BOISE (AP) | Idaho's nursing workforce isn't in bad shape. It is in lopsided shape.
Eastern Idaho is awash in nurses, while hospitals in Boise bring in traveling nurses a few times a year and send recruiters to conferences in search of people to hire.
It is hard to find intensive-care, emergency and operating-room nurses, but easier to find new graduates who don't have the experience to care for an elderly trauma victim.
Overall, stakeholders say the state needs more highly educated nurses who can meet the health care needs of Idaho's aging population and replenish jobs as seasoned baby boomers retire.
"We don't have a shortage. We do have a distribution problem," said Sandra Evans, executive director of the Idaho Board of Nursing.
That's a change from 2006, when a nursing task force told then-governor Jim Risch that Idaho had a shortage of nurses - a shortage "expected to become critical between now and 2020." The shortage was "marked by an alarming exodus of the existing nursing workforce and the industry's inability to adequately compensate by using old, familiar strategies," the task force wrote.
Idaho's higher education institutions have since worked to meet employers' demand for new nurses over the next 10 years, the Idaho Department of Labor found in a recent report.
But Idaho still has the lowest number of registered nurses per capita in the U.S., according to federal data.
And it still takes Saint Alphonsus twice as long to fill local critical-care nursing jobs as it does to fill general nursing jobs. It takes St. Luke's more than 90 days to fill its local specialized registered nurse positions.
Anna Roy and people like her might be key to staffing the hospitals, hospices and public health agencies of the future.
Roy is a 36-year-old Boise-area native who earned a bachelor's degree from Idaho State University, passed a licensing exam and became a registered nurse about 11 years ago.
The job market was dry in Pocatello then - it still is, she said - so she moved back to the Treasure Valley and started working for the Idaho Medicaid program.
About two years ago, she wanted a change of pace: more education opportunities, better pay and benefits, something different. Her husband is a doctor at the Boise VA Medical Center, and Roy took a job in the hospital's anticoagulation clinic. Now she manages VA patients to make sure they don't develop blood clots.
"I really fell in love with getting to make an impact in patient lives," Roy said. "I know personally I can't change their life, I can't cure them, but if I make a difference in (giving) better care and compassion to them, then I've succeeded."
She's thinking about becoming a nurse practitioner. That's an occupation in demand in Idaho, especially as changes in the health care industry put more emphasis on "midlevel" providers. Nurse practitioners have advanced degrees and are legally allowed to prescribe drugs and act as primary care providers. They have a broader scope of practice than registered nurses, who typically have associate's or bachelor's degrees.
Nursing students need hands-on practice; they can't just sit in the classroom to learn.
But the places where students can learn by doing, with adequate supervision by more experienced teachers, is in short supply in Idaho.
Boise State University School of Nursing Director Ann Hubbert said the school doesn't have trouble filling its faculty slots.
But statewide, that's not the case, and instructors are pushing retirement age, Evans said.
"It's the faculty that provide the ability to meet demand," Evans said. Unless young nurses go on to higher education, "we are going to run into a problem."
Compounding the issue is that salaries for nursing school instructors "are so low that they're not competitive with what St. Luke's and Saint Al's and Kootenai (hospital) can pay," Evans said.
The average nursing instructor in Idaho makes $49,660 - about $10,000 less than a registered nurse, $45,000 less than a nurse practitioner and $119,000 less than a nurse anesthetist, according to the U.S. Bureau of Labor Statistics.
Every state that borders Idaho pays its nursing instructors better on average, too - from about $7,000 more in Montana to $35,000 more in Nevada.
THE LEARNING ENVIRONMENT
Hospitals, clinics, nursing homes, jails, home-health agencies and school districts are among the 145 "clinical sites" where nursing students can do rotations in Southwest Idaho. Statewide, there are hundreds of sites for future nurses to hone their skills.
But almost every nursing program in Idaho reports not having enough access to clinical sites for students, according to the Idaho Department of Labor.
That's partly because of the lack of faculty members to oversee them, and partly because a hospital in Boise can't function if it's crawling with hundreds of nursing students from nearby schools.
"Our clinical partners are maxed," Hubbert said. "In addition to nursing students, they're running (student) physician assistants, EMTs ... and from not only the Treasure Valley."
Nursing schools in other states are sending students to the Treasure Valley for clinical education, she said.
Saint Alphonsus has 126 nursing students signed up for spring 2015 rotations, according to Sherry Parks, regional chief nursing officer.
St. Luke's had more than 730 nursing students go through clinical rotations in its Treasure Valley sites last year, said Chief Nursing Officer Cy Gearhard.
Boise State University, which has more than 400 nursing students, built a clinical simulation center in 2010. It's a six-bed pseudo-hospital that holds up to 30 students at a time.
"The simulation center just adds another tool for us to be able to offer our students those clinical experiences," said center Director Becky Bunderson. The goal "is to try to create a realistic environment (for hands-on training) that doesn't pose any risk to patients."
Gearhard and Parks said their hospitals are meeting their patients' needs for nurses. But they're gearing up for big shifts in how health care systems operate under the Affordable Care Act, with nurses in charge of more telehealth and outpatient care.
The hospitals are working with Idaho nursing schools to introduce future nurses to specialties such as critical care, which are stressful, demanding and require staffing around the clock. But sometimes these efforts fall short and hospitals need to hire travel nurses from out of state - staffing that tends to be expensive.
They're also cultivating the next generation of highly skilled nurses from within their own ranks.
St. Luke's and Saint Alphonsus both offer residency programs that orient recent nursing school graduates to the hospital workplace and give them a taste of various specialties.
They want nurses who attended two-year schools to get a bachelor's degree - something the National Institute of Medicine is pushing. The institute says 80 percent of the nursing workforce should have a bachelor's degree - an ambitious goal, given that the national average now is 55 percent and that it took 10 years to get there from about 50 percent.
About 57 percent of Saint Alphonsus nurses have at least a bachelor's degree, and about 66 percent of local St. Luke's nurses do.
Saint Alphonsus is sending employees to college, offering scholarships to Boise State and Northwest Nazarene universities. More than 150 Saint Alphonsus nurses are enrolled now in baccalaureate programs, with 20 of those on full-ride scholarships from Saint Alphonsus.
Saint Alphonsus is budgeting $250,000 in the next fiscal year for nurses to pursue advanced degrees, a spokesman said.
At St. Luke's, Gearhard expects to hire 30 percent more nurses over the next 10 years as the system expands, she said.