By DYMPHNA CALICA-LA PUTT

A severe shortage of nurses in Southern Nevada used to be a magnet that pulled thousands of health care professionals to Las Vegas. But the city's lackluster local economy is gradually shifting that trend, making these previously "in-demand" professionals feel the pinch as well.

For one, hospitals have stopped hiring nurses who just graduated and who lack actual nursing experience. In addition, there are hospitals that, in response to the recession, have trimmed the salaries of nurses, such as what happened recently to the public University Medical Center.

Fortunately, nurse staffing registries and home health care agencies in Las Vegas continue to offer skilled nurses an additional source of income, while giving new nurses a chance to do hands-on training that can lead to job opportunities.

While it may be difficult to predict the future of these agencies given the continued bleak economy in Las Vegas, what is certain is the increase in need for nursing professionals in the city.

"With the increase in health care services that are part of the new (Affordable Care Act), there will be a need for increased resources to treat and care for the newly covered consumers of health care in Las Vegas," Nevada Board of Nursing Executive Director Debra Scott said in an interview.

Anticipating this future demand for health care personnel, nursing registries and home health agencies continue their campaigns to convince nurses to sign up with their companies.

"(A nursing registry) works best for (nurses) who love the flexible schedule and the freedom to dictate their availability and vacations, said Millie Martinez, administrator of Staffing Specialists Inc.

The daily pay scheme or payment given immediately after a nursing shift, common among nursing registries should also be a big draw, Nurses R Special owner Marietta Lanza, for her part, noted in a separate interview.

Reliance Home Health, meanwhile, has recently helped provide some nurses who are fresh out of school with much-needed training that will eventually make them qualify for hospital jobs, said Janette Serrano, the home health agency's administrator and director of professional services.

The three health care agencies are among many that set up shop in Las Vegas during the early 2000s in response to the city's booming population and bustling economy. The owners of all three businesses admit to running themselves ragged in order to survive the bad business climate in the city. But all three have survived thanks to their sound business strategies the staff's innate resilience, and the culture of compassion and caring that is emphasized in their companies.

Sound strategies of business

Setting up a nursing registry in Las Vegas about a decade ago made good business sense as hospitals started springing up everywhere in the city.

This is what drove Staffing Specialists' Martinez, a skilled registered nurse, to open a nurse staffing agency in the city.

Martinez, who was educated and licensed in the Philippines, had set up a nursing registry in Los Angeles in 1981. She also is licensed in California and had worked as an intensive care unit nurse in several hospitals in the state.

Given this background and experience, Martinez noted that she "has a pulse on market demand."

She and her team thus hit the ground running when they set up Staffing Specialists in Las Vegas in 2001. Since then, the Staffing Specialists name has become synonymous for quality nurse staffing as it continues to serve all the large hospitals in the city. It has been certified by The Joint Commission, an independent, not-for-profit organization which accredits and certifies more than 19,000 health care organizations and programs in the U.S. based on performance standards.

Like Martinez, Reliance's Serrano also received her nursing education in the Philippines. The veteran nurse had worked in hospitals in Florida and California before she was recruited as director of nursing for several home health agencies in the Golden State.

Serrano's skill in managing a home health agency is what brought her to Las Vegas where she successively held the same supervisory post in a number of similar companies in the city. Finally, in 2004, she and her husband Paul opened their own home health agency.

Today, Reliance Health Care remains one of the most popular home health agencies in the city given its consistent high rankings in patient care from Medicare. It also is the only firm of its kind in Nevada that has copped a slot in the top 100 home care agencies in the U.S. in the years 2007, 2008 and 2010. It was on the top 500 in 2006 and 2009.

Unlike Staff Specialists and Reliance, the president and chief operating officer of Nurses R Special is not a nurse but a savvy businesswoman.

Experienced in sales and the realty industry in the Philippines, Lanza moved to the U.S. in the 1970s with an itch to find a viable business venture in the country.

"I was thinking, where there are people, there is a hospital," she said. "I wanted a business that will be there forever."

Thus, in 1987, she set up a nurse staffing agency in California. Recognizing the viability of a similar business in Las Vegas, she set up a branch in the city 14 years later. Nurses R Special Las Vegas, also certified by The Joint Commission, has sent registered nurses to a number of hospitals and hospices in the valley.

"The company is solid because it is managed well," Lanza asserted. For this, she credits family members who are involved in the business.

While the company is incorporated, it is run like a family business, she noted. Lanza's youngest son manages the California office. She is currently managing the Las Vegas branch after the recent passing of her eldest who had, until then, have managed the office.

Similarly, both Staff Specialists and Reliance are run like tight ships by either family members or staff members who are all treated like family.

"It's only me and my husband who run the business," Reliance's Serrano said. Her husband Paul is the company's chief financial officer.

This trait is common among Asian businesses as noted by Las Vegas Asian Chamber of Commerce chairman Robert Young.

"(Asian businesses are very much family-oriented. We are using family members working together as a team. That is a core value of Asian enterprises," he said in an earlier interview.

Curl up to toughen up

Apart from this common Asian attribute, meanwhile, the three companies' strengths can also be ascribed to its owners' innate resilience.

"There's no sugar coating the situation. We don't relish such news (of other registries closing shop) because on a broader scale it clearly depicts a shaky economy," Martinez said.

"Still, we try to focus on the positive side. Productivity is much reduced but we make the most of what we get especially on busy days," she added.

In the Philippines, there is a saying that if your blanket is short, you survive the cold by curling up your legs, she said, noting that this guides them through tough times.

A few employee perks such as holiday parties and bonuses have been put on hold at Nurses R Special as cost cutting measures.

For its part, Reliance Health Care never tires of coming up with ways to reduce expenses.

"Our strategy is we continuously try to cut down costs," Serrano said. This includes finding more cost-effective medical suppliers, cross-training administrative staff, and employing licensed practical nurses instead of registered nurses.

"We use LPNs for easier cases, the low-risk and easy to manage ones," Serrano said. "Complicated cases, like those with recurrent admissions to hospitals, cardiac cases, post operative patients go to RNs who can manage (these cases) better."

Indeed the innate Filipino resilience that Martinez described is evident in the business practices of the three firms.

The three companies belong to one of the fastest growing groups in the U.S. Currently there are some 200,000 Filipino-owned businesses in the U.S., a hefty 49 percent of which are in the health care sector, according to the U.S. Census Bureau's 2007 Survey of Business Owners. Filipinos make up the largest minority group whose businesses are in the health care field.

Competence, compassion, and culture of care

What spelled the proliferation of these Filipino-owned medical businesses is the caring and compassionate culture that these people are known for, a local Las Vegas physician and Filipino community leader had noted.

"We are known for being caring and compassionate," said Dr. Ben Calderon, medical director of Calderon Medical Group.

It is this innate trait -- stemming from a society where people take care of the sick and elderly in their families -- that sets these Philippine nurses apart from the rest. It is usually these Filipino health care professionals who set up their own businesses in the same field.

"We have so many medical providers who are already in the system," said Calderon, who was president of the Philippine Medical Association of Nevada.

Meanwhile, the owners of Filipino health care businesses also expect the same level of compassion and caring from their personnel.

"Beyond professional competence, we also strive to cultivate a culture of commitment and caring," Martinez said.

Staff Specialists employs a good mix of Asian, Caucasian, Hispanic and black nurses who, Martinez said, are all expected to display the "caring culture" in their work.

In the same way, the culture of care and compassion also is emphasized at Reliance Health Care.

"It's always our expectation to maintain a high standard of care from all our employees by providing a thorough orientation, continuous education and updates of trends in the health care industry," Serrano said.

"If (patients) are satisfied with our care, there would be more patients who will come to us," she added, noting that this translates to a better bottom line as well.

Nurses R Special's Lanza explained that the "culture of care" indeed has its financial rewards.

"In a registry, you can get a lot of complaints from patients or hospital staff just because of (a nurse's) attitude or bedside manner. If they get that, they are put on the hospital's do-not-send list and they can never go back there," she said.

Fewer nurses sent to client hospitals will mean fewer payments received from them, Lanza noted.

While caring and compassion is paramount in the three companies, competence is obviously very vital as well.

"We place much value on professionalism and we strive to imbue this goal to our staff, both new and current," Martinez said. "Our orientation is focused on policies that define competence."

This includes having the nurses take examinations to test their respective knowledge and skills in medical/surgical nursing, emergency room, telemetry, intermediate care, intensive care, pediatrics and neonatal intensive care. LPNs and certified nursing assistants also undergo the same battery of competency examinations to test their skills.

Similar tests are given to Nurses R Special nurses. Also, Lanza noted that whenever one of their nursing staff is sent to a hospital, that nurse is expected to be highly skilled so he or she can "hit the ground running." After all, the reason hospitals tap nursing registries is because of their pressing need for additional personnel to urgently help take care of patients.

"There is no time for orientation at the hospital," she said.

Experience, thus, is critical because it enhances nurses' competence. For this reason, both Staffing Specialists and Nurses R Special require applicants to have at least one year of hospital experience as a nurse before they are hired.

Reliance Health Care also requires applicants to have nursing experience. Of late, however, Serrano, its director of professional services, has been receiving applications from new graduates.

"Recently there are a lot of new (nursing) graduates that cannot get employment in hospitals, even (for) volunteer positions," she said.

This may be because of hospitals' cost-cutting measures as a result of the sluggish economy, she noted.

"Hospitals do spend a lot of money when they orient staff," the veteran RN said.

While she feels for these new graduates who are desperately seeking employment, Serrano said she cannot hire them. "I also do not want to put patients at risk," she said.

Still, Reliance decided to help novice nurses by giving them training, albeit, without payment.

"We pair them with an RN who does patient visits," she said, noting these new nurses gain hands-on experience under the watchful eye of a skilled nurse. This is in addition to classroom training and continuing education classes they need to attend.

"They also read charts and practice with clinical documentation. They practice calling doctors and writing doctors' orders, too," she added.

Serrano remains highly selective, however, of the novices that she trains, saying "They have to be highly recommended by their school."

She noted that her current trainees include the top two graduates of nursing at Touro University Nevada who came highly recommended by their professors.

"We tell them from the beginning that we will not pay them (for the training). It's like a benefit in itself because nobody (will hire) them," Serrano noted.

After tagging along with registered nurses on home health visits, the trainees take a battery of tests which will determine if they are ready to do visits on their own. Once they are deemed competent enough, Reliance hires them.

"Most of these trainees become assets. You just need to know how to guide them. They are eager and hungry for experience," Serrano said.

Some, however, choose to find employment elsewhere.

"It's a part of the game if they leave," CFO Paul Serrano said. "Reliance nurses leave with good marketability. They get hired (by other employers) easily."

The husband and wife team said this is a reflection of the company's high regard for competence.

"Our vision is that the community sees us as a premier provider of excellent care from health experts they can trust," Paul Serrano said.