Roanoke Times
                 Copyright (c) 1995, Landmark Communications, Inc.

DATE: SUNDAY, January 8, 1995                   TAG: 9501060048
SECTION: BUSINESS                    PAGE: F-5   EDITION: METRO  
SOURCE: SANDRA BROWN KELLY STAFF WRITER
DATELINE:                                 LENGTH: Medium

HEALTH CARE LEARNS TO HEAL ITS OWN ILLS

When the Virginia Hospital Association did its 1994 Health Care Workforce Survey, it found examples of the many-hatted worker like a radiologist specialist with human resources duties and a licensed practical nurse handing admission and discharge procedures.

In the Roanoke Valley, hospitals have trained secretaries to take patients' vital signs and are expecting registered nurses to help with duties once delegated to orderlies. Orderlies have metamorphosed into patient care assistants who have taken on more clinical duties while retaining some of their former lifting and cleanup assignments.

The changing face of health care is evidence of preparation for more managed care, with insurance plans insisting on lower costs. That's what is driving health work force needs.

Health care companies are trimming employee ranks to save money and become more competitive. In the Virginia Hospital Association study, 48 percent of the state's hospitals and 67 percent of the Roanoke-area hospitals were cutting nursing staff. Fifty percent were cutting other clinical personnel. This has put more people than usual in the job market at a time when vacancy rates are less than 10 percent in the state and less than 5 percent in 18 of the 31 professions surveyed.

A person considering work in health care doesn't have to worry so much about finding a job, however, as choosing the right training for the jobs that are available. Central Virginia has the highest vacancy rates in the state, and the far Southwest part of the state is especially in need.

Gone are the days, however, when some health care specialists could expect to have a job at graduation.

``The job outlook is good, but it's taking longer for the graduates to find jobs,'' said Pam Woody, student adviser in the health technology division at Virginia Western Community College in Roanoke. It's not unusual for May graduates still to be hunting for work in the fall, she said.

Because the population is aging, the demand for health care workers won't disappear, said Janet Boettcher, chairwoman of Radford University's School of Nursing. The jobs are shifting, though, away from the hospital setting.

Since patients are encouraged to get in and out of the hospital as quickly as possible, more health care is given outside the institutions. Instead of a new mother and baby staying several days in the hospital, they go home and are visited by a nurse who can advise on care and adjustment issues.

The hospital staff that does exist must increasingly be both more versatile and highly skilled because only the sickest people are in the hospital, and oftentimes many are older with multiple problems.

This has prompted more demand for the nurse practitioner, who likewise is in demand for clinic work in areas that don't have enough doctors. It also has meant that RNs have replaced licensed practical nurses because RNs can make care decisions that LPNs aren't allowed to make. The RN percent of nursing staff grew from 60 percent to 66 percent in the last year. The vacancy rate for registered nurses is at a low of 3.2 percent, down from 6.5 percent in 1993.

The changes also have created greater demand in some specialties and caused others to disappear as career opportunities. Occupational and physical therapists are in high demand; respiratory therapists and medical records technicians are not in demand at all. Pharmacists and nuclear medicine staffers also have bleak job outlooks.