July 27, 2001

San Diego Prescribes Cure for San Diego's Nursing Shortage

By Yvette tenBerge

Miriam Lizarde, 44, is a Registered Nurse (RN) at Sharp Chula Vista Medical Center. She smoothes her periwinkle blue scrubs and laughs when remembering her early nursing days. As a 19 year-old Licensed Vocational Nurse (L.V.N.), it was not unusual for her to man the front desk, rush three floors up to translate for a physician, and scurry back downstairs to prep a new patient in a matter of minutes. Ms. Lizarde's days of racing around the hospital have long been over, and she now holds the coveted position of Clinical Lead Nurse in the Special Procedures Unit.



Miriam Lizarde (right) and Neriza Tagulao, both registered nurses in Sharp Chula Vista Medical Center's Special procedures Unit.

Although Ms. Lizarde undoubtedly earned her assignment through hard work and dedication, she is quick to give credit for the majority of her success to an unlikely figure. She admits that many people have helped her along the way, but she can barely contain her tears of gratitude when she speaks about "Grandma Jones," an elderly missionary woman who taught a homesick little girl the importance of giving back to others through her kindness.

Ms. Lizarde recalls 1962, the year that her family immigrated to the United States from Bolivia. "When I came here, I was sad that I did not have my grandparents. Grandma Jones did not have children of her own. She accepted me for who I was, she believed in me, and she gave me hope," says Ms. Lizarde, who chose nursing precisely because it enabled her to help others as she, herself, was helped. "Grandma Jones became the greatest mentor of my life."

This is what nurses do: they help people. Indeed, their position is the most crucial in the medical field, as once the doctor has diagnosed and prescribed, it is the nurse who oversees the healing process. They are the ones who do the actual work of medicine.

And yet in a day and age where hospitals, clinics, nursing homes and emergency rooms are overflowing with patients in need of care, the nation is experiencing a shortage of these vital care givers.

Statistics from the U.S. Department of Health and Human Services show that California has the second to lowest proportion of registered nurses per capita in the nation. San Diego, itself, has 623 nurses per 100,000 people, compared to the national average of 782 nurses per 100,000 people. To bring itself in line with the national average by 2006, California needs some 45,000 new RNs as well as 28,000 replacements for those leaving the field.

Shortages in the field of nursing, however, are not a new occurrence. Jennifer Jacoby, the Chief Nursing Officer and Vice President of Patient Care at Sharp Memorial Hospitals, states that California has experienced other shortages in the past, and has had them on a somewhat regular basis.

"Shortages are cyclical, and they happen about every 10 years. The last one was from 1985 to 1991, which was followed by an excess of nurses who were laid off between 1992 and 1997. Some of the reasons for the shortage, today, are that less people are entering the nursing field and more patients are finding themselves in hospitals," says Ms. Jacoby, who estimates that Sharp currently has 2,600 registered nurses on staff and they could stand to hire about 200 more.

Unlike past shortages, though, the current situation is not expected to improve anytime soon. The projections for the current shortage are based on a population increase of 52 percent, or 17 million people, over the next 25 years. Couple this with the fact that California's baby boomer population is aging and their demand for health care increasing, and the fact that California's nursing programs are already functioning at capacity, and you end up with more than just your average, cyclical shortage.

Even more problematic is the fact that the current lack of nurses does not come from population increase alone. The system that produces nurses, itself, is also experiencing difficulty. Most associate degree programs, (which currently educate about 70 percent of RNs), have waiting lists of up to three years. This, though, is a problem that can be solved, and help is on the way. A unique partnership between San Diego State University and eight of the region's largest hospitals aims to put a dent in the nursing shortage by opening the doors of education to more students.

Last summer SDSU adopted Nurses Now, a dormant program that was originally introduced in the 1980s by the Hospital Council of San Diego. The goal of Nurses Now is to significantly increase the number of nurses available for employment by doubling the enrollment of nursing students at SDSU's School of Nursing, already the largest supplier of nurses in San Diego.

Alvarado Hospital Medical Center, Children's Hospital and Health Center, Kaiser Permanente, Scripps Health, Sharp Healthcare, UCSD Medical Center, TriCity Medical Center and Paradise Valley Hospital, together, will have contributed $1.6 million over three years, in order to enable SDSU to hire eight new faculty members. This allows the school to nearly double enrollment over the next four semesters, bringing the number of students up from 100 to 180.

Ms. Jacoby confirms that Sharp Healthcare will contribute $210,000 over three years. "This is definitely a unique partnership, but one that is needed and one that is worth the investment. Our hope is that most nurses educated through Nurses Now will decide to stay in San Diego after they graduate," says Ms. Jacoby. "This is a proactive approach to a problem that will not go away in the future."

While programs like Nurses Now focus on getting an ever-increasing number of people into the field of nursing, hospitals like Sharp Healthcare are taking steps to ensure that they stay in it. This means developing the working conditions nurses need to stay fulfilled in their positions.

In a field known for its long, emotionally taxing hours, burn out can come quickly. At times like these, when staffing shortages increase workloads, or when hospitals, themselves, do not do enough for their nurses, many employees may be tempted to seek out employment in other fields.  Such conditions leave those who want only to help others feeling, themselves, a bit helpless. This is not the case, though, for Ms. Lizarde, who loves what she does and where she is doing it. She credits this partly to the administration's respect for nursing, and partly to their policy of allowing their nurses to continue up the ladder.

Ms. Lizarde compares her current function at the hospital to that of the "tuna in between two pieces of bread." She occupies a management position whose responsibilities include not only overseeing, but also extend into hiring. In addition to this, she still serves as a part of the nursing team. Like many of her colleagues, she has worked these hospital floors for more than two decades and has yet to tire of it.

"There are many skills, such as critical thinking, that nurses must develop along the way. We are constantly working with the public and physicians and caring for patients. The majority of nurses are focused, and they yearn for growth," says Ms. Lizarde, explaining that management at Sharp encourages their staff to continue with their schooling and offers them other managerial and administrative opportunities, rather than limiting them solely to positions on the nursing floor.

"Growth is what this institution has promoted, and this has empowered me and really made a difference in my life." To this end, and as a result of her hospital's policies, Ms. Lizarde returned to school and earned her Bachelors of Science in Nursing from the University of Phoenix in June, 2001.

While Ms. Lizarde would not trade her experience on the nursing floor for anything, she does admit that she hopes to return to school to receive her Masters degree and then use it in acting as an advocate for Latinas and other minorities who are searching for a rewarding career path to follow.

"With nursing, the doors are always open. You always have a job to fulfill, and you can always be of service to your loved ones and to your community. Nursing has opened up doors for me. My dream is to go out into the public and speak about the need for more Latinos in nursing," says Ms. Lizarde. "I would also like to be an advocate for nursing programs that would outreach to this community."

SDSU confirms the shortage of Latinos and African-Americans in the field of nursing. In hopes of reversing this trend, the school recently received a grant from the California Endowment that will support recruitment and retention in the nursing program for these minority groups. Ms. Lizarde cites one very crucial motivating factor in the drive to recruit more Latino nurses: the language barrier that often arises between doctor and patient.

Ms. Lizarde admits, though, that the number of bilingual staff at Sharp has increased over the years. The hospital now has translators, and she estimates that each floor has at least one Spanish-speaking nurse. She is aware that as the number of Hispanics in the nation rises, the need for Spanish-speaking nurses who understand the culture of the patients whom they serve becomes even more urgent.

Ms. Lizarde applauds programs like Nurses Now and hopes that the influx of students will give the nursing field the variety of students that it so badly needs. It is this variety that makes nurses who they are and allows them to do what they do. Beyond the sterile and clinical practice of medicine, itself, nursing hinges on outlook and attitude as much as it does on aptitude. Although having your head full is certainly important in nursing, having your heart full is absolutely crucial. The field of nursing seeks out the personal as much as it does the professional.

"Back when I started, employers were always looking for the A students. I have had A students who could not cut it on the floor, so I have learned to look for a person's potential. I hired one nurse who worked a cash register at 7-11 for many years. At first, we were really skeptical about her, but I could see her potential. I felt it in my heart. I decided to take the risk and take her under my wing," says Ms. Lizarde, who describes this nurse's performance as "wonderful" and lists hardworking and flexible as a few of her many virtues. "When I was a child, someone believed in me, and that made all the difference in the world. That is how I want to be remembered in someone's life."

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