1. Belcher, David

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In the year since Hurricane Katrina hit the Gulf Coast, life for nurses has been in flux-whether they're leaving behind abandoned hospitals or moving to the region for ongoing relief efforts. Many of them feel that the area is still emerging from a crisis that the rest of the country, and the press, has forgotten.


"As a society we have a limited tolerance for pain," says Warren Hebert, RN, CHCE, CAE, chief executive officer of the HomeCare Association of Louisiana, "yet the New Orleans area is still decimated. The city's return to normalcy may be a decade away."


Fewer nurses. Prior to Hurricane Katrina, 47,090 RNs were licensed in Louisiana, ac-cording to the Louisiana State Board of Nursing (LSBN). As of June 21 of this year, 46,216 were licensed, a difference of 874 RNs. However, the licensees this year include 660 nurses from other states, 54 foreign nurses, and 1,064 newly graduated nurses. This means that many nurses left the state, says Cynthia Morris, assistant executive director, noting also that 1,904 licensed nurses in the state are seeking licensure in other states.


The four parishes that make up the New Orleans metropolitan area lost 4,843 nurses, according to Morris, many of whom now live in other parts of the state, where thousands have relocated.


"There are shortages everywhere in Louisiana," Morris says. "The areas outside the hurricane-hit areas have hospitals that are overflowing."


"In many cases nurses have left the state because they have families and they're afraid," Hebert notes. "We're dealing with housing issues and closed facilities, which has affected day-to-day life in New Orleans-education, municipal services, even the ability to go to the grocery store and get bread."


Looking to the future. To prepare for future hurricanes, the LSBN moved its office from New Orleans to Baton Rouge, has its data vaulted in a safe location, and is upgrading its computer and phone technol-ogy to better withstand severe storms.


For Barbara Morvant, the LSBN's executive director, the rebuilding of nursing in Louisiana will depend more on reestablishing schools of nursing than on recruiting from outside the state or in bringing back displaced nurses.


"I don't think we're going to know for two or three years whether people will come back to Louisiana," she says.


Nita Green, president of the Louisiana State Nurses Association (LSNA), says her organization played a crucial role in helping nurses immediately after the hurricane and continues to help them.


"We got calls from nurses wanting to find family members and jobs, and we got calls from family members wanting us to find missing nurses," she explains. "We also established the Louisiana State Nurses Association Relief Fund in September to help displaced nurses or those who don't have jobs yet."


Stopgap measures. Joe Ann Clark, executive director of the LSNA, says a bill that was recently defeated in the Louisiana state legislature is an example of the wrong approach to solving the nursing shortage.


"The bill would have allowed nursing aides to administer medication in nursing homes-a job now done by LPNs or RNs," she says. A tremendous shortage of nurses in nursing homes (nearly 3,000 unfilled jobs in the state, according to Clark) almost caused the bill to pass in early June.


"We felt that to turn this task over to less prepared personnel was wrong," she says. "It was passed by the Senate Health and Welfare Committee, but we had a grassroots effort by nurses who didn't want the responsibility of overseeing aides who would be doing this kind of work. It was a close vote in the House, but it was defeated."


Reestablishing nursing will be an ongoing battle, say many of the state's nursing executives.


The basics of life are still a luxury for thousands of people in the area, says Hebert, and many "are choosing not to go back because of the risk of storms."


At the same time, Hebert says, "only about half of the state's hospitals are open and only a fraction of the nursing homes are operating." The result, he says, can be a vicious circle: "You need to have a staff in order to open a facility, but a facility must be open to employ staff."


David Belcher


Looking for Normalcy in New Orleans

Two nurses strive to rebuild their home and their lives.


Gordon Natal, Jr., is an assistant professor of nursing at Loyola University in New Orleans and a displaced resident who aspires to return. Natal, his wife Janine (who is an NP), and their three children left their New Orleans home near the 17th Street canal the day before Hurricane Katrina hit. They expected to be gone only one day. When the levees collapsed and the city flooded, they lost everything they owned except for some china they salvaged later. They were stranded for two weeks in Mississippi and then moved to a rented house in Denham Springs, some 50 miles outside of New Orleans, where they've lived since last September. The year, says Natal, "has been murder."


He was able to continue to teach his online courses after Katrina, first by using computer access at a public library and then by buying a new computer so he could work from their temporary home. Before the storm, Janine was working in a physician's medical practice that has not reopened. She was out of work for several months before finding a job in another medical practice, although it pays significantly less.


Natal says it's been hard financially-not only are they renting a home, but they also have a mortgage to pay on the home they're rebuilding and have had to purchase new furniture, appliances, clothing-"just about everything." They received $2,000 from the Federal Emergency Management Agency and some insurance funds, but he is working shifts as an ED nurse in a nearby hospital to make ends meet.


The rebuilding process has been awful, he says; many suppliers and contractors are price gouging and promising delivery dates they don't keep. Looters are a problem, too, and he can't put appliances in until he gets an alarm system.


"It's a ghost town," he says. "You look out and see dead lawn and shrubs and gutted homes. Things won't be close to normal any time soon."


The Natals hope to move into their rebuilt home this month, one year after the hurricane. They have water and electricity, and phone service was restored in July. About half of their neighbors are rebuilding.


Natal says he and his wife considered leaving the area but stayed because they felt it was important for their children, ages six, 17, and 20, to experience some stability after losing everything. Their youngest child changed schools four times this year.


Looking back, Natal says he has been left numb: "You can only do so much and take so much." -Maureen Shawn Kennedy, MA, RN news director

Figure. The Lower Ni... - Click to enlarge in new windowFigure. The Lower Ninth Ward in New Orleans in June. The photographer said: "It was eerie. There were no people around, no birds chirping. It looked like a war zone."