There was a time when nursing was one of the top career choices for women. Over the years men have entered the field, but the majority of positions were still filled by women. However, as an increasing number of women entered the work force more career options opened up in other fields. With the opportunity to be anything from an engineer to a CEO, the number of professional women choosing a nursing career is dwindling, thus creating a critical shortage.

Nursing used to be considered the career choice for women because it opened up many doors. "Back in the 1950s and 1960s it was the only option, besides teaching, for women," says Sherry Hagemeister, chief executive officer for Arlington, Texas-based Nursefinders. Four decades later, the employment picture is much different. Hagemeister notes that some nurses are leaving the clinical area for non-clinical positions, going into everything from consulting to research. And even though more men have been entering the field, so many more are needed.

The statistics prove just how severe the problem is. According to the U.S. Department of Health and Human Services, nationwide there are approximately 798 registered nurses for every 100,000 people. By the year 2010, 1.7 million nurses will be needed, while less than 635,000 will be available. According to Employment Review's Annual Help-Wanted Indicator, recruitment advertisements through the year 2000 showed that nurses in just about every specialty were desperately needed across the country, and experts agree. They received the highest percentage of ads with 40 percent. The demand is greatest for emergency room, operating room, intensive care, pediatrics and labor and delivery room nurses - in every region of the country, whether it is rural or urban, these professionals are needed.

Several factors are contributing to this shortage. First there is the 1 percent yearly population growth that is generating a greater demand for healthcare services. Second, as the population ages and the elderly live longer, they are acquiring more chronic illnesses and, therefore, need more care. As the large number of baby boomers age, this dilemma will only become more serious. On the technology side, new innovations in treatment will increase the demand for healthcare in many cases. "This is one of the worst shortages we've ever experienced," says Barbara R. Heller, Ed.D., RN, FAAN, dean of the University of Maryland School of Nursing. "It is really a supply-side problem." Dr. Heller explains that another cause for the shortage is the aging population of the nursing work force, which is estimated between 41 and 46 years old. "There just aren't enough people to fill the spots."

The demand for these professionals is greater than ever before - not only in hospitals, but in just about every type of healthcare facility. As the country tries to lower healthcare costs, there are an increasing number of procedures now being performed in nonacute care facilities. Therefore nurses will be needed in ambulatory surgical centers, clinics, eye surgery centers and more. The demand for licensed practical nurses (LPNs) will also increase in nursing homes, assisted living and home healthcare centers.

Employment turnover is another issue plaguing this profession- with low pay as one of the reasons nursing professionals are getting fed up. Working conditions have also had an overwhelming effect on the number of nurses leaving and entering the field because many facilities are in deplorable condition.

Work/life issues are also tipping the scales. "The hours are terrible," Dr. Heller explains, "and today's work force wants balance between work and family." The shortage is not only a national crisis but is slowly becoming a global issue. As in the information technology sector, nurses have been recruited from all over the world to fill positions: Israel, Ireland, Australia and South America, to name a few places. "It is a much more positive experience for them working here," says Nancy Dickenson-Hazard, RN, MSN, FAAN, executive officer for the Honor Society of Nursing, Sigma Theta Tau International.

A movement has started to recruit people into the nursing profession. Many individuals have formed coalitions across the country, striving to have their voices heard. For example, a coalition called Nurses for a Healthier Tomorrow, which is comprised of 24 leading nursing and healthcare organizations, and co-chaired by Elizabeth Dole and Luci Baines Johnson, exists to address the shortage and encourage people to enter and stay in the profession.

Many improvements have started to take shape, but so much more must be done to end the problem. Dickenson-Hazard notes that because the occupation is extremely demanding on an intellectual level, more funding is needed for undergraduates as well as for people seeking master's degrees. In the workplace some employers have become creative with their incentives, offering sign-on bonuses, day care and help with relocation.

Hagemeister stresses that nursing schools must become more sophisticated in the way they train students. "In the past nursing was considered a calling for many people," she explains. "Today it will have to be more of a profession."

As for the future, unless more is done to help recruit and retain highly skilled nurses, the shortage will continue. Schools, healthcare facilities and individuals must come together to open the doors for the next generation of nurses. "We need the public's support and concern to help this cause," says Dickenson-Hazard. Without it, we are only hurting ourselves. - SHERRI PFEIL, Staff Writer