By Colleen Long
Associated Press

DENVER — Nurse Lynn Kier prays none of the other three nurses at Haxtun Hospital's nursing home call in sick. There is little backup for the 12-hour shifts, especially when roads are bad in winter.

"It's nerve-racking," she said. "If anyone called in during a snow storm, we'd be stuck. No one could get out here fast enough."

A nationwide shortage of nurses is compounded in rural areas such as Haxtun, a prairie town of about 1,100 about 140 miles northeast of Denver. Still, they try, advertising several times for help in a nursing journal.

"Here was our little ad placed next to an ad from a huge hospital offering a $4,000 signing bonus," Kier said. "We just don't have the money."

Haxtun Hospital's starting nurses earn about $38,000 a year, according Administrator Jim Brundige. In contrast, the average starting salary in a Denver hospital can be as high as $55,000.

"It has gone up about $3 an hour since I've been here," said Brundige, who arrived here seven years ago. "It's still not high enough to compete with large cities. We just can't get people out here."

While city nurses typically are assigned to one discipline, such as oncology, rural nurses must be prepared for anything. They may assist in heart surgery, help deliver a baby in the hospital or change a bedpan in the nursing home all in one day, Brundige said.

"And usually patients in our hospital are not nameless faces. They are neighbors, friends and teachers. It's mentally challenging," he said.

Brundige said both the nursing home and hospital make do with six full-time nurses and use temporary nurses regularly.

"We lost three nurses and more than 120 years of experience when they retired last year," he said. "Being a small hospital in a small town, we need less licensed practical nurses and registered nurses than other hospitals. Even so, we are hurting right now."

Nursing staffs are getting older, too.

"This is an aging profession. The average age is over 40," said Denise Denton, director of the Colorado Rural Health Care Center, which works to improve care in rural areas.

"Young people want to stay in big cities where there are more things to do. Not many want come out to the rural areas," Denton said.

Also, nursing is no longer one of the few professions that welcome women, Denton said. There are more and more glamorous choices.

"I find myself encouraging my own daughter to be a doctor or a lawyer, not a nurse," she said.

Administrators at Prairie Vista Nursing Home in Holyoke, a town of about 1,900 people about 130 miles northeast of Denver, have worked double shifts to fill gaps left by retired nurses.

"We've tried just about everything: increased wages and signing bonuses. We've even recruited nurses from the Philippines," said Administrator Alice Tropf.

"It takes about 60 percent longer to fill openings in rural areas than in larger cities," said Dr. Jill Scott, associate director for nursing at University of Colorado at Denver School of Nursing.

"We need to get students from the rural areas to go back after they graduate from nursing school," she said.

One way to encourage nurses is to offer scholarships for nursing school, having new nurses work off their debts in rural communities or offer classes online so they can study at home, Scott said.

Rural communities also should just offer more benefits, such as more vacation time and shorter shifts, she said. Many nurses work 12 hours a day.

Targeting males and minorities may also help. More than 90 percent of nurses are female and white, Scott said.

Gov. Bill Owens appointed a panel in July to evaluate the nursing shortage in nursing homes.

Arlene Miles, executive director of the Colorado Health Care Association and chairwoman of the panel, said it is expanding Owens' charge beyond nursing homes to the nursing shortage in physicians' offices and hospitals, and even in dentists' offices.

"Trying to solve one side of the issue is like squeezing a balloon. Something else will pop up here and there," she said.

Some think the panel does not represent rural areas well. Of 22 members, one representative of a national nursing home corporation will speak for both urban and rural nursing.

"I don't mean this critically, but they are not living the need," Kier said. "They are not out here witnessing how difficult it is."

Though Owens' panel will not focus on rural nursing shortages, Miles said rural nurses' concerns are very important.

"We hope people will bring us information so that we can address the issues and attempt to solve the problem everywhere," she said.

The panel will deliver its suggestions to the governor in November.

"We cannot ignore the rural problem," Miles said. "We also can't create a solution for a city like Denver and think it can be blueprinted for a rural community. That is going to be large piece of the puzzle for us."