Tuition rebates and the hobbled economy of the past several years have helped to double enrollments at some of the region's nursing schools.

But even with classrooms stretched to the seams, affiliated hospitals continue to predict nursing shortages, along with difficulty filling an array of other positions in health care.

After several years of luring students with tuition rebates in return for work commitments, nursing schools at the University of Pittsburgh, West Penn Hospital and Mercy Hospital have doubled their enrollments, officials said.

Those schools and others now find themselves limited not by a shortage of applicants but by limits on their own capacity to train students.

"Because of the nursing shortage, we also have a nursing faculty shortage, " said Nancy Cobb, director of the West Penn Hospital School of Nursing.

One result is that admission to nursing programs has become much more competitive, nursing school officials said.

Gail Wolf, chief nursing officer at UPMC Health System, said all of the students in the University of Pittsburgh nursing school's freshman class ranked in the top 10 percent of their high school graduating classes.

"Pitt turned away about 700 applications for 100 slots," she said. "They were able to take the cream of the crop."

Cobb, at West Penn's nursing school, said the Bloomfield institution has had a similar experience, accepting an average of 80 students from about 300 applicants in each of the past couple of years.

"In the days when we had fewer applicants, we were willing to take a kind of student who might have been at a little bigger risk" for not finishing the program, she said.

"Now we're seeing well-qualified applicants" and more students making it through to graduation.

Nursing schools face the same problem around the country, said Joan Meehan Hurwitz, communications director for the American Nurses Association. She said that 125,000 applications to nursing schools nationwide were rejected last year because the schools don't have enough faculty or space to accommodate them.

As recently as the late 1990s, when many high school graduates seemed more interested in then-hot fields such as computer science and business, most nursing schools were having trouble filling their classes.

In addition to tuition aid, a weak economy generated more interest in nursing and health care in general, where job security has been higher than in other industries and where future job growth is expected to be robust as the U.S. population ages and needs more medical care.

"The stock market declined, the economy changed and fields people had thought were safe were not looking quite that way," said Joanne Sperry, director of Mercy Hospital's School of Nursing.

She said her school saw applications start to dwindle in 1997 but climb again beginning three years ago.

Despite the boom in student applications, however, hospitals still don't have all of the nurses they need.

Officials at Pittsburgh hospitals generally agreed that shortages are not as severe in Western Pennsylvania as in some other regions, largely because of the number of nursing schools here. But local hospitals still can't find all of the nurses they need.

"We aren't seeing vacancy rates of 20 percent or 25 percent," as some regions are, "but we're seeing 5 percent and 10 percent, and it will start to get worse," said UPMC's Wolf.

She said UPMC's hospitals hired nearly 800 nurses last year to keep up with attrition and growing patient volume.

In a 2002 study, the U.S. Department of Labor projected that health care and related social assistance industries would grow by 32.4 percent in a decade, adding 4.4 million new jobs, or slightly more than one in every five jobs that are expected to be created by 2012.

At the same time, baby boomers are expected to retire in large numbers, straining the ability of health care institutions to replenish the ranks of nurses and other health care professionals.

"I think with the nursing shortage, we haven't seen anything yet," Wolf said. "It's going to be horrific" as nurses of the baby boom generation retire. "It's all you hear people talk about in professional circles."

To ease the transition, UPMC is looking for ways to retain nurses who are at mid-career or even thinking of retirement.

Three years ago, for example, the Oakland-based health system implemented a "clinical advancement" program, offering nurses who want to continue doing bedside care opportunities for promotions and pay raises that at one time went largely to nurses who took on administrative roles.

Nurses choosing the advancement track must seek additional training, but their salaries can go as high as $80,000 annually, Wolf said.

UPMC also recently surveyed its nurses, seeking clues about what might entice them to postpone retirement. Wolf said UPMC will use the survey findings to develop a pilot program.

The same problems affecting nursing also have caused shortages in some other health care occupations.

At the moment, Pittsburgh hospital officials count radiation therapists, medical imaging technicians and pharmacists among the most difficult employees to recruit.

With pharmacists, hospital personnel specialists said the biggest problem is competing with retail pharmacies.

In respiratory therapy and medical imaging, "there just aren't that many training programs," said Kristy Terling, vice president of human resources at UPMC.

A couple of years ago, Kristen Bell, executive director of human resources at Mercy, realized she had 20 openings for respiratory therapists to fill but found there were only 22 new graduates statewide that year.

UPMC since has tried to expand the pool of talent in cooperation with the Community College of Allegheny County. The college had been running a daytime program, but to draw in more students, UPMC helped create evening and weekend classes. The health care system helps select the applicants and offers upfront tuition assistance in return for their work at UPMC facilities upon graduation.

Terling said employees across an array of health care occupations "are going to continue to be in demand."

As it has with respiratory therapy, she said UPMC will continue to "to develop more of those career ladders."