Out in Bismark, ND: Bismarck Tribune - Bismarck News - Nurses in demand in rural areas

Location plays a role in nursing shortages.

Rural areas are not as fortunate in finding new hires as the more urban areas.

"The state has a maldistribution" of nurses, said Jan Kamphuis, Medcenter One chief nursing officer.

Cities like Bismarck tend to be well staffed, while rural towns are lacking help. The national economy is magnifying this disparity as some facilities in metropolitan areas across the country are cutting jobs or instituting a hiring freeze.

The recession has delayed retirements and increased interest in nursing from people changing careers, said Suzie McShane, director of the Bismarck State College nursing program, a two-year nursing program. Add in staff cuts at some healthcare facilities and nurses and recent nursing graduates are faced with a more competitive job market.

Usually, all the nursing graduates from the local nursing programs who pass the certification exam have jobs. Many though, choose to work in the state's larger communities.

Most of North Dakota is considered a medically underserved area, according to the University of North Dakota Center for Rural Health biennial North Dakota Nursing Needs Study. There are 41 underserved areas, and four-fifths of the counties have at least a partial health professional shortage, according to the latest study released in 2007.

It's hard to attract new nurses to the smaller communities because new nurses want to work in larger facilities. Most of the graduates who do go to rural communities to work usually have ties to the community, such as family, said McShane.

"It (the program) fills the need to grow our own," McShane said.

Until 2004, nurses needed a four-year degree to work in North Dakota. The law was changed in hopes of filling the need for nurses in rural communities. Proponents thought, "If there was a two-year nursing program, we'd get more people and fill vacancies" in rural areas, Kamphuis said. "But guess what? They are not going there."

The BSC nursing program graduated 15 students in May. Most of those graduates now work in Bismarck. Out of the 15 graduates, 10 work in Bismarck, two work out of state, two work in rural communities and one graduate's work location is unknown, according to statistics provided by McShane.

A month after graduation, about a third of the graduates from the University of Mary were still looking for work, said Glenda Reemtz, department chair of the University of Mary nursing program. Six of the university's graduates had job offers from the Mayo Clinic pulled after Mayo closed a hospital.

"I think more are starting to feel it," Reemtz said.

In tough economic times, nurses who work part-time tend to switch to full-time, Kamphuis said. This can reduce the number of open positions, and create less reliance on traveling nurses and agencies to fill positions, Kamphuis said.

The change in part-time and full-time status is like an economic barometer.

"When the economy is down (nurses) go full-time," said Linda Knodel, chief nursing officer at St. Alexius Medical Center. "When the economy is up, they go part-time."

Nurses also delay retirement in an economic downturn, Knodel said. The nursing needs study projected 25 percent to 30 percent of registered nurses, practical nurses and advanced practical nurses to retire in 10 years.

Nationally, employment in health care increased by 21,000 positions in June, according to the Bureau of Labor Statistics. This is down from a year ago when there was an increase of 30,000 positions. Changes like this give the impression that the nursing shortage is alleviated.

"It's a false sense of security because by the year 2012 we will see a huge nursing shortage," Kamphuis said. "We always tell people there is a nursing shortage, not in Bismarck per se, but in places in North Dakota, like Wishek."

Lindsey Gruis, a nurse at St. Alexius Medical Center, found fewer job opportunities earlier this year compared to last summer, when she first applied for jobs. She graduated from the nursing program at the University of Mary in 2008, and found work in Sioux Falls, S.D., so she could be closer to family.

Gruis went to work at Avera McKennan in Sioux Falls. Earlier this year employees received a 4 percent to 6 percent pay cut, depending on the position, she said.

"When I took the pay cut, I was making less than when I started," Gruis said.

When she came to St. Alexius, her salary was $2 an hour more than what she was making in Sioux Falls.

Other nurses also are seeing the number of jobs dry up since they graduated in the last year or two.

"I think it's tightened up," said Scott Schneider, an emergency room nurse at Medcenter One. "There are not as many openings as when I graduated."

Nursing is a second career for him. He wanted a job in Bismarck because he didn't want to move his children out of the community. He started at Medcenter in 2007.

Medcenter works closely with its college of nursing to find job opportunities for the graduates. Each year, the senior class meets with all the department managers to get a feel for where they might want to work.

"It's kind of like speed dating," Schneider said.

The hospital hired 44 new graduates this spring, 36 of whom came from the Medcenter One College of Nursing, Kamphuis said. Medcenter has about 600 nurses.

St. Alexius hires about 67 to 70 nurses each year, Knodel said. The hospital has 671 nurses.

Why do the hospitals have so many openings each year?

The openings occur because people relocate when a spouse moves or they are retiring. For nurses who already have jobs, there is a strong sense of job security.

"The benefit of the shortage is that I will never have to look or wonder about a job," said St. Alexius nurse Sara Jensen.