Cristal Simon is happy right where she is, unlikely to be lured away by a competitor.

Every other Friday, the nurse gets a discounted massage when she goes on break from her job as clinical educator at Children's Healthcare of Atlanta at Scottish Rite. She gets a 25 percent discount in the cafeteria, and a concierge service helps out with movie tickets.

When Simon took a nursing job at Children's Healthcare eight years ago as a newlywed, she liked working three long days, with four off. Now a five-day week suits her better and allows time with her two young children. Even better, the hospital provides day care half a mile away.

"It might sound goofy, but . . . when I came in and knew I was going to accept the position, I asked how much I was going to have to pay to park and got this funny look. When that lady said, 'That's included,' I just had a warm feeling about it," Simon said.

Hospitals such as Children's are trying to hold on to that good feeling amid labor shortages. In 2000 the national shortage of nurses was 6 percent; it's estimated to grow to 29 percent by 2020 if current trends continue.

So far, hospitals on metro Atlanta's Northside report staff shortages around 6 percent, but they know that could spiral out of control as they expand facilities, the population demands more services and nurses reach retirement age.

"We've got to start planning now," said Linda Matzigkeit, Children's Healthcare senior vice president for human resources.

When Children's Healthcare's $344 million expansion is completed in 2008, it will mean 2,000 new jobs, 500 of them for nurses. This year the hospital will hire 1,000 nurses, for new and replacement positions.

North Fulton Regional Hospital in Roswell is adding 10 emergency bays and 35 hospital beds in a $30 million expansion. Today's staff of about 1,000 will have to grow by 20 percent to 30 percent to keep up.

Northside Hospital-Forsyth in Cumming has enlarged its emergency department and applied to add maternity services and a women's center.

Northside Hospital's $64.9 million expansion and renovation plans are pending. And WellStar Kennestone Hospital in Marietta recently was approved for a new oncology imaging center.

Susan Brown, chief human resources officer at North Fulton Regional, said the expansion is driven by sophisticated health consumers who demand more services. That, coupled with an already tight supply of nurses, is a problem. Half the current force of registered nurses is 45 or older and will reach retirement age within about 15 years, according to the Bureau of Labor Statistics.

Nurses also leave hospitals to work in home health care, the legal profession or with insurance companies, jobs they may view as less strenuous or risky. Some just quit. Of the 2.7 million RNs nationwide, 2.2 million work in the profession.

"We're relentless," Matzigkeit said. "We know there are soccer moms [who are nurses], and we're thinking, 'How can we get them?' "

Aggressive recruiting

From 2001 to 2003 the trend began to turn, and the nation gained 200,000 RNs. More than 26,000 potential nursing students were turned away from nursing schools in 2004, mainly because there weren't enough instructors.

Locally, hospitals are encouraging students to go into the field, funding nursing education and looking for help from untapped sources. This year, $40,000 raised by volunteers at North Fulton Regional will fund scholarships for Roswell and Alpharetta students.

Tenet Healthcare, which owns North Fulton Regional, is donating more than half a million dollars over three years to Georgia State University's fast-track nursing program.

Children's Healthcare also sponsors a faculty member at Georgia State. In return, it will have first dibs in hiring members of the class of 2005, said Ann Miller, Children's vice president of work force strategies. Children's also is looking at sources like the military from which to recruit nurses and at programs for cognitively challenged people from which to hire people to perform some jobs previously part of a health worker's tasks, Matzigkeit said.

Keeping new hires

Once they've found and hired nurses, hospitals are trying to keep them from looking for greener pastures. The American Nurses Association estimates that 15 percent of RNs will leave their current jobs by next year.

North Fulton Regional greets every new hire at a staff luncheon, where they meet every senior staff member, from the chief executive officer on down.

Children's Healthcare is experimenting with a sixmonth- on, six-month-off program and is also considering a schedule like a teacher's, with nine months on and three off, Miller said.

Georgia ranks low on the nurses' pay scale nationwide, but salaries are going up. The average nurse salary in Georgia in 2003 was $47,630, according to the Bureau of Labor Statistics, placing it 33rd in the nation. The national average is $54,574, according to a survey by the journal Nursing 2004.

North Fulton Regional reviews wages twice a year and adjusts accordingly, said Brown, the human resources officer.

A small pay difference usually isn't enough to entice a nurse to move. But if they do leave in good standing, Children's Healthcare stays in touch to let them know they're welcome to come back at any time, Matzigkeit said.

"Any hospital that's competing only on pay can only do that so long," she said.

Easing the pain

Nurses look at working conditions, pay, benefits, scheduling, career advancement opportunities and what nurses already on the staff think about their employers.

"One-third of our nurses come from employee referrals," Matzigkeit said. Referral incentives at Children's range from $1,000 to $3,000. At North Fulton, 30 percent of hires come from in-house referrals, which pay from $2,500 to $5,000.

In addition to perks like the massages and free parking, Children's paid for Simon to get her master's degree by attending on-site classes led by an instructor flown in from Michigan.

"You will always feel the effects of a shortage in increased patient load, not being able to get an entire break or when going to the cafeteria and sitting down for lunch is almost like a dream," Simon said. "The shortage is critical, but I think what the hospitals do is find ways to ease the pain."

One of the benefits she likes best is that, during critical times like flu season, the administrative staff up to the CEO will help fill in the ranks and take care of patients. For staff nurses, it's hard to put a price on that, Simon said.

- This article is a reprint from The Atlanta Journal-Constitution.