One of the most serious problems in United States health care may also be one of the most soluble - at least in the short run. It's the much-discussed nurse shortage. But in the long run the problem may be more difficult to cope with.
``There is definitely a shortage,'' says Linda H. Aiken, vice-president of the Robert Wood Johnson Foundation, who has studied the issue.
Hospitals, where most of America's nurses work, certainly agree that a shortage exists. The American Hospital Association estimates that as of the end of last year 13.6 percent of all full-time hospital nursing positions were vacant, slightly more than twice the number a year earlier. Little change is expected this year.
Ms. Aiken, a registered nurse, says hospitals can take two steps to try to alleviate the problem for the moment:
Restructure hospital jobs. Too many nurses, as they will readily state, have to do secretarial, administrative, and food-preparation work, resulting in what in effect is an artificial shortage of nurses, Aiken indicates. The situation leaves many nurses feeling harassed, overworked, underpaid, and often unable to spend much time directly aiding patients. Aiken says more secretaries, cooks, and administrators should be hired.
Computerize hospital work. Hospitals ``have been extremely slow to computerize,'' she says, especially in the area of medical record-keeping.
Whether these steps will head off a long-term shortage is questionable. The number of students in US nursing schools has declined substantially during this decade. Enrollment in nursing schools is down 20 percent since 1983, and the number graduated is forecast to decline from the current 80,000 a year to 28,000 by 1995. ``Whereas we might have an artificial shortage of nurses now,'' Aiken says, ``we might have a real shortage later.''
Nurses have plenty of problems with their jobs, as many will volunteer. Although three-fourths of those with registered nurse degrees are employed in their field, nurses say that on-the-job difficulties contribute to the shortage by causing many nurses to leave their jobs, or to decide to work part time. ``Many leave nursing in hospitals and are going to work in industry, pharmaceutical companies,'' or home health care, says Nolan Byrne-Simpson, a registered nurse employed full time in a Rhode Island hospital and president of a local union.
Pay ceilings are one problem: Nurses hit ceilings ``in about five years,'' says Kathy Smith, a registered nurse in Portland, Oregon. Nurses also work nights, holidays, weekends, and on rotating shifts. That's ``disruptive to your personal life,'' says Ann Twomey, a nurse and local union president from Englewood, N.J.
In the early 1960s hospitals reported that one-fourth of their nursing positions were vacant; nurses' salaries then rose and so did supply - for a while. But by 1979 salaries stopped rising, Aiken notes, and the shortage of nurses reappeared. Since then, this cycle has repeated itself and the shortage is back.
One step that would help in the longer run might be to persuade the 500,000 part-time nurses, one quarter of all US nurses, to work longer hours. To do that might necessitate changes favored by Aiken and individual nurses: raise pay substantially for experienced nurses, and for nursing duty during nights, weekends, and holidays. But hospitals could be reluctant to follow this costly remedy. Medical expenses in general, have risen faster than the rate of inflation in recent years.