Krista Brown decided to become a nurse after spending two years as a community health volunteer with the Peace Corps in Togo, West Africa. Working side by side with a nurse-midwife, Brown was impressed not only with how well respected the nurse-midwife was, but also by how easily her skills translated to another country and another culture.

"I wanted an opportunity to combine my interests in social work and counseling and be able to really help people on a one-on-one basis," says Brown. After returning to the United States, Brown, who already holds an undergraduate degree in international relations from West Chester University in Pennsylvania, applied to the Johns Hopkins University School of Nursing where she is pursuing a Bachelor of Science in Nursing with the assistance of the Peace Corps Fellowship Program. Brown hopes to become a nurse practitioner, work in an emergency room, and eventually return to Africa as a Peace Corps medical officer. "I've finally found a niche that combines everything I want to do."

It's only coincidental that Brown has since learned what a good career choice she has made. "This is a great time to be in nursing," she says. "There are so many openings and opportunities." Brown is entering nursing at a time when the profession is beginning to see shortages, especially in specialized areas such as operating rooms, labor and delivery, emergency rooms, intensive care units, and high-risk pediatric units.

According to the American Association of Colleges of Nursing, its 500 member colleges--which offer both bachelor's and master's degrees in nursing--reported enrolling 5.5 percent fewer nurses last year than in 1997, the fourth consecutive year in which a decline was observed. A report sponsored by the American Organization of Nurse Executives, a subsidiary of the American Hospital Association (and conducted in collaboration with the Department of Health and Human Services and the American Nurses Association) indicated that this nursing shortage "appears to be a new and different type." "Previous shortages," the report read, "have been about sufficient numbers of nurses, while this shortage appears to be about an increased demand for nurses with competence, skills, and experience to meet patient demand for care in a changing health care system."

A number of reasons have been given for the current-and projected--nursing shortage, including demographics. The average age within the nursing population is 45; many of those now working will be retiring in 5 to 10 years. Within the past two decades, women--who still make up the majority of the nursing profession (although the numbers of men entering the field are growing and have now risen to 10-15 percent nationwide)--have had more career choices than they once did, including becoming doctors.

Barbara R. Heller, Ph.D., dean of the University of Maryland School of Nursing, points to several other reasons for the nursing shortage, including an "older and sicker" population. "As we live longer," she explains, "we're going to see more chronic health care problems and more frailty. We can expect more and more health care services for the elderly, including primary care, chronic care, and intensive care." Because many of these patients are going to be more acutely ill, Dr. Heller adds, there is also going to be a higher level of skill knowledge required of nurses to manage the technological advances in the health care professions.

"There are so many opportunities and challenges now," says Dr. Heller. "Nursing can attract the best and the brightest." Whereas once nurses plied their trade primarily in hospitals, the changing scene of health care is now giving rise to increasing opportunities in different settings, from community health centers to long-term care facilities to home health agencies and more. And within nursing itself there are increasing numbers of options such as telenursing (triaging patients over the telephone), case managers, and outcome managers.

With the nursing shortage have also come increased opportunities for traveling nurses who work from three to six months at understaffed hospitals across the country. The nurses are paid not only their hourly wages, but also benefits, and expenses for rent, utilities, and travel.

"All nurses are going to play a significant role in the changing health care environment," says Dr. Heller, "especially in an atmosphere in which prevention and health promotion is stressed." Dr. Heller sees nursing as a lifelong career with growth opportunities, career mobility, flexibility, and attractive salaries. An acute care nurse practitioner, for example, can earn approximately $70-$75,000, nurse-midwives (UM is beginning a midwifery program in the fall) from $60-$80,000. To attract qualified nurses, many hospitals are also offering a signing bonus.

With an increasing need for managerial skills, nurses are expected to combine business skills with patient care--the additional knowledge results in higher salaries, says Dr. Heller, adding that UM is also offering joint programs with the University of Maryland-College Park and the University of Baltimore so that nursing students can obtain both an M.S. in nursing, along with an M.B.A.

Like Krista Brown, who is 30, many students now choosing nursing have been out in the world for several years and are coming back into the classroom. In Brown's class, says Linda C. Pugh, Ph.D., R.N.C., director of professional education programs at Hopkins' School of Nursing, the average age of the students is 28, and the class includes former bankers, lawyers, sales professionals, and approximately 30 returned Peace Corps volunteers. At the University of Maryland, 50 percent of the nursing students come in with a bachelor's or master's in another field, says Dr. Heller, adding that it's a very heterogeneous class, with more men, more cultural diversity, and more career changers who are looking to be in a more people-oriented or service-oriented profession. "These are smart, educated, committed, and very career-oriented individuals," says Dr. Heller. "At one time nursing was a job-now it's a career."

In addition to the increasing numbers of job openings, which are predicted to continue well into the millennium, people are attracted to the intangibles nursing is now providing--interdependence with other professionals, more independent decision making, more critical thinking, and leadership and management opportunities. "Nurses are much more autonomous and independent than they ever were," says Dr. Heller.

"Nursing is such a wide open career now," adds Hopkins' Dr. Pugh. "There are so many possibilities that weren't available even 10 years ago." The growth in nursing opportunities is being seen across the country, but is going to be especially strong in this region, says Dr. Heller, who calls health care the "economic engine of this state."

Another bonus that Dr. Pugh points out is that becoming a nurse is an affordable--as opposed to medical school--way to work within the health care profession, but she is quick to point out that it shouldn't be seen as a lesser alternative. "Nursing is very different from medicine," she observes. "In nursing we work with people directly...we're much more involved with people on a one-on-one basis. Nurses want that people contact, they want to be critically involved in people's lives."

Marie Stokes, like Krista Brown, a senior at Hopkins' School of Nursing, was a pre-med student at the College of the Holy Cross in Worcester, Massachusetts, when she started re-thinking her career choice. "Did I really want to spend eight years becoming a doctor," she recalls asking herself. "Doctors don't spent as much time with patients as I wanted to spend." Stokes changed gears, received her undergraduate degree in psychology, and then applied to Hopkins, in large part because of the number of students who already had degrees in other fields as well. Stokes hopes to become a nurse practitioner (a master's level nurse with more specialized training) and is interested in working in critical care, taking care of patients when they are at their most vulnerable.

Like Krista Brown, Marie Stokes did not choose nursing because of its career opportunities, but she is encouraged by the positive outlook. "It's a flexible, portable career," she says. "You can find a job anywhere in the country. And you can move from specialty to specialty, or from patient care to administration to education...the opportunities are tremendous."

Written By: Carol Sorgen