It's official: Florida's nursing shortage is back.

A workforce survey by the Florida Center for Nursing shows that vacancies and turnover began to accelerate in 2011 after a four-year slide. The nonprofit center predicts that Florida will run short of registered nurses by 11,000 openings in 2015 — and by 50,000 in 2025.

The state's lack of qualified nursing professionals never went away entirely, even in an unforgiving economy. Demand at hospitals, nursing homes and home health agencies remained strong through the worst of Florida's recession years, especially for more highly trained registered nurses. But the much-anticipated crisis that had prompted a statewide expansion in nursing education — to more than 200 separate degree programs — failed to materialize on schedule.

That left fresh nursing graduates unable to find work at the same time that the economy forced more licensed nurses to return to the field, for lack of other opportunities. As health care employers struggled to contain costs, hospital vacancy rates for direct care registered nurses in Florida fell from more than 8 percent in 2007 to only 4.6 percent in 2009.

But that trend has now reversed itself.

The center projected that almost 16,000 new nursing positions will be created in the state this year — after a significant dip in 2009 and 2010. With some 200,000 nurses now working in Florida, that represents an annual job growth of 8 percent.

That is good news for nursing school students, and for those now in the workforce who are looking to better their positions.

But a lack of qualified nurses could put health care operations in competition with each other — ultimately applying upward pressure ono the cost of patient care.

Whether this will mean higher wages and more clout for nurses is unclear.

Teresa Passalacqua of Sarasota, now studying to be a nurse practitioner in Florida State University's Doctor of Nursing Practice program, has seen the shift from feast to famine in her 12-year career.

Even before she earned her bachelor's degree in 2007, she said, "we had our pick of jobs. People were grabbing you up when you got out of school."

Her timing was good.

Florida's job market stagnated and nursing turnover rates decreased sharply from 2007 to 2009, at hospitals, nursing homes, home health agencies and public health networks. After getting a master's degree in 2009 and moving into management at Orlando Regional Medical Center, Passalacqua experienced the shift in supply and demand from the other side.

"A lot of graduating nurses were being turned out that could not get jobs," she said. "We were handpicking our nurses."

Room at the top

In the next few years, demand will be highest for registered nurses, especially in hospitals and nursing homes. Expected growth in the home health industry will also strain the supply, the FCN report said.

Recent nursing graduates should find it easier to land jobs, said Michelle Yore, assistant director of research for FCN. Of the hospitals surveyed, 89 percent said they would hire straight out of school, and 29 percent have nurse residency programs to continue their training after school.

But demand for nursing skills is not simply a question of numbers. The most severe shortages are expected to occur well beyond the entry level.

"We did notice that all the employers that responded said that their difficult-to-fill positions required nurses with experience and advanced education," Yore said.

Passalacqua decided to pursue a doctoral degree when her passion for patient care prompted her to move from management back to the bedside. But she said that nurse practitioners — qualified to diagnose and treat in addition to providing care — are "very underutilized in this state."

Still, she has no regrets about continuing her studies.

"When you have a degree you are more marketable," she said, advising fellow nursing students to "start with your associates' and go forth and don't stop."

Supply and demand

At $30.29 per hour, registered nurses in Florida earn about $90 a week less than the national average.

Some health care unions are working to improve wages through collective bargaining. One, the National Nurses Organizing Committee, has pressed for better hospital nurse-to-patient ratios, through legislative efforts and in negotiations with employers.

"That's a huge issue for the nurses," said Ross Eisenbrey, vice president Economic Policy Institute, a nonpartisan Washington think tank that monitors labor issues. "Obviously, they do care about the patients, but it's also a serious workload issue for them."

Eisenbrey predicted that escalating shortages will give nurses more bargaining power to extract better wages and working conditions.

"Down the road," he said, "if the unions keep up their organizing attitude, it's going to pay off for them five or 10 years from now."

This could trigger a rise in health care costs just when the huge baby boom generation reaches an age when more services are needed.

But Libby Devlin, a state organizer for National Nurses United in Florida, is less optimistic that employers will bend their business models to maintain quality of care. High turnover, she said, does not automatically guarantee better opportunities for nurses.

"There is already a revolving door at the low end of the wage scale," she said, "and the hospitals take it as a matter of course, as part of the cost of doing business."

Devlin said there are more than enough licensed nurses in Florida to meet demand for years to come — but many have left direct patient-care jobs because of poor working conditions and pay. According to FCN data, more than 11 percent of licensed registered nurses in Florida are not working in the field.

Devlin believes more nurses can be retained if their concerns about patient care are met. After California became the first of 14 states to establish legally required nurse-to-patient ratios in 2004, she said, "100,000 nurses in California went back to the bedside."

But in the absence of such regulations, she said, employers tend to respond to staff shortages by piling on more tasks — prompting more nurses to quit in frustration.

"They just assign more patients to the nurses remaining," she said, "thereby exacerbating the problem."