I've been reading lately about the persistent nursing shortage in the U.S. that threatens the quality of patient care. I know something about this: I was born in the Philippines—the world's leading donor of nurse labor—and many of my own relatives, including my mother, migrated to the U.S. to help fill this nursing gap. My mother studied at the University of Philippines and was trained at the Philippine General Hospital. She, like thousands of others, was exported to the U.S. and then later to Australia in the '80s where she was guaranteed a higher salary and greater opportunities. This hasn't changed much. The mass exodus of nurses from the Philippines continues today.

But with the current economic crisis, is there still a growing demand for nurses in the U.S.? Some hospitals have laid off nurses. And some senior nurses are remaining in, or rejoining, the workforce as they choose to postpone retirement or come out of retirement because of financial insecurity.

We've all heard of the national nursing shortage, so why are newer nurses currently finding it so hard to get a job?

The answer lies in the economic recession and a temporary increase in the number of experienced, working nurses. As people feel the financial strain brought on by the current economic downturn, more of them, including nurses, are returning to work.

"We've got college costs in three years and our retirement plans are losing money," Tammy Frankauski, a mother of three who returned to work, told the Washington Post. "It's easier to keep ahead than risk falling behind, and you want to be prepared in case anything happens."

The nursing shortage has been a big problem for the past decade, and it's forecasted to get a lot worse in the next 20 years or so. In the past, hospitals have gone out of their way to recruit nurses and incentivize them to stay-offering signing bonuses, vacations, and on a positive note, quality initiatives.

However, hospitals are now actually turning away nurse applicants and reporting fewer job openings.

After decades of letting newly-licensed nurses sink-or-swim on the job, some hospitals are finally tossing their new nurses a life preserver. The goal is both better quality care—-and fewer newly-minted nurses who quit.

 According to the Los Angeles Times, a recent national study found that one in five newly licensed nurses quit within their first year of work. This is not what we need given our nursing shortage. Peter Buerhaus, of the Vanderbilt University Medical Center, told the LA paper that we could have a shortage of 500,000 nurses by 2025, due to increasing rates of retirement and the demands of the aging baby-boom generation. This shortage too comes at a time when nurses may actually have a larger role to play in a reformed health where we place more emphasis on primary care, care coordination, and management of chronic diseases.

Nurses just want to have ... autonomy.

Facing a worsening nursing shortage, often accompanied by poor morale, some hospitals are trying retain nurses not with cars, cash, and Bahamian junkets but by making their jobs more satisfying. And that can also improve the quality of patient care.

With more than 100,000 open nursing jobs last year—and the numbers expected to surpass one million about 15 years from now when aging Baby Boomers will need more nursing care—the nursing shortage is a serious problem for hospitals. A story in Sunday's Washington Post said the practice of luring nurses with signing bonuses and incentives turned out to actually boost turnover, because nurses would change jobs to keep accumulating bonuses

Replacing a nurse can cost up to $100,000 because of temps, overtime, recruiting and training the new nurse. That doesn't include salary. So hospitals took another look at what they can do to keep their nurses. And the answer, at least in part, is giving nurses more control over patient care and opportunities to get more advanced training. Some are doing research into problems they observe, coming up with new care plans that improve quality.

Nurses on medical-surgical units in hospitals spend less than a third of their time providing direct patient care. But before you get all indignant and leap to the conclusion that they are spending 70 percent of their time chatting on cellphones, doing their nails, or watching American Idol, think again. Nurses work hard. Very hard. But, through no fault of their own, they are not always working at maximum efficiency actually taking care of patients.

"A picture emerges of the professional nurse who is constantly moving from patient room to patient room, nurse station to supply closet and back to patient room, spending a minority of time on patient care activities," according to the interesting time and motion study called "How Do Medical-Surgical Nurses Spend Their Time?" published recently in the Permanente Journal, brought to our attention by the Robert Wood Johnson Foundation.