Last Halloween night, Carol Jean Mays frantically searched up and down the halls of Independence Regional Health Center.

The former Missouri state legislator from Independence was looking for a nurse to help her husband, Ronald Mays. He was in the hospital's intensive care unit that night, fighting for his life against kidney failure. He needed a bandage changed; another time he needed pain medicine.

"There was nobody at the nurse's station," she recalled. "They were in patients' rooms, working with other patients when I found them."

Ronald Mays died Nov. 7 at age 73. Carol Jean Mays said she did not blame anyone at the hospital for his death. She has tremendous admiration for the nurses.

But, she said: "If a nurse has too much to do and is overworked and overstressed, the stress level is undoubtedly going to wear on her and perhaps make it impossible for her to do as good a job as she would like to do."

Independence Regional at that time was owned by Health Midwest, which was purchased in April by HCA Inc. Hospital officials declined to comment on the incident involving Mays but said steps had been taken to increase the number of nurses there.

"Nurses are vital to Independence Regional Health Center for delivering quality care," said Michelle Smith, the hospital's chief nursing officer. "Because of this, we have made great strides to recruit nurses. This includes increased salaries for both incoming and existing nurses, and efforts to make working for Independence Regional Health Center more rewarding and less stressful. We have recruited 31 new registered nurses since our purchase by HCA," for a total of 256, she said.

Still, Mays' anecdote points to a serious threat to the health of Americans: a chronic shortage of nurses that is affecting the quality of care being delivered and contributing to nurses burning out.

For several years, report after report, from entities such as the U.S. Department of Health and Human Services and the Joint Commission on Accreditation of Healthcare Organizations, has sounded alarms about the tightening supply of nurses, spewing out worrisome numbers and warning of dire consequences.

Hospitals and nursing schools have responded in a variety of ways, including recruiting more men.

The commission said in a 2002 report that there were 126,000 nursing positions unfilled in hospitals around the country.

Sicker patients with fewer nurses to care for them amount to a "prescription for danger," said the commission, a nationwide accrediting group based in Oakbrook Terrace, Ill.

The commission reported nearly 400 incidents in which inadequate nurse staffing levels had been a factor in patient deaths, injuries or permanent loss of function.

In the meantime, the nation's estimated 78 million baby boomers are approaching the age where they will need more care. Nurses also are aging. The commission said the average age of a working registered nurse in 2002 was 43.3, and that was expected to rise to 50 by 2010.

"This is a critical problem," Dennis O'Leary, president of the commission, said in an interview. "It is one of the areas in which the federal government needs to put more resources on the table. They have failed miserably."

Many nurses say they feel overburdened by having to care for too many patients. Because of changes in hospital admission patterns, the patients are sicker than they used to be and require a more intense level of care.

Even nurses in the best of circumstances work harder to keep up. Donna Carnicom, a rehabilitation nurse at St. Luke's Northland Hospital's Smithville campus, said nurses had more responsibility for patient care and must take charge of more sophisticated procedures and equipment.

She said she saw more nurses burning out and that the pressures get to her sometimes, too.

"There have been times when I've gone home and thought, `Oh my God, I can't do another day of this,' " she said.

But the gratitude she receives from patients makes it all worthwhile, Carnicom said.

Like Carnicom, 54, many nurses are nearing retirement age. But recruiting all the young people needed to replace them is tough. The nursing work force is still largely composed of women, and they have many more career opportunities than they used to.

Nurses also can find many jobs outside traditional hospitals, such as at specialty clinics that offer easier working conditions.

Nurses who work for temporary employment agencies fill some of the gaps, but the overall problem continues to fester.

"There is indeed a shortage," said Mary Ellen Doyle, vice president and chief nursing officer at St. Luke's Hospital. "You've got an aging population requiring increasing intensity of service and an aging work force. As the aging nurses are dropping out of the profession, the number of young nurses coming in has been declining."

The issue of nurse staffing levels has become a bone of contention between Nurses United for Improved Patient Care and HCA Inc., which bought the former Health Midwest hospitals earlier this year.

Nurses United, a union, complained for years about staffing levels at the former Health Midwest hospitals.

Officials of Nashville, Tenn.-based HCA promised to bolster nursing ranks after the company bought Health Midwest in April.

HCA announced soon after the purchase that it had earmarked nearly $6 million to give raises to nurses. Bryan R. Rogers, president of HCA's Midwest Division, said the company has recruited more than 200 nurses to its area hospitals, for a total of about 2,300.

But nurses with the union say HCA has not solved the problem.

"HCA has not addressed the nursing shortage at all," said Barbara Hopkinson, a post-surgical nurse at HCA's Menorah Medical Center in Overland Park. "You're there for the patient, to give the best quality care you can give. You just don't have the time to give it."

Julie Ginther, a nurse at Menorah and a Nurses United organizer, said there also is a problem with HCA moving nurses into departments where they are not properly trained.

"It's a daily crisis," Ginther said.

Ginther said some nurses are filing "assignment despite objection" documents with the union to indicate that they, under protest, performed assignments they considered unsafe. Examples are caring for patients without adequate staff or giving care in an area in which the nurse lacks adequate training.

Rogers said HCA moves nurses around to different departments if they are needed, "but not to areas they're not experienced in."

But while nurses and their employers may disagree on particulars, virtually everyone acknowledges the seriousness of the problem.

The U.S. Department of Health and Human Services reported in 2000 that the registered nurse population grew only about 1.3 percent a year between 1996 and 2000, compared with average annual increases of 2 percent to 3 percent in earlier years.

The nursing shortage also has drawn the attention of Kansas City area malpractice attorneys.

"More and more clients of mine come in with concerns and experiences of nurses not being available when needed in the hospital," said Kansas City lawyer Jim Bartimus. "And it's not from the nurses not working hard. Today, the nurses are being asked to do more with less than ever before."

In a case that drew national attention, HCA's Wesley Medical Center in Wichita in 2000 agreed to pay $2.7 million to the family of Shirley Keck. A lawsuit against the hospital alleged that Keck suffered a paralyzing stroke because of nursing shortages at the hospital.

Wichita attorney Brad Prochaska, who represented Keck, said hospitals continue to scrimp on nursing staff.

A typical salary for registered nurses in the United States is about $45,000, though wages vary based on factors such as education and experience.

There are many professions in which people can make more money, but some say pay is not the main culprit behind the nursing shortage.

A 2001 study by Peter D. Hart Research Associates said the top reason nurses leave patient care, other than retirement, is to seek a job that is less stressful and less physically demanding.

Cheryl Thompson, a recovery room nurse at HCA's Medical Center of Independence, said her salary is adequate. What makes her unhappy is not being able to take the two 15-minute breaks she is supposed to get in the morning and afternoon.

"My feet hurt," Thompson said. "I can't get a snack. I go home exhausted."

Much of the discussion on the nursing shortage focuses on nurse-to-patient ratios, which quantify the number of patients a nurse takes care of.

AFT Healthcare, the American Federation of Teachers affiliate that includes Nurses United, has issued guidelines on what the minimum nurse-to-patient ratios should be in various hospital departments. Examples are 1-to-4 on general medical-surgical floors, 1-to-2 in intensive care units and 1-to-1 in operating rooms.

AFT said appropriate staffing levels must take into account factors such as the type of facility and how sick the patients are.

Rogers said the nurse-to-patient ratios in HCA's area hospitals meet AFT ratios in most areas, but the nurses with the union dispute that.

The alarms and complaints also are being heard in the halls of government. Last August, President Bush signed the Nurse Reinvestment Act, which is designed to relieve the shortage through means such as nursing scholarships. Earlier this year, Congress appropriated up to $20 million to fund the legislation, but critics say that is not nearly enough.

"This is a drop in the bucket," said Margaret VanAmringe, vice president for external relations for the Joint Commission,

A sum closer to $200 million is needed, VanAmringe said.

Sen. Pat Roberts of Kansas recently called for $175 million in funding for Nurse Reinvestment Act education programs.

California has passed regulations on nurse staffing levels. Sen. Daniel Inouye , a Hawaii Democrat, recently introduced the Registered Nurse Safe Staffing Act, which would establish a requirement for minimum staffing ratios.

Mary Nash, an intensive care nurse at Medical Center of Independence and a Nurses United negotiator, said the union would like to see nurse staffing legislation passed in Kansas and Missouri.

"We could have these ratios without legislation, if the hospitals were willing to do that," she said.

Officials of area hospitals and nursing schools say they are taking actions to ease the shortage, with some help from job cuts in other professions.

Angela Connelly, spokeswoman for Independence Regional, said the additional nurses hired there have enabled the hospital to offer nurses more flexible scheduling. This should help reduce the nurses' stress level, she said.

The University of Missouri-Kansas City School of Nursing added a bachelor of science in nursing program in 2001, said Nancy Mills, dean of the school. Fall 2002 enrollment at the school was 472, up from 363 in 2001 and 318 in 2000, she said.

"As the job market has gotten worse, more people are entering nursing school, many seeking a second career option," Mills said.

Karen Miller, dean of the University of Kansas School of Nursing, said it has established programs to attract experienced nurses into advanced degree programs that would qualify them for leadership and specialty roles, such as nurse administrators and clinical nurse specialists.

Bridget Koan, a KU School of Nursing spokeswoman, said the school had 462 enrollees in the fall of 2002, down slightly from 469 in 2001. Koan said the decline was caused by a decrease in graduate student enrollment. The number of undergraduate enrollees totaled 296 in 2002, up from 282 in 2001 and 278 in 2000.

Miller said media coverage of the nursing shortage has raised awareness of nursing career possibilities.

"People have a sense that there are jobs available in nursing and that there are lots of opportunities for nurses, here and nationwide," she said.

Mills and Miller said both schools were getting help from federal grants.

Dana Dye, chief nursing officer with HCA's Research Medical Center, said the Research College of Nursing sends speakers to junior high and high schools to talk up nursing and offers an accelerated nursing degree program for people who already hold a bachelor's in other fields.

Doyle, the chief nursing officer at St. Luke's, said it seeks to retain nurses through programs such as flexible work scheduling and continuing education paid for by the hospital. Nurses participate with doctors and administrators in making key decisions, she said.

Nurses at Truman Medical Centers also are reimbursed for the cost of continuing education, said Lewis Hughes, chief nursing officer.

UMKC's Mills said her school and other nursing schools are seeking to recruit more men to nursing. Men made up 5.4 percent of the nation's 2.7 million nurses in 2000, up from 2.7 percent in 1980, according to a survey by the U.S. Department of Health and Human Services' Division of Nursing.

"That's a great pool of people that's been under-recruited," Mills said.

Carnicom, the rehabilitation nurse, said the gratification of helping patients get back on their feet has helped her avoid burnout. It also helps to work in a hospital where there is good teamwork, she said.

But Carnicom worries about what will happen when she and her peers retire.

"I'm scared to death," she said. "Who's going to be taking care of me?"