BURLINGTON — The vacancy rate for registered nurse positions in Massachusetts' acute care hospitals declined to 5.7 percent in 2006, according to a new study released by the Burlington-based Massachusetts Hospital Association (MHA) and the Massachusetts Organization of Nurse Executives (MONE).

In this year's survey, the nurse vacancy rate at specialty hospitals was 10.1 percent, the MHA reported today.

According to the survey of acute care hospitals, the RN vacancy rate as of January, 2006 was down from 6.2 percent in 2005 and 6.7 percent in 2004.

The report noted that while vacancy rates have declined for the fourth consecutive year. They still remain high when compared to rates during the 19 years that the survey has been conducted. The median vacancy rate at acute care hospitals from 1988 2006 is 4.7 percent.

Although the news on vacancy rates seems encouraging, experts predict that the national nursing shortage will grow at a rapid clip beginning in 2010. when large numbers of baby boomer nurses reach retirement age. Nursing education programs nationwide have not proved sufficient numbers of graduates to replace retiring nurses.

Hospitals have recognized this problem for many years and have pursued a number of strong steps to address it. More than 90 percent of the hospitals surveyed by MHA and MONE sponsor school career days to generate interest in nursing careers. Virtually all — 99 percent — have also held clinical rotations for RN students.

"Massachusetts' hospitals have been recognized nationally for their leadership in instituting programs, benefits and practices that have led to better morale on the nursing floors," explained Massachusetts Hospital Association Senior Vice President for Clinical Affairs Karen Nelson, RN.

"They have committed to programs of excellence like Magnet recognition and Patients First that contribute to greater job satisfaction Despite all of the challenges in healthcare, recent studies have shown that the vast majority of nurses — 80 percent like their jobs. We need to get that message out to wider audiences to attract more talented professionals to nursing. Nursing requires special skills and is challenging work, but it is a profession where you can make a significant difference in a patient's life."

National nursing studies suggest that the recent decrease in vacancy rates has been caused by the re-entry to the workforce of older, married nurses responding to improved wages, job losses on the part of their spouses, and more recently, healthcare initiatives aimed at improving working conditions and hours worked.

However, these studies say the forecast of a long-term, structural shortage is unchanged. The U.S Department of Health and Human Services (HHS) projects that the deficit of full-time equivalent (FTE) RNs in Massachusetts —which HHS currently estimates at nearly 5,000 — will double by 2010 and grow to over 25,000 by 2020.

"Although we have employed a number of strategies to address these looming shortages, there is still a lot of work we need to do," explained Massachusetts Organization of Nurse executives President Patricia Reid Porte, RN, DNSc, FAAN, in order to meet the needs of an aging generation.

The healthcare industry, in partnership with academic institutions as well as federal and state governments, must invest in creating new high-quality and efficient pathways to educate nursing faculty and to continue to implement effective strategies to attract and educate greater numbers of talented people to these rewarding professions.

We must also assure that our practice environments successfully engage our nurses, provide the technology to support safe interdisciplinary practice and create partnerships with patients and families to assure high quality and compassionate care."

The MHA/MONE study further noted that the deficits in RN vacancies occur primarily in evening and night shifts. Seventy seven to 85 percent of hospitals reported shortage on "off-shifts," twice the share that reported day-shift shortages. Vacancy rates were highest in rehabilitation services, neonatal intensive care, skilled nursing, and oncology units. The lowest vacancy rates were in labor and delivery, ambulatory care, maternal, and child health services.

When asked about the impact of the nursing shortages, hospitals indicated emergency department overcrowding, emergency department diversions and reductions in the number of staffed beds were the most common effects. The survey also found the leading reasons for RN departures were related to changes in the nurse's family situation, a decision to accept a different job in nursing, or better wages and benefits 'from another employer.

The survey results are based on the responses of 71 Massachusetts acute care and specialty hospitals in January 2006. The respondents included 58 acute care hospital campuses and 13 specialty hospitals. The acute care hospital respondents represented 82 percent of the state's acute care hospitals and 86 percent of acute care hospital beds.

Measures of nursing staff shortage

* The vacancy rate for Registered Nurses (RNs) in all survey hospitals was 6.0 percent. Acute care hospitals reported a 5.7 percent vacancy rate, and specialty hospitals reported a 10.1 percent rate.

* The RN vacancy rate declined for the fourth consecutive year, but still stands at a high level relative to rates over the 19 years of data collection (acute care hospital median 4.7). Vacant positions are covered by per diem nurses, staffing pools, on-call staff, overtime, and agency or traveler nurses.

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* Among 65 hospitals that responded to both the 2005 and 2006 surveys, the number of filled RN positions grew 3.7 percent, the product of a 2.2 percent drop in vacant positions and 3.4 percent growth in budgeted positions.

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* National studies (Buerhaus and others, Health Affairs Web Exclusive, Nov. 2004) suggest that the dip in vacancy rates is caused by the reentry to the workforce of older, married nurses responding to increasing RN wages and the toll of relatively high unemployment rates on their families, and, more recently, widespread private-sector initiatives aimed at increasing the number of people who become nurses. For now, however, the forecast of a long-term, structural shortage is unchanged. Large numbers of baby-boomer nurses will soon begin to reach retirement age, and nursing education capacity is currently insufficient to replace them.

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* The U.S. Department of Health and Human Services projects that the deficit of registered nurses in Massachusetts will almost double by 2010 and grow to over 25,000 in the following decade.

* Hospital nursing is a 24-hour, 7-day a week service. As reported in past years, the nursing shortage is concentrated principally in evening and night shifts. The 2006 survey found that 77 to 85 percent of hospitals reported shortages on "off-shifts," twice the share that reported day-shift shortages. This and other data on shift disparities suggests that the nursing shortage has significant roots in lifestyle expectations of nurses.

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* RN vacancy rates were highest in rehabilitation services, neonatal intensive care units, skilled nursing units, and oncology units. The lowest vacancy rates were in labor & delivery units, ambulatory care. post-anesthesia care units, and maternal and child health services.

* Hospitals reported that emergency departments, adult critical care units, home health, and operating rooms were the services that took longest to fill open RN positions, measured by the share reporting 60 or more days to fill open positions. Sixty-four percent of hospitals reported that it took 60 or more days to fill open RN positions in emergency departments, with 41 percent reporting greater than 90 days to fill those positions.

* Vacancy rates were 10.2 percent for licensed practical nurses (LPNs) and 9.3 percent for certified nurse assistants (CNAs). The 2006 rates increased from 2005 levels, but still are well below levels in 2002, when LPN and CNA vacancy rates were 14.2 and 12.2 percent respectively.

* ED overcrowding, ED diversions, and reductions in the number of staffed beds were the most commonly cited effects of RN shortages.

* Hospitals ranked departures related to the nurse' s family situation as the leading reason for RN departures from their institutions, followed by departures for higher pay for the same/similar job at another employer and departures to accept new/different job responsibilities in nursing, and relocations.

Management practices

Recruitment & Retention

* Short-staff/critical vacancy bonuses (42 percent of respondents), night-shift bonuses (32 percent), and sign-on bonuses (28 percent) were the most commonly reported types of RN financial bonuses.

* Reported sign-on bonuses for RNs ranged from $1,000 to $7,500. The frequency of use of such bonuses was unchanged from 2005 levels.

* Outside of financial bonuses, the most commonly employed financial incentives were tuition reimbursement, continuing education, retirement plans, and experienced-based compensation.

* Increased staff participation in decision making was the most commonly reported non-financial recruitment and retention practices. Adoption of mentoring/preceptoring programs for new RN hires and training programs for preceptors, along with special recognition ceremonies and were also among the most common practices.

Outreach to Grow the Supply of Nurses

* Hospitals reported using a variety of approaches to attract and support young people in pursuit of nursing careers. The most commonly reported programs were hospital clinical rotations for nursing students, school career days, internships, and cooperative educational programs.

* Hospital-paid/sponsored faculty in nursing schools and hospital nursing staff serving as faculty in nursing schools showed gains over levels reported in 2005.

Quality & Safety Management

* Hospitals reported high rates of use of JCAHO and National Quality Forum-endorsed measures designed specifically to assess the quality of nursing care. Sixteen of 21 listed clinical measures were reported to be in use in 80 percent or more of hospitals. Near universal use was reported for measures of adverse drug events, patient/family complaints or satisfaction with care, injuries to patients and patient falls.

The survey results are based on the responses of 71 hospitals that received the survey in January 2006. The respondents included 58 acute care hospital campuses and 13 specialty hospitals. The survey response rate was 76 percent. The acute care hospital respondents account for 82 percent of the state's acute care hospitals and 86 percent of acute care hospital beds.