MOREHEAD CITY — Amid an ongoing nationwide shortage of registered nurses that is expected to worsen over the next decade, officials at Carteret Health Care are undertaking efforts to attract and retain qualified nursing professionals.

According to trade publications, the U.S. is projected to experience a shortage of nurses over the next decade, especially as the Baby Boomer generation ages and the need for health care increases. The Journal of Nursing Regulation found four primary challenges facing the nursing workforce: an aging population, a shortage and uneven distribution of physicians, an accelerated rate of RN retirements and the uncertainty of health care reform.

“We’re in need of about 236,000 additional registered nurses nationwide between now and 2026. We’re going to have somewhere around 40 to 50 percent of our workforce as registered nurses retiring,” said Pat Ausband, vice president of patient care services at CHC. “The colleges cannot keep up with demand due to shortage of clinical staff, educational staff or lecturers and clinical sites.”

Mr. Ausband said studies indicate the shortage is expected to be most intense in western and southern states, and rural areas in particular will likely be hit hard.

“It is much worse in rural areas than in urban areas, principally because there are a lot more people that live in urban areas and they’re closer to schools,” he said.

Some hospitals struggle to keep nurses because of stressful working conditions due to inadequate staffing levels. Mr. Ausband said around 15% of nurses quit after only one year in the field, and surveys show an additional third of all nurses consider quitting because of stress associated with the job.

“It’s not always about the money, it’s about the ability to practice what they learned to practice at the bedside,” he said. “They have to have appropriate staffing levels and support staff and the time, most importantly, to do that.”

Not only do nurses themselves suffer from the shortage, but studies also show a lack of qualified nurses in hospitals has a direct effect on the care patients receive.

“Additional nurses at the bedside reduce length of stay, reduce serious complications and reduce admissions,” Mr. Ausband said.

In light of the challenges facing the nursing industry and the effects a shortage could have on the care hospitals provide, officials at CHC have taken several measures to attract and retain registered nurses, as well as other support staff. Mr. Ausband said when hospital took stock of the situation last December, there were 129 nurse vacancies and a ratio of about 1 nurse to every 6 patients. Now, the vacancies are down to about 60 open positions and the nurse to patient ratio is closer to the hospital’s stated goal of one to four.

“Our facility has taken that challenge quite seriously,” Mr. Ausband said. “We are in the process of transitioning our staffing model. The ideal staffing model is one registered nurse for every four medical/surgical patients, which is a significant change to what we’ve done in the past.”

Mr. Ausband said the 1-to-4 ratio is generally accepted in the health care community as ideal for providing the best possible care to patients. He said while it is difficult and to achieve, the positive effect it has on patients and their families is invaluable.

Tonya Dixon, an RN who has worked in the field for decades, is assigned as a dedicated nurse recruiter for the hospital, a role which was created recently. Vickie Clanton, chief human resources officer for CHC, said Ms. Dixon has been instrumental over the past year in attracting new nurses from near and far to work for the hospital in Morehead City.

“Tonya has worked really, really hard to get everything filled. She is very proactive in getting people contacted, getting them with the department directors for interviews, getting them set up, so she’s very instrumental in getting these numbers down tremendously,” Ms. Clanton said.

The hospital also works closely with Carteret Community College and the county’s three high schools to introduce students to opportunities in the medical field and encourage them to stay in the county to work in health care careers. As part of that effort, this year CHC introduced a nursing scholarship that pays up to 90% of college costs in exchange for a commitment to work at CHC for at least two years upon graduation.

The CHC Board of Directors dedicated $100,000 for the scholarship program’s first year, and Mr. Ausband expects it will make the same commitment next year. Eight students attending various schools in North Carolina, including several at CCC, were selected for the first round of scholarships. CHC board member David Carr has spearheaded the project and said at Monday’s board meeting the students are doing well and the hospital is ramping up for a new round of scholarship applicants.

Mr. Ausband said the hospital also tries to create a positive working environment for nurses to keep them from burning out. There are several councils nurses can serve on to get their voices heard, and hospital leadership said it tries to incorporate feedback from nursing staff into policies. Thanks to these measures and others, Mr. Ausband said the hospital has seen increased nurse retention recently.

“Nursing leadership is out talking to the nursing staff to see what it is that they need, to see what frustrates them, what we can do to provide support for them,” he said.

There are still some ongoing challenges CHC faces in attracting qualified candidates to work at the hospital. Although Carteret County is an attractive place to live and work because of its proximity to the beach, Mr. Ausband said many instead choose to work in Wilmington or the Outer Banks, which offer similar attractions. Also, he acknowledges affordable housing is hard to come by in the county, so CHC has to keep its pay competitive to ensure nurses make enough to afford living here.

Ultimately, Mr. Ausband recognizes nurses are an integral part of keeping a hospital running, and he hopes CHC’s recent efforts help combat some of the challenges faced by the health care industry at large.

“People need to understand that (nurses) are an important part of why the hospital exists,” he said. “By the same token, if we’re going to espouse that our nurses need to be professional in their roles, they need to be in leadership positions and advancing the cause of nursing research, nursing education and nursing practice, which I think we do, for a small hospital, very, very well.”

Contact Elise Clouser at; by phone at 252-726-7081 ext. 229; or follow on Twitter @eliseccnt.

(5) comments


First, there is not a national nurse shortage. There IS a shortage of qualified nurses who choose not to nurse. This is secondary, many times, to abusive administration, absurd nurse to patient ratios, and poor management. Thus, hospitals, such as CHC experience a "shortage" of nurses, and poor retention.

Lastly, and something that is not being addressed, is the problem with some practicing nurses. Lately, I queried the N.C. Board of Nursing to provide complete records on several registered nurses that were found to have diverted or misused drugs, falsified records, failed to properly dose patients which includes failing to administer pain medications because the nurse was taking the medications. Surprisingly, the data showed a complete lack to protect the public by allowing these nurses to continue to practice. The question begs: Is this the way to address not enough nurses? One particular troubling case occurred here, in Carteret County. All of this is public record, and the Board will provide if requested. All complaints are public record, as are the Boards action (or more to the point, inaction). These cases of stolen controlled substances were not reported to law enforcement. I intend to forward the complete history to the district attorney, and to the newspaper. The so called nursing shortage is far more complicated than not enough nurses, or attrition due to retirement. The reverse side is the employment of impaired or less than honest nurses, due to drug issues. Like Paul Harvey used to say: "Now the rest of the story".


I agree totally. I recall one incident of medication diversion specifically during my working there.


Editor: What is the best way to submit the evidence to the paper?

Send to the managing editor, Jackie Starkey

(Edited by staff.)


I totally agree with the comments. Its my personal experience that if you're not in the "clique" you aren't welcome. Too much to post here, but believe me there is not a shortage, but lack of support from the senior nursing staff.


Nurse retention would be higher if CHC was actually competitive with the surrounding market regarding nursing pay. If you want your nurses to be able to afford to live in Carteret county then compensate them accordingly. Yearly raises are barely enough and they wonder why retention is low.

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