The solution to the nursing shortage plaguing many U.S. hospitals lies not just in higher pay, but also in letting nurses be nurses once again, a federal commission said Monday.

A major problem, the commission report said, is that hospitals have laid off 100,000 non-nursing employees over the past five years at the same time that sicker patients are being hospitalized.Outpatient treatment is now more likely for the less seriously ill, leaving hospitals with the most difficult cases. Nurses, meanwhile, find themselves burdened with increasing amounts of non-nursing duties, the report to the Department of Health and Human Services said.

The 19-member commission said nurses not only are being asked to render more care typically carried out by higher-priced personnel such as respiratory and physical therapists, but also are required to do more paperwork previously handled by support staffs that have been reduced to hold down hospital payrolls.

"Health care delivery organizations should preserve the time of the nurse for the direct care of patients and families by providing adequate staffing levels for clinical and non-clinical support services," the report said.

The panel did call for higher pay for nurses, but said:

"Increasing compensation alone, however, will not be sufficient to resolve the shortage. Attention must also be given to increasing professional recognition, increasing representation of nurses on policy-making, regulatory and accreditation boards as well as increasing the use of more collaborative approaches between nurses, other health care professionals, and management."

The document was welcomed by the Federation of Nurses and Health Professionals. "The commission's recommendations are very similar to what we have been advocating for a long time," said Candice Owley, the union's vice president. "We are encouraged that the federal government has finally given proper recognition to the problems of the nursing profession and has offered some concrete solutions to the crisis."

The commission said several trends, "including an aging population, new technologies and treatment possibilities, legislative changes and the emergence of new diseases" such as AIDS will further increase demand for registered nurses.