American hospitals are in a serious crisis, from large numbers of uninsured patients to spiraling costs, from outlandishly expensive prescription drugs to a severe and dangerous shortage of nurses, a shortage that can best be summed up by the fact that there are now over 120,000 open positions for registered nurses nationwide.
If that sounds like just another statistic, think about this: Emergency rooms are shutting down, surgeries are delayed and, most disturbing of all, patients are sometimes not getting the critical care they desperately need. Lesley Stahl reports.
How worried should a patient be when he pushes that little button for the nurse and she doesn't show up for a half-hour?
"I think you should be worried," says Joyce Thompson, a professor at the University of Pennsylvania's School of Nursing.
A new Harvard-Vanderbilt study of thousands of hospital records confirms a direct link between a lack of nurses and potentially fatal patient complications.
"Hospitals aren't run by physicians,' she says. "Hospitals are only successful if nurses are there. A physician can cut you up, he can put you back together, but if you don't have that nurse who's following up, who's helping you to understand what is the impact of this particular condition on you, then the hospital falls apart."
Hospitals have struggled to attract more nurses, but working conditions keep getting tougher. Nurses frequently have to work double shifts, and new insurance rules, under which only the sickest people are treated in hospitals these days, mean that each of the patients requires much more care and attention.
Nurses like Laurel Leclaire say the pace has become relentless: "It's very stressful. This isn't - we're not shuffling papers. These are patients' lives, I mean. And we make one little mistake, and it could--it could harm the patient." The pressure is much higher than it used to be, she says.
Stahl found Laurel working a 12-hour shift on the cardiac floor at New York's Montefiore Hospital. She was very busy.
Laurel's patient had to get blood at a specific time, and it's already late. Because of the staff shortage, she has to find someone to bring it to the floor ASAP. She found someone to do it, but it was hectic.
Even though the work has become more difficult, wages have not even kept up with the cost of living.
Leclaire says she is underpaid. "With my longevity, in another position I would be making much more money."
There is a major reason for the shortage. Ever since the mid-'80s, young people have been choosing more lucrative careers. At the same time, the nurses we do have are getting older; the average age is now 45. Just as the baby boomers are starting to need more care, the pipeline is running dry, and it's going to get much, much worse.
Thompson says that over the next 20 years, this country is going to be short 400,000 nurses, unless something is done to change things.
She says we have to make nursing a more appealing choice. "The societal image is anybody can be a nurse. It's like anybody can be a teacher. That's wrong, extremely wrong."
Hospitals have been slow to respond, and so has the government. State legislatures have only recently begun trying to restrict the number of hours nurses are required to work and increase the number of nurses on each shift. And there are proposals for scholarship money and student loans, but everything has a price tag.
"We have the solutions in this country. We have to have the political will to put the solutions in place," says Thompson. She's dismayed that instead of spending more to attract the number of nurses we need, we are turning outward; we have begun hiring nurses from overseas.
Armand Circharo runs CoreMedical, a nurse recruitment company. More and more hospitals are hiring staffing companies like his to find qualified nurses from English-speaking countries, like Ireland, India and the Philippines.
But now Core and other companies are targeting some of the poorest countries in the world, like South Africa, which has its own shortage.
Nicola Hopkins is a recruiter for Core. She's making the hard sell to a group of nurses in Johannesburg. "We have positions in Arizona, California, in Florida, Georgia, wherever you're wanting to go," she recently told a group of nurses there.
Hopkins used to be a nurse herself in South Africa, until she was recruited to work in the States. She understands how little these women earn. An average South African nurse makes about $5,000 to $7,000 a year; Core offers them five times that - and a package of incentives that overworked South African nurses find hard to turn down.
"Automatically, for families, we will be sponsoring you for your green cards because this then entitles husbands to come through with you," Hopkins told them. "We will help you find an apartment."
The pitch is 'Pack your bags, we'll do the rest.' As long as the nurse agrees to work in an American hospital for two years, Core will offer everything, from an airline ticket to a green card.
"We encourage you to bring your family because we want you to come across as a family unit to support one another," Hopkins told them.
The reason South African nurses are in demand is that they are so highly trained. Because doctors are scarce there, nurses have become more experienced at treating and diagnosing patients. Core vets these nurses with reference checks, a battery of credential screenings and tests in English.
Hasina Subedar, head of the South African Nursing Council, is appalled that the United States is trying to poach nurses, and she's trying to stop it.
She doesn't blame the nurses for taking more money. "I think that everybody wants to improve their standard of living," she says. "I do, however, blame the recruiters of First World countries, and I feel our country's at a stage where we're trying to recover from a very, very difficult past, and by taking our human resources, you are taking away our future; you are taking away our ability to improve the quality of life of people. And I think that this is something I would like to say to American society. Think about it."
South Africa's health system is stretched to the breaking point. Hospital waiting rooms are overflowing, partly because the country is now in the throes of a catastrophic AIDS crisis, with the highest number of cases in the world. According to the United Nations AIDS Program, an estimated one in five adults is infected with HIV.
While America has just begun its active recruitment in South Africa, other countries, such as Saudi Arabia, Australia and especially England, have already lured thousands of nurses away to alleviate their own shortages.
"Each country that has a crisis, you need to deal with it within your country. Don't see your solutions as coming to our country and resolving your problems," says Subedar.
What galls her is that the recruiters are going after the nurses they can least afford to lose: The cream of the crop.
There may not be a more dramatic example of that siphoning off of the elite than what's happening at South Africa's Cecilia Makiwane Hospital. It sits on a hillside in the midst of a sprawling and very poor township. Lulama Galeba, deputy director of nursing, says she has lost almost half the nurses in this hospital.
Foreign recruiters have come here to lure away the best and the brightest. One of the best of all is Patricia Mayaba, who worked her way up to supervisor of pediatrics. She has just given notice after 20 years on the job.
She is leaving because of "financial problems," she says, and because her children are hungry. Her leaving will make what's already a desperate situation at the hospital even worse. The ratio of nurses to patients on the pediatrics ward is one nurse to 10 babies. The ratio is supposed to be one to two.
"Some wards have had to shut down completely. These rooms should be filled with AIDS patients," Galeba says.
Hopkins says she doesn't feel guilty about recruiting: "If I don't help them and bring them across with a company that's going to keep them happy, they're going to go somewhere else. So, no, I don't feel guilty because if they want a better life, I'd like to try and offer it, if I can."
But Professor Thompson is greatly disturbed by the foreign recruitments: "It's extremely unethical. It's such an egotistical, parochial view that in the United States, we can buy anything that exists in the world to make ourselves better. And let's not be concerned about poor Africa. Why shouldn't we be concerned? We're a part of this world."
Stahl asked Circharo is he thought recruiting was ethical. "I'm sure there are people there that see it that way, but, again, I don't think that's an issue that we can afford to allow to slow us down in this process," he said.
"We have a very fragile health care system that we're trying to keep intact, and nurses play a large role in that. They're the single-largest population in health care. We really cannot get along without them, and I think we're going to find that the effects of not having nurses is going to be quite devastating. So I really don't feel like we could look at a problem like that and allow it to stop us."
In October 2002, a study from the University of Pennsylvania showed that for the first time, there's a direct link between the nursing shortage and an increase of patient deaths.