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OURS: Nursing shortage a problem that demands action

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Quick! Somebody call a nurse, because South Dakota has complex health-care problems.

Nationally, demand for registered nurses has grown nearly 2 percent per year since 2001. South Dakota employers, meanwhile, pay registered nurses the lowest average wage in the nation.

Not surprisingly, it’s harder to fill South Dakota job openings for nurses.

That’s just the visible part of an unsettling iceberg explored in Sunday’s Rapid City Journal story on nursing trends. Bigger issues lie beneath.

South Dakota’s burgeoning shortage of nurses isn’t a run-of-the-mill workforce issue. Fail to get this right, and we’ll struggle with plenty. Long term, the effects will play out across the community. Nursing shortages force additional nurse overtime, raising costs and increasing hospital diversions by reducing available beds. Forced overtime or working shorthanded fuels nursing burnout, increasing a reliance on transient nurses, which in turn results in declining nurse morale and lower physician satisfaction. The foot bone’s connected to the leg bone. It’s all connected.

Quality health care is a central consideration among employers searching for places to expand, so a lasting nursing shortage makes economic growth here that much harder.

The question of which state pays lowest is a complex issue, as several measures of nursing pay exist — the mean, the average, the mean adjusted for cost of living. South Dakota fares poorly on most.

So, pay them more, right? If only it were that easy.

In the Black Hills, Regional Health with its 1,200 registered nurses is the 800-pound employment gorilla, making its current shortage of 186 nurses a good case study. You’d expect a health-care system that pays lower wages to nearly one fourth of its employees to be rolling in cash, but that’s not the case. Hospital leaders claim the health system loses $1 million per week.

The problem — as Mike Diedrich, Regional’s vice president of governmental relations, laid out for a June article of HealthLeaders — is the problematic local payer mix. Employer-sponsored health insurance — the gold standard — covers too few patients here. Worse, too many patients rely on the wrong kinds of government reimbursement.

At Regional, 68 percent of reimbursement is government-based, according to Diedrich. That’s about 10 percent above average.

It gets worse. Under Diedrich’s breakdown, the Department of Veterans Affairs reimburses at 40 percent of what the hospital bills, Medicare at 35 percent, Medicaid at 30 percent, and Indian Health Services at 26 percent.

Due to recent changes at Sioux San, Regional now serves 23,000 Native Americans who were previously treated across town. An additional 27,000 Native Americans from Pine Ridge occasionally get treated at Regional.

In short, it’s getting harder — not easier — for the hospital to pay nurses more.

As pointed out in Sunday’s article, nurses choose where they want to work based on more than pay, and several strategies have been tried to leverage noneconomic benefits.

Hospitals can grow their own nurses by creating or expanding nearby nursing schools, developing feeder programs, and subsidizing tuition.

They can use sign-on bonuses, hoping to root young nurses before they start families.

They can also import nurses from foreign countries — Regional recently employed 75 nurses from the Philippines.

And they can work to treat existing nurses better — promoting quality, removing abusive physicians and implementing flexible schedules.

In the best case, they also work to raise professional standards, fostering cultures of excellence, creating places where dedicated people want to work.

These strategies, employed consistently, yield benefits over decades.

The question for the Black Hills, however, is how much progress can it expect to make amid the growing national shortage? Similar recruitment strategies are being employed everywhere, and South Dakota still pays the lowest wages in the nation.

When good students invest considerable effort and finances to get ahead, the issue of lowest pay stands before every other. We saw this with the nation’s lowest teacher pay. Shortages began to disappear only when pay increased.

There’s a lot to fix here.

Institutions of higher education could raise the pay for nursing instructors to improve their ability to meet the growing demand.

Congress could improve IHS compensation to slow the drain on hospital funds.

The Legislature could expand Medicaid to lessen the burden imposed by the uninsured.

Individually, we all can value nurses more. Nurses are caring, courageous and community-oriented team players with a sense of purpose. In many cases, they spend more time with patients than do doctors. Nurses do the ultimate dirty jobs at the most intimate times. They keep us alive, and they care for us as we die.

This low-wage issue has been festering. The patient isn’t getting better spontaneously. We need to listen to what nurses are saying with their feet.

— Rapid City Journal Editorial Board members are: Chris Huber, editor; Patrick Butler, managing editor; Candy DenOuden, online editor; Mark Andersen, Editorial Page editor; and Brandis Knudsen, sales manager. Contact us at

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