Picketing at Harborview Medical Center highlights a change in the demand for health-care workers. For a time, nurses and others could almost pick and choose their jobs, but the recession, hospital cost-cutting and a sharp increase in the number of workers being trained has changed all that.

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A dozen years ago, hospital leaders, state officials and political leaders were wringing their hands about a looming shortage of nurses and other health-care workers.

Hospitals were expanding, and health-care workers — particularly the most highly trained nurses — could almost pick and choose their jobs.

But a combination of events, including the recession, hospital cost-cutting and a sharp increase in the number of workers being trained, revised that equation.

“There’s not the high demand like before,” says Tim Sweeney, spokesman for the state’s Workforce Training and Education Coordinating Board.

What does this mean for health-care workers now on the job?

During a noisy rally outside Harborview Medical Center last week, more than 300 nurses and other employees complained of staffing shortages and lack of money to attract and keep workers.

“Our patients are affected,” said Susan Tekola, a registered nurse on the neurosurgery and neurology floor who has worked at Harborview for 15 years.

Although she is supposed to be able to take breaks, she said, there’s nobody to fill in, so another nurse who already has a full load of patients must double up. “My co-worker will have 10 patients for 45 minutes. This is not safe.”

The nurses, technicians and other health-care workers, members of Service Employees International Union (SEIU) Healthcare 1199NW union, called on management to open the purse to recruit, educate and retain staff, who too often leave for higher-paying jobs, they say.

“We’re not able to retain staff,” said Tekola, who sits on the bargaining committee. “They leave because there are better wages a block away, at other hospitals. That’s a major concern.”

Tina Mankowski, associate vice president for medical affairs at UW Medicine at the University of Washington, which manages the hospital, said in a statement: “We are and remain committed to patient safety and to the successful resolution of our collective-bargaining initiative.”

The union and management have been bargaining a contract since late June.

Mankowski said she believed that with the assistance of mediators, “we can look forward to a mutually successful resolution.”

Harborview, the only top-level trauma center for adults and children in Washington, Alaska, Montana and Idaho, is owned by the taxpayers of King County.

King County Councilmember Larry Gossett, who attended the rally, said wages at Harborview are 20 to 30 percent lower than at other hospitals in the region.

But even private health centers with reputations for paying better wages, such as Swedish Medical Center and Group Health Cooperative, have recently announced plans to cut their budgets.

Supply vs. demand

Some peg the beginning of the supply-demand changes in the health-care-worker marketplace to the dot-com crash, which pushed workers into health fields many saw as more stable sources of employment.

In addition, a major public-private training initiative pumped more health-care workers through the pipeline: For example, the number of registered nurses completing training in Washington went from under 1,800 in 2004 to more than 3,000 last year, according to preliminary figures by the state workforce board.

In the meantime, the weak economy intervened. Nurses delayed retirement, and hospitals instituted layoffs and other tightening as fewer insured patients came through their doors.

More recently, hospitals have held back on hiring, in part out of uncertainty about future cuts in insurance reimbursements, particularly from Medicare and Medicaid.

Tight staffing and the issue of breaks has led to disputes, including one that reached the Washington State Supreme Court. Last month, in a ruling involving Sacred Heart Medical Center in Spokane, the justices said: “Rest periods are mandatory and promote employee efficiency … (and) help insure nurses can maintain the necessary awareness and focus required to provide safe and quality patient care.”

Most observers say they don’t expect the current contraction in the market for health-care workers to last. The state still considers nurses an “in demand” profession — just not as “in demand” as before, Sweeney noted.

According to the latest figures from the state workforce board, between 2014 and 2019, an additional 190 registered nurses per year will be needed if the 2010 “new supply” of nurses — 2,677 — remains steady.

Projections for other workers, including radiation therapists, dispensing opticians, dental hygienists, medical transcriptionists and respiratory therapists, show smaller gaps.

A typical registered nurse in Washington now earns nearly $75,000, according to the state’s figures, but that includes many with years of experience. The average age of registered nurses in Washington is nearly 49, older than the national average.

Growth in the health-care industry still is outpacing general growth in the economy, and the demand for higher-level nurses remains high.

Forecasters predict even greater demand for nurses and other health-care workers in the near future as baby boomers, who began turning 65 at a rate of about 10,000 per day last year, begin requiring more care. The highest demand is expected in the nation’s South and West.

At the same time the general population is aging, noted Linda Tieman, executive director of the Washington Center for Nursing, many nurses are nearing retirement.

“It’s tight right now but by 2015 we expect to see a large gap between the numbers of nurses needed and those available,” Tieman said. “If we don’t keep this fact out in front of us, Washingtonians will not get the care they need, in any setting.”

Diverse service

For Harborview, the situation is unique, workers there say. In addition to receiving the most severely injured accident victims, the county-owned hospital provides care to many homeless, indigent and immigrant patients, whose needs often involve social workers and other staff.

Five members of the Metropolitan King County Council have urged the Harborview board of trustees to “lead by example in providing a fair and positive environment for medical staff.”

In a letter to the board, the five council members acknowledged the hospital’s challenges in providing quality services on a limited budget.

“However, rectifying staff concerns is essential to providing safe patient care, and we urge you to resolve current disputes with Harborview Medical staff,” they said.

“We want Harborview to remain a leader in medicine and to support our dedicated nurses and caregivers with fair working conditions and adequate pay.”

The union’s bargaining unit at Harborview includes 1,900 registered nurses and other health-care workers, including 60 nurses who fly with Airlift Northwest, transporting severely injured patients to Harborview and other regional hospitals.

Carol M. Ostrom: 206-464-2249 or costrom@seattletimes.com. On Twitter @costrom.