Not so long ago, Jeff Johnson was thinking about leaving Bradenton. He had held several jobs after retiring from the Air Force in 2004, but they didn’t suit him. He also had lots of experience working with computers, and had even gone back to school for two years to become a registered nurse (RN), but with a wife and young daughter to support, he needed to earn more. So he went back to school to get advanced IT training in nursing. Right away, he was offered a better job. “I’m exactly where I want to be now,” he says. “I just need to climb the ladder.”


Even in the midst of a severe recession, well-qualified nurses can have their pick of jobs pretty much anywhere—and this is especially true on Florida’s Gulf Coast. The state’s Agency for Workforce Innovation (AWI) expects about 260 openings a year for RNs in Sarasota and Manatee counties over the next seven years, along with 134 openings for licensed practical and vocational nurses (LPNs) and 173 openings for aides and orderlies. The Federal government is forecasting a national need for 600,000 more RNs in the decade between 2008 and 2018. How can they be so sure? Because demographics are destiny, and healthcare spending isn’t optional. An aging population and an aging workforce are driving a national nursing shortage that seems sure to deepen.


The Need

Healthcare and social assistance already claim one-sixth of all jobs in Sarasota and Manatee counties, and the field is destined to grow. Nursing is one of the industry’s most common jobs, and also one of the best-paying: the metro area has more than 5,400 RNs who earn an average of about $60,000 a year, along with 2,500 LPNs who earn about $40,000, according to the AWI. There are also about 4,900 nursing aides, orderlies and attendants in the Sarasota-Bradenton-Venice metro area, but their average annual wage is only about $26,000. Anybody can empty bedpans. But it takes a year of training to become an LPN, at least two years to get an RN, and nurse management jobs (which can pay more than $100,000 a year) require at least four years of college. Nowhere is this connection clearer than in healthcare—the longer you go to school, the more you’ll earn.


“This is happening in all kinds of industries,” says State College of Florida spokeswoman Katherine Walker. “Employers are setting the bar higher for the best jobs.” For example, the area’s largest healthcare employer, Sarasota Memorial Hospital, is designated a “magnet” facility. To keep that status, the hospital by 2013 will need to show that all nurses in management positions have a four-year degree. “There are six hospitals in our area, and three of them are actively pursuing magnet status,” says Walker.


As the industry rewards those with more education, two demographic trends are driving up the overall demand for nurses. The first is the aging of the baby boomers, that massive generation that has been ringing cash registers since the end of World War II. Florida’s Gulf Coast has always been home to a lot of people who’ve celebrated their 65th birthday, but in the next decade its boomers will also pass that milestone. This year, boomers are between the ages of 46 and 64. So while the overall population of Sarasota and Manatee counties is expected to grow about 15 percent between 2010 and 2020, the population aged 65 to 74 should grow 43 percent, according to the University of Florida’s Bureau of Economic and Business Research.


Aging boomers don’t link the ’60s to the Summer of Love anymore. Now, that term brings to mind the stage of life when people start to develop chronic health conditions, some of them severe enough to require a nurse. Meanwhile, the local population aged 80 and older—the core market for nursing care—is expected to grow 19 percent over the next decade. Sarasota-Bradenton-Venice is already one of the oldest metros in the nation, with more than 27 percent of the population aged 65 or older in 2010. But you ain’t seen nothing yet. By 2020, it’s likely that one-third of all residents in Sarasota and Manatee counties will be eligible for Medicare.


The second trend behind the nursing shortage is the impending retirement of many nurses. The average age of RNs in the United States is in the mid-40s and rising. Most surgical nurses at Manatee Memorial Hospital are in their 50s, according to chief nursing officer Chris Malloy. And a recent survey in Nursing Management magazine found that a majority of nurses in the U.S. plan to retire between 2011 and 2020.


“This isn’t sustainable,” says Bob Meade, CEO of Doctors Hospital in Sarasota. “If we don’t have enough people going into healthcare, the shortage will get much worse. Right now, we can manage it. Five or seven years from now, we might not be able to.”


Getting and Keeping Nurses

Training nurses is complicated. “It isn’t just sitting in a classroom until you get your ticket stamped,” says Dr. Bonnie Hesselberg, provost of the Lakewood Ranch campus at the State College of Florida (SCF) and dean of its four-year nursing program. “There’s a clinical component. Students are required to spend a lot of time caring for patients in a well-equipped facility. But our area doesn’t have a lot of big hospitals, so it’s challenging to find clinical space.” This is one reason why it isn’t a snap to get into nursing school. “Last year, 12,000 applicants to nursing school were turned away in the state of Florida,” says Kathy Mitchell, chief nursing officer at Doctors Hospital.


The nursing program at the University of South Florida enrolls more than 1,200 undergraduates and 700 more graduate students. State College of Florida’s program is also well-known and has more than 300 students, but it was a two-year degree until the college began a major expansion this spring. The first 25 four-year nursing students started attending classes at SCF in January at campuses in Venice and Bradenton, and the college plans to enroll about 25 more every semester until it reaches 200 to 300 four-year nursing students.


Finding clinical time for them will become easier next fall, when a brand-new, two-story, 40,000-square-foot building, the Medical Technology & Simulation Center, opens at the SCF Lakewood Ranch campus. The building contains cutting-edge adult and infant simulation technology in mock-ups of an intensive care unit and birthing room, as well as science labs and classrooms. The simulated hospital settings can handle up to 25 percent of the programs’ clinical requirement, says Hesselberg.


Far from being put off by the prospect of students practicing on plastic people, local hospitals are strongly supportive of the Lakewood Ranch facility. They all helped lobby the state education department to grant SCF permission to start the four-year program. Manatee Memorial made a $500,000 donation. “We like to hire home-grown nurses,” says Moody Chisholm, CEO of Manatee Health Systems, “and we try to give them a strong voice in our organization. The Lakewood Ranch campus is very important to us.”


With nurses becoming harder to find, local hospitals need to make sure that new hires succeed and experienced staff stay happy.


“We give new graduates a long internship to make them feel at ease, and we give them a year of support classes after we hire them,” says Chisholm. “We also have flexible staffing. Our nurses do their own schedules, within limits, of course, and that has worked out very well.”


Back in Sarasota, Doctors Hospital was recently honored as the best health provider to work for by Modern Healthcare magazine, out of 317 participating organizations across the country. “We’re pretty selective,” says Meade. “We want the whole package: people who are skilled and who also interact well with patients and have customer service acumen. Once we find them, we spend a lot of time and effort to create a good workplace environment.” Nursing is an inherently stressful job, but the shortage has employers padding its sharp edges wherever they can.


It takes cash to become an RN. Two years at USF will cost you about $9,000 in tuition and fees; at SCF, the tab will be more than $5,000. But the Gulf Coast Community Foundation of Venice is poised to help metro residents get past this barrier, too. Mark Pritchett says the foundation has raised $1.5 million for its career ladder program from local stakeholders who are interested in workplace training, including a $1 million gift from the Knight Foundation, and hopes to reach a goal of $3 million.


“We will put together grant packages and give them to healthcare employers and local organizations so they can assist workers who want training,” he says. So if someone living on public assistance wants to become a nursing assistant, they will connect with an organization that will send them to school. And if a certified nursing assistant wants to get a four-year degree, his or her employer can use the foundation’s money to unlock that door.


Home Healthcare Nurses

A growing number of nurses don’t work in hospitals or nursing homes. Home healthcare services were a $56 billion industry in 2008, and their revenues had more than doubled since 2000. Susanne Wise says there were perhaps two dozen small businesses supplying private duty nurses in this market when she founded Take Care Private Duty Home Health Care 15 years ago. Once a practicing nurse, she’s now the CEO of a company that has 550 employees, serves 400 clients and has annual revenues of $15.7 million. Take Care doesn’t bill Medicare; its clients pay with savings or insurance, so they tend to be from higher-income households.


Take Care’s employees benefit from a slower pace and so are able to develop closer relationships with their clients, says Wise. The hours also tend to be more flexible for home care, so it is a particularly attractive option for nurses who have children in school.


But coordinating care for geriatric clients isn’t easy.  “We typically see people who have overlapping conditions that can combine to create new problems,” she says. “We also have to think about the side effects of multiple prescription drugs, and managing insurance companies. I have run into clients who don’t actually need nursing care—they just need someone to interpret the results of tests, coordinate medical appointments and deal with insurance carriers.”  


People who can’t afford a private duty nurse can use Medicare to pay for home visits, and Medicare home care providers are also hiring. But be careful here. The legitimate providers we talked to say they are competing with small businesses that pop up and offer their nurses extremely high salaries—salaries so high, they say, that the only way a provider could offer them is to overcharge Medicare. It’s fairly easy to open a Medicare home care business in Florida, and there aren’t many fraud inspectors to go around, so there’s definitely a layer of slime at the bottom of this business. But the fly-by-night operations tend to come and go.


“Everything about healthcare is a growth industry,” says Wise, “so you have to be comfortable with constant change if you want to become a nurse. You also need to have a passion for what you do—a commitment to care for others.”


But you don’t necessarily have to empty bedpans. Jeff Johnson’s new nursing job involves upgrading the information management system at Manatee Memorial. He says the higher pay has made it possible for his wife to quit her job as a nurse’s aide and go back to school to become a pharmacy technician.


“It’s great that we can stay; we love Bradenton,” he says. “The beaches here are a lot nicer than the ones in Oklahoma.” ■


Brad Edmondson is the former editor of American Demographics magazine.  A native of Nokomis, he now lives in Ithaca, N.Y.


The shortage is a big reason why the nurse training program at the State College of Florida (formerly Manatee Community College) just expanded from two years to four. Jeff Johnson is one of the first students in this program. It’s also why the Gulf Coast Community Foundation of Venice is starting a career training grants program that will pay tuition costs for people who want to acquire nursing skills. The goal of the program is to move people from low-wage to higher-wage jobs, says Mark Pritchett, the foundation’s vice president for community investment. He says the foundation decided to start with the healthcare industry because it offers local workers the best prospects for upward mobility. The experts are all saying that nursing is a great career to go into right now—as long as you’re passionate about working with people, and you don’t mind a challenge.

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