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KNOXVILLE — The state’s nursing shortage is worse than a national survey indicates, the University of Tennessee’s dean of nursing said Tuesday.

Despite a federal survey that shows Tennessee has the Southeast’s best nurse-to-patient ratio, a third of them do not work in hospitals or bedside settings, Dean Joan Creasia said.

“Hospitals throughout the region came to our career fair in January to recruit our graduates,” Creasia said. “All of them said they were experiencing a shortage and had a vacancy rate of at least 10 percent or more.

“Economists regard an extended vacancy rate of more than 6 percent as a crisis or shortage.”

Creasia said the shortage is especially acute in critical care areas such as labor and delivery, emergency rooms and operating rooms.

A recent U.S. Department of Health and Human Services survey shows 872 nurses per 100,000 residents in Tennessee. It’s the region’s best ratio, ranking 18th nationally and surpassing the U.S. average of 782.

Creasia said managed care and faulty reimbursement programs resulting in hospital staff cuts and more stringent patient admission criteria have contributed to the problem.

“Managed care created hospitals with sicker patients who need more nursing care, but fewer nurses to do work,” Creasia said. “The added stress and responsibility discouraged some people from entering the field.”

Other factors contributing to the nursing shortage include a shrinking workforce, an aging population and financial concerns, she said.

A Tennessee Hospital Association survey in 1998 found 727 nursing vacancies in 60 hospitals across the state, mostly in Memphis and Nashville.

That survey, the most recent conducted by the state, did not report a shortage in Knox and nearby counties, but that situation has likely changed.

“Memphis had the worst problem at the time, but if we did another survey, I think it would show the shortage has traveled completely across the state,” Dr. Rumay Alexander, THA vice president for clinical services, said. “There may be pockets that don-t have a shortage, but overall I think all three regions need more nurses.”

Creasia said UT graduates about 120 nurses annually, and has graduated about 2,800 entry-level nurses since the program began in 1972.

The college is working to add online degree programs and boost minority recruitment to help meet the demand, she said.

The DHHS survey, conducted about every four years since 1977, shows the number of registered nurses grew only 5.4 percent from 1996-2000, the smallest increase ever recorded. In comparison, the 1992-96 increase was 14.2 percent.

It also shows the share of registered nurses below age 30 dropped to 9.1 percent in 2000 from 25.1 percent in 1980, and the average age is over 45 years old.

“One of the most significant factors is the aging nursing workforce,” Creasia said. “When you look ahead to the year 2020, nurses practicing now will be retired and there is not a good supply coming up behind them to meet the demands of the future.”

DHHS survey results are available at http://www.bhpr.hrsa.gov.