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(This: article originally appeared in the Las Vegas Review Journal on February 22, 2004 - Reprinted with Permission)

What does it mean to you if Southern Nevada is experiencing what is believed to be the most severe nursing shortage it has ever seen?

It doesn't mean anything - if you don't have a baby, don't become sick, don't need an operation, don't become injured, don't have to visit an emergency room, and don't plan to age over the next decade or two.

"It's a critical nursing shortage we've never seen before," says Vicki Huber, University Medical Center's senior associate administrator for patient services and the hospital's chief nursing officer.

"And the problem is not just local. It's not just a regional or statewide problem. It's national. It's even international now, in some respects, because we've recruited a lot of international nurses from the Philippines and other countries, and we've depleted their supply."

Valley hospitals, nursing schools and health care administrators are taking steps they hope will alleviate the shortage. But, they agree, lasting relief isn't in sight anytime soon.

The job description covers a variety of health care professionals including registered nurses and licensed practical nurses. It also describes nurses who work in settings ranging from hospitals and nursing homes to doctor's offices, schools and factories.

The most acute shortage across the country is in registered nurses - those who receive training in either two-year associate's degree programs or four-year baccalaureate programs - who work in hospitals.

The U.S. Department of Labor ranks registered nursing as the occupation projected to see the largest number of new job openings through 2012. The department estimates that about 2.9 million RNs will be on the job in 2012, up from about 2.3 million in 2002.

Closer to home and more short term, Nevada is behind the curve. Fran Brown, dean of the division of health sciences at the Community College of Southern Nevada, cites a 2001 U.S. Department of Health and Human Services study that ranks Nevada as having the lowest number of nurses per capita in the country, with 520 nurses per 100,000 people, compared to 782 nurses per 100,000 people nationally.

The shortage is felt most acutely in such specialized areas as critical care units, emergency rooms and operating rooms, Huber says.

Part of the problem is the valley's rapid growth.

"Because that population is growing so dramatically, there is a need for hospitals and health care providers to continue to grow and meet the needs of people," says Bill Giezie, director of human resources for Valley Health System.

America's RNs also are aging, and the supply of new RNs has not made up for those who are leaving hospitals or retiring.

Lisa Black, executive director of the Nevada Nurses Association, says the average age of registered nurses is 45 nationally, but 47 in Nevada.

Studies indicate about half of today's RNs will retire in the next 10 to 15 years, around the time aging baby boomers increasingly will require their services, Huber adds.

While there are signs nursing school enrollments are inching up, nursing education programs still are lacking enough RNs with postgraduate degrees who can teach prospective nurses.

"One of our dire shortages is nurses who are nurse educators, the people who train nurses," notes Dr. Joe Hardy, a Boulder City family practice physician and Republican state assemblyman.

To teach at the community college or university level, an RN must have at least a master's degree in nursing, notes Connie Carpenter, director of the nursing program at Nevada State College. But, she adds, there's more money for such RNs in clinical practice than in education.

Retirements also are looming among nurse educators, Carpenter notes, given that the average age of nurse educators nationally is about 54.

An increase in career opportunities in other fields during the past several decades also may have helped to siphon off young people - women, primarily - who otherwise might have chosen to become nurses.

Presented with the chance to pursue more lucrative careers in medicine, law or business, women "don't necessarily choose nursing," Black says. "They're lawyers or physicians.'"

The image of nursing may have helped to steer prospective nurses into other professions, too.

"Sometimes you have trouble recruiting people because it is hard work and the salary is not always commensurate with the responsibility," says Cheryl McKinney, an RN and education specialist at Valley Hospital and Medical Center.

Nursing is "recognized for being high stress for little recognition," Black agrees, although "to be fair, pay scales have increased significantly over the last five or 10 years, more locally but also nationally."

The median annual wage for RNs nationally was $44,840 in 2000, according to the U.S. Department of Labor. Several Southern Nevada hospital and nursing executives estimate the starting salary for newly minted RNs here is about $21 per hour, or about $43,680 annually.

However, Candyce Wehrkamp, vice president of human resources for St. Rose Dominican Hospitals, says hourly wages can jump to $35 for RNs in highly specialized fields.

Several hospital representatives here say that because Southern Nevada's hospitals must compete for RNs, wages can rise whenever new hospitals open, and some facilities offer signing bonuses to desirable candidates.

Mary arme Salm, political director of Local 1107 of the Service Employees International Union, which represents about 4,000 local RNs, says the shortfall in hospital RNs stems more from working conditions and retention issues than demographics.

The problem, SaIm says, is "we're not doing enough to retain nurses in the nursing profession."

Studies indicate "one-third of all nurses leave three years after getting into the profession, and that's scary," she says. "We spend a lot of money on the education side only to say goodbye to those nurses three years later. And when you do a cost-benefit analysis, that's a pretty costly way of approaching the issue."

According to Black, a 2000 American Nurses Association study said as many as 40 percent of working nurses were "planning not only to leave the job but the entire nursing profession in three to five years just because (of) the stress levels and workload.

"So when you couple that with the nursing shortage, if you don't put mechanisms in place to keep nurses you already have, what you have is it spinning out of control."

SaIm says the workday consequences of low staffing levels - most significantly, high nurse-to-patient ratios and mandatory overtime - are the primary reasons RNs leave jobs in hospitals and acute care settings.

What does this mean to patients?

"One of the ripple effects is the (additional) time to get seen in the doctor's office and get some elective (hospital) procedures done," Giezie says.

Or, he adds, patients may find themselves waiting in emergency rooms longer.

A shortage of nurses also may mean that nurses don't have the time to talk with patients as much as they would like to or as much as they could in the past.

Patient care can be compromised, Huber says, and several studies suggest that "the higher your RN percentage, the higher our quality outcomes are."

"If you don't have enough nurses to take care of patients, then (administrators) have to start shutting down beds," Wehrkamp says. No one has reported that here yet.

To combat the shortage, valley hospitals have adopted several programs designed to produce, attract and retain RNs. "

For example, Giezie says, Valley Health System's 2-year-old Adopt-a-Student program offers RN students in their final two years of training as much as $2,000 per semester for books and tuition. In exchange, the students agree to work at a Valley facility for two years after graduation.

Other hospitals offer similar tuition reimbursement programs for nursing students, as well as for RNs who wish to further their education. St. Rose Dominican Hospitals even offers RNs contributions of as much as $2,500 toward the purchase of a home.

Meanwhile, hospital administrators say they're more attuned than ever to the necessity of offering nurses a professionally fulfilling work environment.

That entails not only such obvious issues as keeping salaries competitive, but such measures as trying to more closely match work schedules to nurses' needs, says Helen Vos, chief nursing officer at Mountain View Hospital.

"It's the kind of culture you create in an organization," Vos says. "It's, "How supportive are you?'

"And it's not just the nurses. It's all of the clinical and support staff and making it an environment where people want to stay."