Nurses aren’t exactly knocking down the door to work at Jefferson County Memorial Hospital in Winchester.

And the recruiting problem facing smaller, rural hospitals in Kansas is about to get worse.

Kansas University Student nurses, from left, Jean Fortier and Anna Zinn, practice their skills with dummies before they graduate to the real thing. Kansas University faces budget cuts that could reduce the number of nursing students accepted each year.

“Recruiting people is a huge challenge,” said Joye Huston, the hospital’s acting chief operating officer. “Nursing jobs are very competitive in the city, and those are very attractive to new grads. Young people want to do exciting things, and our operation here doesn’t tend to be real exciting.”

The state’s efforts to train and recruit nurses seemingly are at cross purposes.

On one hand, nurses are in such demand that the Kansas Board of Regents offers scholarships that will pay for most of a prospective nurse’s education.

On the other, two of the state’s three largest nursing schools — at Kansas University and Wichita State University — face budget cutbacks that could reduce the number of students they accept each year. Nursing school officials already turn away students because they simply don’t have space.

“It’s an interesting paradox,” said Karen Miller, dean of KU’s School of Nursing. “We need more of these people, and yet we’re unable to meet the demand because of our educational budget. I certainly understand the situation the state is facing (with its budget), but it affects public health.”

Increasing need

Statewide, an average of 12.5 percent of nursing positions in Kansas hospitals were vacant last year, according to the Kansas Hospital Assn. The national average vacancy rate is 11 percent.

The need is sure to grow, experts say, as the population ages. According to a study by the Kansas State Department of Human Resources, by 2006 there will be 27,580 registered nurse positions in the state, and 8,500 licensed practical nurse positions. That’s an increase of 35.3 percent for RNs and an increase of 28.6 percent for LPNs since 1996.

The growth comes at a time when nursing school applications are down overall. Enrollment in state nursing schools decreased from 1,474 in 1992 to 1,198 in 2001.

Budget cuts have hit the nursing industry hard, especially in small towns. In Winchester, registered nurse Diana Bryant cares for patients like 93-year-old Loretta Weishaar at Jefferson County Memorial Hospital.

And as the rest of the population ages, more nurses are approaching retirement. The average age of nurses in Kansas is 44 and is creeping up slowly.

“It’s going to get much worse in the next two years,” said Terri Roberts, executive director of the Kansas Nurses Assn. “The demand is going to continue, and we are not graduating enough nurses to fill the vacancies we have.”

Fewer students?

KU, Wichita State and Washburn University in Topeka have the largest nursing programs in the state. Each of the state universities, almost all community colleges and many private universities also have programs.

KU currently admits 120 students each fall. For each position filled, two students are rejected; not because the applicants don’t qualify, but because there is no room in the program for them.

The number of students each school can accept is decided by a State Board of Nursing formula that relies heavily on faculty-to-student ratios.

The KU School of Nursing is bracing for a potential 6 percent budget cut, which likely would mean a reduction in faculty. That could mean the number of students KU accepts could be lowered still further as early as this fall.

Miller said the numbers won’t be finalized until the state budget is approved.

Wichita State may be in a similar situation. Its nursing department accepts 40 students each fall and another 40 in the spring. In recent years, 10 students or fewer were rejected for space reasons.

But WSU already has 68 applicants for this fall.

“We’re turning away more than 20 students in a time of great shortage,” said Juanita Tate, Wichita State’s chairwoman of nursing. “I’m going on faith at this point I’ll be able to maintain what I have for the upcoming year. It’ll probably be touch and go.”

The news isn’t so bad at other Kansas universities and community colleges. They have openings in their programs, including at Washburn University.

Washburn admits about 50 nursing students each semester.Cynthia Hornberger, the school’s dean, said Washburn’s program is looking to expand – its goal is to admit 125 students a year.

Though Washburn is governed by the Kansas Board of Regents, its funding isn’t so dependent upon the state. Topeka taxes also support the school. So far, Washburn isn’t considering the same type of budget cuts as state universities. The community college programs also benefit from local tax support.

Rural problem

It’s one thing to convince someone to go into nursing. It’s another to convince them to move to rural Kansas.

Instead of trying to lure nurses from the cities, small-town health-care providers are trying to keep residents with an interest in nursing from moving away.

“We’re trying to grow our own staff,” said Huston of Jefferson County Memorial Hospital, which currently has two of 11 nursing positions vacant.

Huston said her hospital offers tuition assistance for lab technicians and other employees who want to pursue nursing degrees. Two employees are taking the hospital up on the offer now.

The situation is similar at the other end of the state. Norene Iliff, director of nursing at the Cheyenne County Hospital in St. Francis, said she hasn’t had much luck luring big-city graduates to her town of 1,500, near the Colorado and Nebraska borders.

“They’re grabbing them as they get close to graduation,” she said of the city hospitals. Instead, she focuses her efforts on Colby Community College graduates just down the road.

Nancy Noble is the exception to the rule. She knew about the rural nursing shortage when she completed her family nurse practitioner degree from KU in 1994.

That’s why she decided to get away from Topeka — where she had spent much of her career as an RN ? and went to work in Centralia, near the Nebraska border.

Now, she treats patients in Holton, north of Topeka. She said she likes the variety of her job and small-town life.

“You get to know your patients, their cousins, mothers, aunts, uncles,” she said. “It’s the same person you see at the grocery store and at Wal-Mart. You get more involved in your patients’ lives.”

Location’s key

Health-care providers with community college programs nearby have an advantage in recruiting , said Darien Leiker, marketing director at Southwest Medical Center in Liberal. Most of the hospital’s nurses were trained at Liberal’s Seward County Community College.

“When they go into the nursing program at the community college, they do clinicals at our hospital, and that gets them acclimated to our hospital,” Leiker said. “Our hopes are to keep those people here. It’s our best chance to get nursing students.”

Lawrence Memorial Hospital doesn’t have as many challenges in recruiting nurses as its rural counterparts. Deborah Thompson, vice president of human resources, said she thought Lawrence’s location ? between two major nursing schools — and the hospital’s work environment helped fill positions.

About 15 of LMH’s 300 nursing positions are currently vacant. Thompson said the hospital’s nursing turnover was about 10 percent last year, compared to a national average of 19 percent.

‘Not a frill’

If health-care officials were skeptical about overcoming the nursing shortage before, the idea of scaling back two of the state’s biggest nursing schools makes them downright pessimistic.

“I can’t believe they’re even thinking about that,” Iliff said.

A private/public scholarship program administered by the Board of Regents is attracting some nursing students. It offers up to $2,500 per year for LPN students and $3,500 to RN students. In exchange, the students agree to work for sponsoring institutions after graduation for one year for each year of financial support they receive.

And officials are looking at media campaigns such as one launched recently by Johnson & Johnson to get the word out about nursing.

Roberts, of the state nursing association, said she thought nurses could do a better job of selling their profession to potential recruits — and to let them know about the salaries, which can range from $14 to $21 an hour, depending on location and experience.

Either way, Noble, the KU graduate, said nursing schools and the state need to make filling positions a priority.

“Health care is not a frill,” she said. “Don’t cut out the basic needs. If before there’s a cutback we have a problem, why on earth would we want to make it worse?”