When nurses stay home, nation’s clinics suffer

A medium-sized hospital in Suwon had to close its intensive care unit for a month in January, not because of an insufficient number of patients or budget, but for lack of nurses.

Suwon Hospital is a provincial hospital with a history going back a century. It shut its intensive care unit after 11 nurses resigned in December. The hospital quickly placed help-wanted ads and barely managed to fill the vacancies before reopening in January.

According to the Korean Small and Medium Hospital Association, hospitals with less than 500 beds are classified as small and medium hospitals. There are about 2,500 such hospitals in the country.

The Health Insurance Review and Assessment Service does a quarterly study of the ratio of nurses to beds, ranking them from 1 to 6. If one nurse takes care of more than six beds, a hospital receives the lowest ranking.

According to this year’s second quarter data on 1,000 small and medium hospitals, about 80 percent of the hospitals received level 6 for having an insufficient number of nurses.

A chief nurse surnamed Sohn at a university hospital identified as “K” said she has been busy these days interviewing nurses for jobs.

“I am under a lot of stress doing these job interviews,” said Sohn. “The problem is not actually a shortage of nurses. There are many registered nurses out there. The problem is that they quit after experiencing the tough work in the hospital,”

According to a report by the Korea Institute for Health and Social Affairs, Korea is expected to face a shortage of nurses of up to 30,000 by 2025.

Oh Young-ho, a researcher at the institute who conducted the research, said the number of nurses obtaining licenses is increasing but the gap between active and inactive nurses will become greater if working conditions aren’t improved.

By 2025, there will be about 391,000 licensed nurses, while only 250,600 are expected to be actually working.

Currently, there are about 75,000 registered nurses who are not working, and among them, 45,000 are in their 20s and 30s, the report said.

According to the Health Insurance Review and Assessment Service, there are about 81,681 medical facilities in Korea, which is equivalent to 58.8 facilities per every million people, well exceeding the OECD average of 31.03. However, the number of medical staff is well below the OECD average of 6.74 per 1,000 people. Korea has 2.37 nurses per 1,000 people.

“Among active nurses, not many want to work at hospitals,” said Yim Seo-young, a policy coordinator at the Korea Health and Medical Workers’ Union.

“You can get many types of jobs with a nursing license,” Yim said, “and among the working nurses with a license, they tend to avoid getting jobs at hospitals. That’s why hospitals are faced with shortages.”

The main problem is poor working conditions at hospitals. “Nurses work on three shifts, because patients are at the hospital all the time,” Yim said. “And those who didn’t experience working at night before don’t know how difficult it is to work from 10 p.m. to 6 or 7 a.m. It’s going against one’s biorhythm.”

Such arduous work, combined with a relatively low salary, is what drives young nurses out of hospitals, said Yim. “Young females these days look for life-enhancing jobs but being a nurse requires sacrifice and earnest devotion.”

According to a report by the Korean Nurses Association, nurses at hospitals receive a starting annual salary of 20 million won ($18,700) to 30 million won for a 40-hour week.

In the U.S., the starting salary for registered nurses in hospitals is $39,000, according to Nursing Degree Guide, an online site for nurses.

A 28-year-old registered nurse surnamed Joo, who has been working for four years at a hospital in Seoul, said she often thinks of quitting due to the burdensome work.

“As hospitals hire a minimum number of nurses, the working nurses have frequent night shifts compared to Western countries,” said Joo. “When you work with people, it puts you under a lot of stress, and nursing is about dealing with sick people. It’s obvious how much stress nurses get. I’ve been thinking about obtaining a nursing license to work in the U.S., but I just don’t have the courage.”

Joo said some of her colleagues quit after a year at hospitals and studied for the U.S. National Council Licensure Examination for Registered Nurse (NCLEX-RN), which qualifies nurses to practice in the U.S.

In fact, the U.S. has been facing nursing shortages for decades.

To deal with the shortage, U.S. hospitals have been trying to lure nurses from abroad with better pay and working conditions. Korea ranked third in the number of nurses taking the exam for U.S. hospitals, according to data from the National Council of State Boards of Nursing.

According to e-NCLEX, an education center in Korea that prepares students for the NCLEX exam, nurses who take its courses range from fresh graduates to women in their 40s and 50s.

As U.S. health care facilities struggle to fill nursing vacancies, the U.S. government introduced legislation allowing a new category of visas for registered nurses from abroad with an annual limit of 50,000. It attracted nurses from Asian countries including Korea. And some blame Korea’s nursing shortage on this measure.

However, Hwang Ji-hoon, a senior manager of e-NCLEX, said, “It’s hard to say Korean nurses obtaining the U.S. license contribute to the nursing shortage here.”

Hwang said that only about 2,000 Korean nurses obtain the U.S. licenses and among them, only about 20 nurses actually leave Korea annually.

The nursing shortage in Korea has spurred the government and public health-care leaders to push for serious and creative solutions to the problem.

In early June, Lee Jong-heuk, a GNP representative who sits on the National Assembly’s Knowledge Economy Committee, submitted a bill that calls for the government to provide administrative and financial support for nurses to come back into the field.

In line with Lee’s proposed bill, the Korea Nurses Association announced in June a plan to bring inactive nurses back into practice.

“As a commissioned project of the Ministry of Employment and Labor, the Korea Nurses Association will open up seven RN training centers throughout the country starting in July,” said an official from the KNA. “The centers will not only train unemployed RNs on new medical practices but also connect trained RNs with job opportunities.”

According to the KNA, most unemployed nurses have quit due to child-care issues but many have expressed the desire to return to work after their children get older.

Shin Young-ok, 55, a registered nurse who just sent her youngest daughter to university, said she wants to go back to work. “Not for the money,” she says, “but from my deepest desire to help those suffering from illnesses.”

“Unless working conditions and salaries are improved, young female nurses will not stay long,” said Yim from the KHMU.

By Yim Seung-hye [sharon@joongang.co.kr]