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Jeanne Perry, left, and Johanna Shennett, registered nurses at Portsmouth Regional Hospital. Don Clark photo

Imagine the pain of needing your hip replaced. Yet when you try to schedule the operation, the hospital says it is delaying "elective" surgeries until more nurses are hired or trained.

This is not a hypothetical situation, but something that has been occurring at hospitals across the country and in the Seacoast, according to experts.

A nursing shortage began in the 1970s, when women started pursuing careers beyond nursing and teaching. Yet, as the years go on so does the problem. Experts say the shortage will hit its peak around 2020.

The gap between the number of nurses available versus the number needed speaks for itself.

In a study conducted in New Hampshire in 2002, it was reported that 70 percent of nurses were more than 40 years old, and more than 40 percent said they planned to leave the profession in the next five to 10 years.

The U.S. Health Resources and Services Administration reports there will be 1 million nurse staffing vacancies across the country by 2020.

There is an increase in the interest of pursuing a career in nursing; however, applicants are being turned away by the hundreds from nursing schools in New Hampshire because there is not enough staff to educate them.

Supply and demand

"The number of nurses is directly related to patient outcomes: their infection rate, ulcer prevention, and even mortality," said Dr. Susan Fetzer, RN, associate professor of nursing at the University of New Hampshire and president of the New Hampshire Nurses' Association.

Schools and hospitals have begun to address the situation by increasing the number of nursing graduates and extending nursing programs, but efforts are still not enough to meet the demand.

Linda Taylor, clinical director for the Seacoast Visiting Nurse Association, worked as a critical-care nurse for 30 years. She retired in 1998, about when the shortage was beginning. Looking back on her experience, she calls nursing noble, yet she says she understands why a shortage is occurring.

"It is very demanding, both physically and emotionally," Taylor said. "We're open 24 hours, and if someone else can't come in, you stay longer because there's no one to cover. You also have to work one out of every three weekends."

Nurses often work overtime shifts, but then run the risk of burning out or not being able to make the best decisions for patients because of the number of hours they are asked to work.

"You hope patients under their care are not noticing the stress you have because of staffing issues, but national studies show a decreased staff has a negative impact on patient outcome," Taylor said. "You can't refute that."

Jane Bishop, chief nursing officer for Portsmouth Regional Hospital, said the shortage has had less of an effect here than in other areas.

However, even Portsmouth has struggled to fill nursing positions for the intensive-care unit and operating room, portions of the hospital that require experience and expertise.

As a result, about a year ago the hospital instituted an intensive training program that allows its nurses to work with an intensive-care unit nurse for six months to a year learning the trade.

"We went through a slump, but now we're on an upswing," Bishop said.

Even through the "slump," though, Portsmouth Regional never turned patients away, Bishop said.

"There were times when we were not able to accept patients from other hospitals because of a nursing shortage, but that was infrequent."

But Portsmouth is not your typical situation, other nurses say.

"Beds are often closed to admission," Fetzer said. "This means that your elective surgery would have to be rescheduled. If your hip needs to be replaced or your gallbladder needs to come out ... those would be delayed until there were more nurses or they could staff better. They put those surgeries on waiting."

At Wentworth-Douglass Hospital in Dover, its 6.8 percent vacancy rate for nurses is lower than the national 16 percent, which Noreen Biehl, vice president of community relations, said was due in part to new programs and incentives.

Biehl said the hospital does not have a shortage of new nursing school graduates or fewer senior nurses, but does have a shortage of experienced nurses, "although we are better than the national average."

Numerous calls placed to Exeter Hospital and York Hospital in Maine, inquiring about how those institutions are being affected by the nursing shortage, were not returned.

Wanted: Faculty

The number of nurses and patient care will only continue to decrease if a change does not occur soon, Fetzer said. That change will have to come in the form of educators.

While the shortage of nurses has remained consistent, the level of interest in becoming a nurse has increased, according to Fetzer. Each year, hundreds of potential nurses are being turned away by schools because there is not enough room in the classrooms.

"In New Hampshire, we could triple our output of nurses tomorrow. We just need to triple the number of faculty," Fetzer said.

In 2006, nearly 43,000 qualified applicants to baccalaureate and graduate nursing school programs were turned away primarily due to an insufficient number of faculty, according to information from Andrea Higham, director of the Johnson & Johnson Campaign for Nursing's Future.

But the idea of teaching nursing rather than practicing it is not very enticing. To teach, nurses must earn at least a master's degree, if not a doctorate, which typically involves anywhere from five to eight additional years of education.

Educators at a university level are expected to teach multiple classes about a variety of different types of nursing, as well as conduct research and remain up-to-date on the most recent technology and techniques.

If a nurse does make the transfer from nursing to teaching, he or she will also most likely take a pay cut.

"Faculty are making less money than a staff nurse who works in Boston who doesn't have the extra eight years of education," Fetzer said.

Colleges and universities have to have the foresight to build incentive programs or loan-payback programs to entice nurses into the education world; otherwise, the nursing shortage will go from grim to dismal, Fetzer predicted.

New Hampshire Technical Institute in Concord announced earlier this month it will expand its program, which will reportedly allow it to accept 50 of the 150 applicants turned away each year.

Fetzer said after being a nurse for 30 years, she decided to transfer to teaching because she knew about the need and wanted to help future generations of nurses.

"I want someone around to take care of me someday," Fetzer said laughing. "There is self-interest as well."

This story originally appeared in Seacoast Media Group's Herald Sunday publication.