Aging nursing workforce could worsen state staffing challenges
State finds it hard to compete with the private sector when hiring nurses
Allen Goodwin is concerned about the future of his profession and what it could mean for people who need health care.
Goodwin, a 57-year-old nursing care consultant for the Department of Social and Health Services, works in an office where a majority of nurses are nearing retirement and in a field where a shortage of nurses will mean less comprehensive care for the agency’s low-income clients.
“The nursing force is aging,” Goodwin said. “We have trouble recruiting nurses because they can make more money in the private sector. They can earn overtime. … It’s just difficult to recruit nurses away from those higher paying jobs into what we do.”
The problem may only deepen as a general shortage of nurses — public and private — is projected in Washington state. According to a 2014 U.S. Health Resources and Services Administration report, Washington is projected to have a shortage of about 7,000 nurses by 2025. Only five other states fare worse in the forecast.
As a nursing care consultant, it is Goodwin’s job to provide health assessments to determine whether potential DSHS clients are eligible for the agency’s long-term care services. Some days he works in the office at Home and Community Services in Seattle, where Goodwin is based. Other days, he makes house calls at the request of a social worker or a client’s loved one.
He helps patients find more affordable care options than the emergency room, which in turn saves taxpayers money.
Competitive pay is one challenge that has made recruitment hard. Last summer, a bipartisan committee of legislators convened to recommend improvements to state hospitals. Their discussions included increasing compensation for public-sector nurses. According to a market analysis done by the state, registered nurses working in state hospitals made 22.5 percent less starting out than those working at Harborview Medical Center in Seattle — and that excludes what they could earn in private-sector overtime.
To address the shortage of registered nurses such as Goodwin, Washington has negotiated targeted pay increases for the approximately 1,500 nurses who work for the state. The 27.5 percent increase goes beyond the modest increase most other state workers negotiated. (For some nurses at Western State Hospital, the increase is already in effect.)
However, those negotiated pay increases for state workers still require approval from the Legislature, which is working on a compromise on the 2017–19 budget. Although the governor’s and the House Democrats’ budgets include all of the wage increases negotiated last summer, the Senate Republicans’ budget funds only a few of the proposed increases and does not include the pay increase for many state nurses.
Many areas of state government continue to struggle with keeping trained employees on the job. Child Protective Services investigators stay on the job only about 18 months because of high stress and low pay. Western State Hospital has had a similar problem recruiting employees, who could make more at nearby hospitals. But the inpatient psychiatric facility and state leaders are working to fix the problem.
Lawmakers approved a 4.8 percent general wage increase for most employees in the current two-year budget — the first general wage increase since 2008. Those intervening years were the longest stretch since the early 1960s that state employees went without one. And, in recent years, state employees were required to pay more for health care and other benefits.
Changing patient needs spur new challenges
Goodwin has been a registered nurse since 1994. He started his current job 10 years ago.
In his office, he estimated, there are about 16 nurses, but just a couple of them are under 50.
Another trend he’s noticed is that the medical problems his patients have are becoming more complex.
When he started with the state in 2007, he said, his patients were mostly elderly. Now many of his patients are younger and suffering from multiple health problems, such as those brought on by diabetes, he said.
The nursing shortage is affecting the quality of services that DSHS clients receive, Goodwin said. Many social workers are having to visit clients without the assistance of a nursing consultant such as Goodwin to help identify or explain health problems, he said.
“I have the clinical expertise and training that social workers don’t have,” he said. “Most of the social workers that are seeing clients have little or no medical background, and that’s one reason we are there.”
Through his assessments, Goodwin determines whether a patient needs to go to an adult family home or an assisted living facility, for instance. If the patient’s health issues are more severe, it might mean a trip to the hospital is necessary.
For example, one of the patients Goodwin visited had liver disease, affecting the client’s cognitive abilities such as remembering to take medication. Over a two-week period, the patient was hospitalized five times to be stabilized. Each stay lasted two to three days, at a cost of thousands of dollars a day. Because of financial problems, the patient also faced eviction from home.
Goodwin was able to recommend a residential medical setting for the patient, which safeguarded the patient from becoming homeless and likely returning to the emergency room. Instead, the adult family home provided more stable care at a lower cost than continual trips to the ER, Goodwin said.
When patients who are on Medicaid, or who have no income, go to the emergency room, that creates a cost for the state, he said.
In the region where Goodwin works, many of his patients are homeless, so he does a lot to keep them out of the hospital. If he and other nursing consultants aren’t available to assess patients early on, the patients’ problems only worsen.
“If we lose our wage increases … I’m worried we won’t have enough nurses who have the specific training to follow up when a patient needs to go back to the doctor or emergency room,” Goodwin said. “Our clients need this care, and it saves all of us money.”