 264,000 licensed nurses in California, or 544 working nurses per 100,000 population. California ranks next to last among the 50 states. The national average is 782 nurses per 100,000 population. Therefore, the acute nursing shortage in the nation is felt even more acutely in California. 
  
In addition governor’s Davis 2001-02 and 2002-03 budgets include $4 million for an additional 1,000 nursing training slots at community colleges. 
 California hospitals and other healthcare facilities were very pleased about this initiative and hailed the governor’s efforts. 
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