Associated Press It was clear from the results of the Post-Gazette's Top 50 poll that hospital workers face lots of stress to go along with long hours.

By Bill Toland
Pittsburgh Post-Gazette Anyone who's watched more than an episode or two of "ER" knows that hospitals can be difficult places to work, with lots of stress to go along with long hours and low pay for nurses and young residents.

Maybe that's why so many hospital workers went out of their way to criticize their employers in our Top 50 poll.

One woman griped that "UPMC is a multimillion-dollar company that does not fairly pay employees for their expertise." Another said that at UPMC, "the little guy just gets stepped on."

Working at the Magee-Women's Research Institute was a "very bad experience ? you worked hard, got zero credit, and my pay; I am ashamed to talk about it." At Children's Hospital of Pittsburgh, "my income went up $720. My insurance went up $740. So I am really making less. This has been going on for years." A bit out of our circulation range, a nurse MacNeal Hospital network in Illinois felt compelled to tell the PG that the "nursing managers are the worst people I have ever worked for." Plenty more respondents praised their current employer, sometimes a private practice, while panning the hospital they used to work at.

Why all the negative remarks from hospital employees? First, we'd be remiss if we didn't note at the outset that hospitals are huge employers in the Pittsburgh area, and most urban areas. UPMC, in fact, is the Pittsburgh region's largest employer. It would be more surprising if the Post-Gazette didn't receive a few SOS signals from hospital workers.

Associated Press One poll showed that the percentage of nurses who were very satisfied or moderately satisfied with their jobs moved from 69 percent in 2000 to 78 in 2004. Click photo for larger image.

Second, plenty of people are no doubt happy to work at hospitals -- and the Top 50 poll indeed reflected that, too. One nursing practitioner said he loved working at UPMC St. Margaret, and a researcher said that at "Allegheny General Hospital I have found an atmosphere of collaboration, intellectual stimulation and advancement." A few Mercy Hospital employees told us that working at Mercy feels less like a job, and more like a vocation.

But plenty aren't happy, and various polls and studies conducted over the years suggest that this is an indication of not just the long hours and low pay, but also chronic staff shortages that plague almost every department in every hospital. Nurses, especially, find that their ranks can't keep up with the demand for services, and by 2020, the nursing shortage could reach 20 percent nationally, according to the Health Resources and Services Administration (HRSA). In raw numbers, that's a shortage of 500,000 nurses, says accounting giant Ernst & Young.

But it's not just nurses. Medical assistants and doctors also have reported lower levels of job satisfaction in recent years.

An unscientific online poll of hundreds of doctors said a majority wouldn't encourage children to get into medicine, allegedly frustrated by increasing medical malpractice insurance premiums and hospital cost-containment. Ernst & Young says HMOs have played a role in doctor dissatisfaction over the last 10 years.

"We're in the middle of a culture change," said Chuck Moran, spokesman for the Pennsylvania Medical Society. Doctors are independent creatures and historically have enjoyed working for themselves, but over the last decade, more doctors find themselves taking orders, either because they've linked their private practice to a larger health group, or because they decided against private practice in the first place. That's especially true of younger doctors, who work for hospitals right out of med school and never leave, Mr. Moran said.

So hospitals will always have unfulfilled, under-appreciated employees. That's the bad news -- the good news, says the HRSA, is that nursing satisfaction actually ticked upward from 2000 to 2004. The federal agency, which polls tens of thousands of nurses every four years, says the percentage of nurses who were very satisfied or "moderately satisfied" with their jobs moved from 69 percent in 2000 to 78 in 2004. Part of the increase is due to an increase in nurses' real wages, after a decade of stagnation or regression.

Happy nurses are good for the overall morale in a hospital, since they typically make up one-third to 40 percent of a hospital's work force. But Steven Berkow, executive director of the Advisory Board Company, which consults with hospitals, health systems and insurers across America, foresees trouble on the horizon.

"We know that we're going to begin to experience a lot of retirement," primarily among baby boomer nurses, he said.

Of the 78 percent of nurses who said they were satisfied, about two-thirds said they were moderately so -- and that might look good on paper, but it might not be good enough to keep talented nurses from bolting once the going gets tough and their senior colleagues with institutional memory have begun to retire.

"Moderate satisfaction isn't the level you need to create loyalty," Mr. Berkow said. He also noted that the lowest satisfaction numbers come from the people who work the overnight shift -- which is probably true of lots of workplaces, not just hospitals.

Other polls show varying levels of nurse frustration -- one, by the policy journal known as Health Affairs, says that 41 percent of hospital nurses are dissatisfied, and one-fifth of them plan to leave their jobs in less than a year. Pennsylvania's Department of Health surveyed 83,000 nurses a few years ago and found that 84 percent were satisfied, but that poll included nursing administrators, as well as the more than 40 percent of respondents who work for nursing homes, doctors' offices and home-care agencies, rather than hospitals.