The worst nursing shortage in Utah history doesn't scare Toni Propotnik, assistant administrator of nursing services at LDS Hospital.

What does, is the American Medical Association's recommendation to solve the crisis.Blaming nursing leaders for a "bankrupt policy" that has contributed to the severe shortage nationwide, the AMA recently called for a new field of hospital workers to handle bedside chores.

Specifically, the AMA's House of Delegates recommended training "registered care technologists" who would take vital signs, bathe patients and perform other types of patient care. Rejecting stiff arguments from nurses, the AMA's policy-making arm are developing pilot programs for training the technologists to help nurses care for patients.

Don't look for such a pilot program in Utah.

According to Propotnik, Utah physician Alan Nelson, president-elect of the AMA, has agreed that unless nurses, hospitals and physicians in a community agree on the proposal, it won't be imposed.

And Utah nurses aren't budging.

"You've gone too far," is Propotnik's message to physicians. "You are not helping nursing, you are substituting for something that is already in place. You are assuming that because it's under the umbrella of medicine, it is going to be more acceptable to more people. That's not true."

What should the nation's largest doctors' organization (with 295,000 members) have done?

Propotnik said they should have come out with a strong plan to support the nursing agenda to change the work environment in hospitals, support higher salaries the nurses and legislation to make nursing education a top priority.

"Physicians don't realize, and must realize, that they make a difference in job satisfaction for nurses," the administrator said. 'If they solicit nurses' input in planning for patient care, if they would treat the nurses with more respect, they could make a significant difference in job nurses."

Propotnik, her colleagues say, has made a difference.

The turnover in the nursing staff has been significantly reduced since Propotnik arrived in 1985, determined to make LDS a magnet hospital.

History, she knew, could repeat itself.

During the country's last nursing shortage (in the early 1980's), the American Academy of Nursing studied the hospitals that were successful in retaining nurses.

Their conclusions, published in "The Magnet Hospital Study," has become Propotnik's guide. In the past 3-1/2 years she's implemented many of the variables tocreate a magnetism which attracts and retains professional nurses.

The variables - participative management, appropriate staffing, flexible scheduling, career advancement, continuing education and recognition - are all in operation in one form or another at LDS Hospital.

So is a financial compensation program.

"We had for a long time been satisfied with a bandage approach to wages," Propotnik said. "It was obvious to me that we needed to do something to increase the base wage."

With the support of Intermountain Health Care, nurses' salaries over the last three years have increased 28 percent at LDS. A pilot career ladder program, which gives fiscal rewards to nurses staying involved in patient care, has also been implemented.

Both female and male nurses are reaping the benefits.

"Nursing is equally as attractive to men as women today," Propotnik said. "Wehave in this state four times as many men in nursing than in other states in thenation."

Propotnik, who's also been a nursing administrator at New York's Bellevue Hospital, is looking for more ways to enhance nurses' jobs - and images.

"The work is very stressful; it's going to continue to be. The industry is indisarray right now; it's fraught with tension. But the rewards are ones you willfind very few other professions," Propotnik said. "There's immediate feedback from patients whose lives are impacted by nurses."