Proliferation of Schools Looking to Capitalize on Unemployed

Would-Be Caregivers, Beware
By PHILIP SHISHKIN
May 7, 2008; Page D1

Tammy Barnes, an unemployed mother of three, used up her $12,000 in savings last year pursuing a career in nursing. But after completing a course offered by Advanced Medical Training Institute, in Marietta, Ga., Ms. Barnes can't get a nursing license or a job, because Advanced isn't accredited by Georgia's nursing board.

Ms. Barnes, who lives in Hiram, Ga., and two other Advanced students have sued the school and its owners, claiming they were duped into believing the school was properly certified. The owners have been battling regulators in West Virginia over similar issues, and in February, they were ordered by the Texas Workforce Commission to stop operating an uncertified school in Dallas.

One owner, Joseph Tucker, declined to comment, and the other, Edlyne Charles, didn't return calls. In depositions and hearings, Ms. Charles and Mr. Tucker have denied wrongdoing and have said that Advanced is a legitimate business.

The actions against them represent the potential risks would-be nurses face amid a proliferation of schools looking to capitalize on the fast-expanding nursing field. As job openings for nurses have grown, established nursing schools haven't been able to keep up with the demand. According to a recent study, U.S. colleges turned away about 40,000 qualified applicants for nursing programs in 2006.

For-profit schools have rushed into the market -- and a number of them are drawing scrutiny and litigation. Texas regulators issued cease-and-desist orders against a total of six unlicensed schools this year. Last year, California regulators issued two similar orders against uncertified schools and say they are investigating three more. In September, the Massachusetts attorney general filed a lawsuit against an outfit that allegedly collected thousands of tuition dollars by claiming a nonexistent link to a bona fide college. Nancy Spector, education director at the National Council of the State Boards of Nursing, says that over the past few years, she has heard about one new suspect program a month, up from zero in 2002, when she joined the council.

Some unscrupulous operators have relied on loopholes in the regulatory system. There is no law that prohibits schools from offering courses that purport to teach nursing skills. But state nursing boards will issue permits to practice as a registered nurse or a licensed practical nurse only to those students who train in certified programs and pass a state nursing exam.

In Georgia, Advanced Medical had 96 students in the class that graduated in June 2007. Many are of modest means. Maxine Rogers, a single mother of two in Decatur, Ga., who took classes until late 2007, took out an $8,000 personal loan to complete the Advanced course before she discovered it was a dead end, she says. She is now struggling to keep up with $222 monthly loan payments. "I had to double my shifts," says Ms. Rogers, who works as a nursing assistant.

Chichi Sabor, a licensed practical nurse in Haltom City, Texas, enrolled in Merit Excellence Institute in nearby Carrollton to upgrade to a registered-nurse degree. After she made a down payment of $2,500, a Merit official raised her suspicions by suggesting she teach a course, she says. She declined the offer and ultimately went to the state's regulators -- who issued an order against the school after it went out of business. Ms. Sabor says she lost her $2,500. Merit's owners couldn't be reached to comment. The school, which charged $7,500 to $10,000 in tuition, had at least 55 students in its last session.

Advanced Medical's owners managed to recruit students, obtain hospital cooperation for training, and build a network reaching as far as Texas and Jamaica. Its president, Ms. Charles, is a licensed practical nurse who once falsely identified herself as a registered nurse in a brochure for another venture, according to a consent decree she signed with Georgia nursing regulators in 2002. Mr. Tucker, who was vice president, told a recent closed-door hearing at the Texas Workforce Commission -- where the school was to trying to expand -- that he hardly knows "how to put on a Band-Aid." Mr. Tucker claimed to be worth "a million and a half dollars" in the hearing. "I don't need to do this," he added. "I do this because I like to work and I like helping people."

Advanced Medical classes in Georgia were held twice a week from 9 a.m. to 1:30 p.m. Ms. Barnes said lectures became progressively more cursory, with instructors rushing through coursework. When she started training at Kindred Hospital Atlanta, "I was very, very nervous, I was so sick about what I might do to patients," she says. Still, she says, she was permitted to give them drugs.

Brian Pugh, the hospital's chief executive, confirms Advanced Medical students trained at Kindred, but says they weren't allowed to administer medication. He says Kindred revoked its agreement with Advanced in September after being notified by Georgia authorities that the school wasn't certified.

Although Ms. Barnes intended to practice in Georgia, she said she applied for a license in West Virginia at Ms. Charles's suggestion. She said she was told by Ms. Charles that she would be able to obtain a license in Georgia through state reciprocity agreements. Ms. Charles denied this in a deposition.

Last fall, to Ms. Barnes's surprise, she received a letter from the West Virginia nursing board asking her for proof of having gone to school -- in Jamaica. A transcript sent to the board, Ms. Barnes later learned, showed her attending not Advanced Medical, but Hospicare Nursing Academy in Mandeville, a town in Jamaica she had never visited. The transcript also showed her studying for six months longer than she actually did. Advanced Medical has said it has a franchise agreement with Hospicare.

In October, Hospicare sent the West Virginia board a second set of transcripts for Ms. Barnes. The records were different this time, and Ms. Barnes was shown to have received A's in all 33 courses listed -- including courses she says she never took.

Hospicare is registered with Jamaica's Ministry of Education. The ministry official whose job is to monitor such schools, Yvonne Campbell, went to bat for Hospicare and Advanced Medical in the U.S., arranging a meeting with West Virginia's nursing-regulatory board to try to convince the state that the program was legitimate, says Lannette Anderson, the board's executive director.

Reached by phone in Jamaica, Ms. Campbell said, "I'm not at liberty to discuss the issue." In a brief interview, Hospicare principal Lovern Spencer said she'd "heard of Advanced," but added that "we don't do business in the U.S."

Ministry of Education spokeswoman Charlene Ashley said the ministry didn't know Ms. Campbell had been to West Virginia. On Feb. 14 the West Virginia board ruled that Hospicare/Advanced students will no longer be allowed to take the board exam and voided licenses already issued to the school's graduates.

Back in Marietta, Ms. Charles decided to liquidate Advanced Medical, she said in a recent deposition. She now runs a school called Mega Career Institute at the same number and the same address as its predecessor.

Slowdown's Side Effect: More Nurses

Slowdown's Side Effect: More Nurses
Economy's Woes Prod Many
Who Left Field to Return;
Brushing Up on Anatomy
By CONOR DOUGHERTY
May 7, 2008; Page D1

The ailing economy is helping to ease the nursing shortage.

With house prices falling and the cost of gasoline and food rising, many nurses are going back to work, in some cases to make up for the income of a spouse who has lost a job. Hospitals say part-time nurses are taking on extra shifts. And nursing schools are seeing an increase in people applying for refresher courses on the ins and outs of modern hospitals. Some older nurses are putting off a planned retirement.


"We are seeing a temporary lessening of the nursing shortage," says Jane Llewellyn, vice president of clinical nursing affairs at Rush University Medical Center in Chicago. But, she says, "as soon as the economy turns up we'll see them staying home again."

It's a familiar pattern during economic slowdowns. For years, the high demand for nurses has allowed them to design work schedules that suit their financial and family needs. Many start off working full time on difficult shifts and then reduce their hours when they have a family -- the profession is more than 90% female -- or as they approach retirement. But when the economy goes sour, many nurses go back to work full time.

Dana Goodin, a nurse at Chicago's Rush University, worked three evening shifts a week for nearly two decades, giving her time to raise her four children. But after her husband, a carpenter, was laid off late last year, Ms. Goodin began working four days a week to boost the family's income and to qualify for cheaper health benefits. Although her husband has since found a new job at a retail warehouse, he makes just half of his former salary, and Ms. Goodin is looking for another shift to push her above full time.

The nursing profession also is attracting greater interest among new recruits, drawn by expanding job opportunities and rising wages in some places. Nursing school enrollment surged in the wake of the Sept. 11, 2001, terrorist attacks and the economic slowdown that followed. Enrollment continues to grow apace, though at a reduced rate, and schools are turning away thousands of qualified applicants for lack of faculty. Even so, nursing experts predict shortages will grow in future years as demand for nursing services outpaces the number of professionals entering the field.

For hospitals, the renewed interest in nursing is a relief. Shawn Tyrrell, chief nursing officer at Rush-Copley Medical Center in Aurora, Ill., says that until last year the hospital used outside employment agencies when it didn't have enough nurses to cover the shifts. Now, despite an increase in patient volume, the hospital's own nurses want extra hours, so it doesn't need the agencies. "We've been able to handle that volume increase through our own staff members," she says.

The nursing shortage began in the 1990s as older nurses started retiring and there were fewer newcomers to take their place. The crunch got worse as baby boomers got older and demand for health care increased. By 2001, there were 126,000 vacant nursing positions in the U.S., according to the American Hospital Association. That means about 13% of all nursing jobs were unfilled.

Beefing Up Recruiting

To attract nurses, hospitals have increased wages and beefed up recruiting, including from overseas, and have offered potential hires signing bonuses of cash or even new cars. Hospitals have also taken steps to keep older nurses in the work force by making their jobs easier, including replacing hand cranks used to lift beds with automated lift devices, bringing in lift teams so nurses don't strain themselves picking up patients, or putting supplies closer to patients' rooms to cut down on walking. By the end of 2006, the nurse vacancy rate had fallen to 8.1%.

Of course, nurses who haven't been working for some time can't just jump back into the job. Nurse-education requirements vary from state to state, but in general the longer the nurse has been out of the work force the more likely it is he or she will have to complete a refresher course to be relicensed. The Mount Carmel College of Nursing in Columbus, Ohio, for instance, offers a refresher program for $700 plus the cost of textbooks that includes 230 hours of online courses, covering such topics as anatomy, new medications and privacy regulations. Students also log 100 hours working in a clinical setting such as a nursing home or a hospital.

Economic Indicator

For the past few decades, nursing has been a kind of reverse economic indicator. In periods of economic weakness or recession -- including in the early 1980s, the early 1990s and earlier this decade following the technology-company bust and the Sept. 11 attacks -- the number of full-time nurses grew at an average annual rate of 3.5%. By contrast, in times of healthy economic expansion, the increase has averaged just 2.4%, according to an analysis of government data in "The Future of the Nursing Workforce in the U.S.," a book by Peter Buerhaus, director of the Center for Interdisciplinary Health Workforce Studies at Vanderbilt University Medical Center, Douglas Staiger, a Dartmouth College economics professor, and David Auerbach, a principal analyst in the Health and Human Resources Division of the Congressional Budget Office.

Last year, there was a net increase of about 113,000 nurses in the work force, the largest increase since 2002, and most of the added nurses were over 50 years old, according to the Census Bureau. The pattern has continued this year. Although the U.S. economy lost 20,000 jobs in April, the fourth monthly decline in a row, health-care employment rose by 37,000 and is up 365,000 jobs over the past 12 months, according to Labor Department data released last week.

"In bust periods, unemployment is rising, which means there is a lot of pressure on married RNs to be working," says Mr. Buerhaus.

Jennifer Schlesser, a 57-year-old Ellicott City, Md., resident, says she worked as a nurse for 27 years before leaving the profession a decade ago, feeling overworked and underpaid. She went to work in the mortgage-lending industry, but the housing slowdown has forced her to change employers and has cut into her commissions.

Refresher Courses

Ms. Schlesser is currently enrolled in an online refresher course for nursing and she expects to be relicensed by next month. She plans to work part time in both nursing and mortgage lending. "Whatever works out best," she says.

But over the long term the nursing shortage is expected to continue and eventually worsen, as retiring baby boomers ramp up demand for care. In their book, Messrs. Buerhaus, Staiger and Auerbach use Census data to project that the nursing work force will plateau in 2015. By 2025, they estimate there will be a shortage of almost 500,000 nurses, representing a vacancy rate of 40% or higher.