It's a help wanted message that never goes away.

Nurses wanted.

Kootenai County and the rest of the state is facing a shortage of nurses with specialized training and advanced degrees, according to local providers and a state Nursing Overview just released by the Idaho Department of Labor.

Some believe this could hinder health care down the road.

"I think in three to four years, we are really going to be in crisis mode," predicted Lita Burns, dean of health professions and nursing at North Idaho College.

Kootenai Medical Center has had to go to extra lengths to find nurses trained in specialty clinical areas like critical care, labor and delivery, neonatal intensive care, emergency room and operating room, said Carmen Brochu, vice president of patient care services.

"There is a definite shortage of critical care nurses," Brochu said. "It takes a long time to find those positions, or it takes a significant time to train them."

While other hospitals in Idaho like St. Luke's Health System are reporting gaps of up to 100 open positions, however, KMC's ability to provide care has not been affected by the shortage, she said.

It's mostly thanks to aggressive recruiting, Brochu said.

Since last August, KMC has filled 15 specialty trained nursing positions in critical care, Brochu said, recruiting from as far as Florida.

"Trying to find nurses with experience qualified to do the work you are asking, it's not easy at all," she said, adding that there are five more open positions between the operating room, critical care and labor and delivery.

The difficulty, she said, is finding nurses with 5 to 10 years experience in general medical/surgical care, with certification and training in specialty areas.

Such extensive background is essential to serving the complex patient population in critical care areas, she said.

"It takes a significant amount of experience and time to gain that confidence and skill, along with the critical thinking skills," she said.

Most with those qualifications don't want to leave their positions at other hospitals, she said, where some are tenured or have accumulated benefits.

Most experienced nurses at KMC aren't leaping to train in specialty areas, she added.

"There's a lot of nurses who love what they're doing. We need them where they're at," she said. "There's not a pool of nurses waiting for employment who have experience."

To help address the issues, Brochu said, KMC implemented a new program in 2007 that puts new graduate nurses on an advanced, 6-month training program to place them immediately in specialty units.

But the hospital only takes on a handful in that program a year, she said.

"That's a big expense," she explained. "And you have to be very selective, because they have no critical background."

Burns said many nursing students at NIC enter the program with hopes of working in a specialized area, only to have those hopes tapered.

"Some think, 'As soon as I graduate, I'm going to work in the emergency room," she said.

After pocketing their associates degrees, they often get settled in general care, she said. Some are turned off by the higher stress environment of specialty areas, that doesn't necessarily mean higher pay.

"Specialty areas (positions) have always been the hardest to fill," she said.

Burns is also concerned about the lack of advanced practice nurses, like nurse practitioners, which a recent Idaho Department of Labor report labeled as one of Idaho's most significant problems in the nursing industry.

Masters and doctorate graduates with registered nursing or advanced practice licenses are the smallest but most highly trained pool of nurses, according to the study, making up about 11 percent of the state's nursing population.

More are needed, Burns said, as those nurses can perform general physician duties.

"We don't have enough physicians in Idaho," she said. "These are providers who can fulfill that role."

The need will be even greater if President Barack Obama's health care reform is implemented, she added.

"There are going to be many, many more people who are eligible for health care, and no providers to provide it," she said.

Mike Baker, CEO of Dirne Health Center, said advanced practice nurses can ease the load for local health care demands.

Dirne's medical office has two physicians and four nurse practitioners, he said.

"They can really extend the reach of a physician and help see more patients," he said, adding that nurse practitioners usually start as nurses then go through another two-year program. "We don't have enough providers to take care of all the people in the community who are sick, whether physicians or nurse practitioners."

Burns hopes to see more graduate nursing programs in Idaho.

Idaho State University and Boise State University are the only schools in Idaho offering graduate nursing programs. Northwest Nazarene University offers an online masters program.

"If that's not your choice, you are very, very limited," Burns said. "Online programs across the country, though many are very, very good, are usually also very, very expensive."

Health care demands will only increase in upcoming years with the aging baby boomer population, Brochu said, adding that a flux of nurses at KMC are on the brink of retirement.

More general medical and specialty care nurses will be needed soon, she predicted.

"That's why it's naive to think we don't have a nursing shortage anymore," she said. "There will always be a need for nurses."