This is to honor the nurses of America.  You are the women, and the men who staff our hospitals, tend the sick, comfort the dying, perform triage at disaster sites and emergency rooms, and manage the hundreds of details that make modern medicine function.

This is your week — National Nurses Week — the seven days when the hundreds of millions of us, thank the 3.1 million of you for being there when we need you.

It’s amazing that it took almost three decades from the first seed of a suggestion that nurses should have a special day to the Congressional act declaring May 6th National Recognition Day for Nurses. In 1990, the day became a week that now includes May 8th as National Student Nurses Day.

Nursing has come a long way from the days when Florence Nightingale made her nighttime rounds of injured soldiers during the Crimean War. The work is still demanding, the material rewards are better, but it is the calling that is still the same. “God,” wrote Nightingale, “called me in the morning and asked me would I do good for him alone without reputation.”

Today, the calling comes in many ways and takes many forms. As our population ages, the calling increasingly comes from hospitals, and doctors’ offices, and clinics, and hospices, and from staffing companies like we, here at Green Key, who help to fill the need.

Wanted Technologies, which tracks online job ads, says demand for registered nurses is growing. The three year decline reversed at the end of 2010, and, except for a short period late last year, has been rising. In the first two months of this year some 120,000 jobs were posted online, a rise of 8% over the same period in 2011. About a quarter of those ads came from staffing firms.

In the coming years, the need for nurses will continue to grow. Not only will the aging U.S. population need more caregivers, but nurses themselves are getting older and will be retiring. The average age of working nurses today is 45.5; the largest age group is 50-54. By 2025, when that group of nurses will be at or beyond retirement age, the profession will be short some 260,000 nurses, says the American Nursing Association.

It may be even more acute, once the national health coverage program is fully implemented.

Fortunately, the problem is at least being recognized. Halting progress is being made to increase the number of students admitted to nursing programs, and reduce the 75,587 qualified applicants who had to be turned away last year because of faculty and facility shortages.

“The nursing shortage is likely to re-emerge and nursing is going to continue to be a good occupation choice for young people,” says Douglas Staiger, a Dartmouth College economic professor and author of a nursing employment.

So as National Nursing Week winds down, ending tomorrow, the anniversary of Nightingale’s birthday in 1820, remember to thank a nurse for hearing the calling and taking the pledge  to “do all in my power to maintain and elevate the standard of my profession.”

Based on how frequently the job turns up in online ads, physical therapists are the most in-demand job of any posted anywhere online. Wanted Technologies, an online data analysis firm, says employers posted more than 11,600 jobs online for physical therapists in March. It’s the highest number of ads seen in any single month since October 2009, and represents a 19% increase over March 2011. The biggest demand is in the Washington, DC area where 916 jobs for physical therapists were posted in March, a 205% increase from a year before. Wanted says the average time these jobs remained online was seven weeks, a sign of how hard they are to fill. Wanted Analytics

“The average cost to a company for the health care of an employee is $12,000,” says futurist and business adviser David Houle. That high cost, the result of American healthcare’s focus on cures, not prevention, is handicapping business in the global marketplace.

With 70% of healthcare costs going to treat just 10% of the population, Houle maintains that a change in approach to medical care is both necessary and about to occur.

Today, insurers pay for procedures and not prevention; there are 18,000 billing codes for treatment, he says, and “not a single code for payment on keeping a patient healthy.” “That is about to change. Primary care physicians, the ones who know the patient best, will become central to the new health care delivery system and will actually get paid for doing what they are supposed to do, keep their patients healthy.”

In The New Health Age: The Future of Health Care in America, Houle and his co-author Jonathan Fleece, lay out a vision of healthcare reform that brings medical information and accessibility into the 21st century, and rearranges medical priorities to reward physicians and their patients for getting healthy, being healthy, and staying healthy.

A veteran of the media industry where he was part of the senior executive team that launched MTV, Nickelodeon, VH1 and CNN Headline News, Houle first described the current changes and future transformation wrought by the telecommunications revolution, international relations, and business globalization in his 2007 book The Shift Age.

Now, he and Fleece explain the impact of traditional medicine on business competitiveness and individual health. Houle, who has addressed hundreds of business leaders on global trends and future prospects, says despite the opposition to health reform — and its mandatory provisions — change is coming and it’s necessary.

Writes Houle on his blog, Evolution Shift:

Health care represents almost 18% of America’s GDP. All of the technology driven innovation we have come to accept in the 80% of the GDP is now coming to health care. Digital records, search, connectivity, convenience, efficiency and the ability to compare performance, all things we now demand in the rest of our lives are now coming to health care. It is almost that simple.

The medical profession and health care delivery are now about to catch up to how we expect the rest of the marketplace and economy to operate. Open markets, competition, cost benefit analysis, the power of the free market to both increase quality and drive down costs. All of this is now coming to health care. Health will increase and, after a short transition period, costs will go down.

Healthcare providers will have to give their patients access to electronic health records (EHRs), and get them to use the digital technology, under government rules announced last month. The so-called Stage 2 rules, if adopted after the comment period, which is currently underway, will require clinics and private practices to also prove at least 10% of their patients are actually accessing healthcare information on EHRs. The details were announced by the government’s Centers for Medicare & Medicaid Services as it pushes forward on the broader EHR implementation initiative. Computerworld

Not that long ago, all the buzz in healthcare was about the nursing shortage. Hospitals, skilled care facilities, medical offices, not to mention those other providers we don’t generally think of — insurers and public health centers among them; it seems everyone was hunting nurses.

Today, the nursing shortage has eased, though jobs – both permanent and temporary – for experienced nurses with special skills still remain. Elsewhere in healthcare, the demand is as high as ever. As a whole, the industry is expanding rapidly with demand for professionals and skilled workers (and even entry-level) approaching record levels.

In the 12 months from January 2011 to January 2012, the healthcare industry added 312,500 jobs. That’s almost a sixth of all the new jobs the economy created. Hospitals alone accounted for some 96,000 of the new healthcare jobs. The number of jobs in physician offices — and that includes positions from receptionist, to billers, records clerks, physician assistants, technicians, patient counselors — grew by almost 65,000.

Indeed, the job search engine, reports that in one year — from February 2011 to February this year — the number of job listings for healthcare workers rose 21%. That’s one of the largest increases of the 13 sectors Indeed tracks. If percentages don’t impress you, consider this: In February Indeed counted 700,000 jobs in healthcare. Retail, which was second in total listings, had less than half that.

Topping the list of openings are medical assistant jobs. There were 241,382 listings for them on Indeed in February. Also among the top 10: pharmacy tech, receptionist, clerks, and phlebotomist.

While hiring is keen across the board, one overlooked area is beginning see the early signs of a candidate shortage, at just the same time demand is poised to take off.

Healthcare management positions are expanding and the need is only going to going to grow for all the same reasons that healthcare generally is growing.  More managers are needed to supervise growing staffs to care for the aging U.S. population, and to prepare for the influx of new patients that will be covered when the federal health insurance program takes full effect in a couple of years.

The industry is well aware of those twin issue. Less well known is the impending retirement of senior and mid-level managers, many of whom are in their 50s and 60s. At the same time, while colleges and universities are expanding their healthcare degree programs, fewer than 70 made the U.S. News list of graduate programs in healthcare management. Fewer still have nursing or medical schools making it almost impossible to earn a dual degree.

Two years ago CNN/Money’s Top Jobs list ranked hospital administrator positions 36th on its list of 100 best and in-demand jobs. The median salary in the CNN report for an experienced administrator was $98,000.

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However, even more modest management positions are seeing salaries rise as the competition grows keener.

The Bureau of Labor Statistics offers this list of salaries for managers in specialty practices: $54,314 in gastroenterology; $54,201 in dermatology; $58,899 in cardiology; $48,793 in ophthalmology; $44,910 in obstetrics and gynecology; $51,263 in orthopedics; $51,466 in pediatrics; $48,814 in internal medicine; and $47,152 in family practice.

Naturally, the top pay goes to the most experienced professionals. However, even first-time manager salaries are increasing, as the industry recognizes the impending shortage of administrators.

At the entry-level, experience in the specific area is the number one requirement. To move up the ladder, business administration, finance or similar higher-level coursework is not only desirable, but a requirement of many employers. For the more senior positions, an MBA or advanced degree in hospital management is indispensable.

Women are especially in demand, as hospital administration has been a typically male-dominated industry.

Like Apple fans worldwide, the medical community is counting down to Friday’s release of the iPad 3. But unlike most fans, healthcare professionals have some very specific reasons to be excited about the latest version of the wildly popular tablet. That is, besides its faster, more powerful computer brain. Radiologists, and any healthcare professional who relies on imaging for any part of their job, will appreciate the incredibly sharp screen resolution Apples calls “retina display.” At 2048 x 1536 think HDTV. And though it won’t have Siri, the curiously compelling spoken natural language assistant, the iPad 3 has voice dictation, a boon for nurses, office assistants, as well as busy doctors who can dictate while on the go. More on the healthcare applications of the new iPad can be found at iMedicalApps.

Temporary workers and staffing agency hiring drove a big part of February’s 227,000 new jobs, according to the report from the Bureau of Labor Statistics.

It’s the third consecutive month of job increases over 200,000. The numbers of new jobs created exceeded what most economists were expecting, even if the 8.3% unemployment rate was expected.

“The labor market has found its legs in the last few months,” said Julia Coronado, chief economist for North America at BNP Paribas in New York.She told MarketWatch, “it looks like there’s enough of a broad base that the momentum can be sustained.”

Much of what’s fueling the growth is the hiring of temporary and contract workers. The Bureau of Labor Statistics shows that since January 2010 temp hiring accounted for 477,000 of the 3 million new jobs created. The good news is that all signs point to a continued surge in temp workers as employers react cautiously to improving business conditions. As the accompanying chart shows, temp hiring and staffing placements are headed up and the pace is accelerating as the economy slowly improves.

February’s job gains were spread across most sectors. However, the staffing and employment services sector contributed 27% of the total new hires. Temp placements alone added 45,200 new jobs to the economy. That’s almost 20% of all the new jobs during the month.

The two charts pretty clearly show the connection between staffing industry hires and the economy. As would be expected in any downturn, employers first reduce their temporary and contract workforce, before laying off their permanent hires. That began in early 2007, accelerating toward the end of the first quarter of 2008.

By the fall of 2009, the first signs of an improving economy were evident, as employers turned to staffing firms. Work was beginning to pick up for some employers, but not strongly enough to offer the confidence to hire permanent workers. In fact, even as pace of bringing on temporary workers was quickening, many employers were still laying off staff and reducing their permanent workforce. The few blips in spring of 2010 came from the huge — and short term — hiring of Census workers. Without them, monthly job growth through the summer of 2010 would have been negative.

Now, as is evident from the chart, with the improving economic outlook employers are continuing to grow their contingent workforce. If the current pace continues — and all signs say it will — then in a matter of months the number of temporary workers on America’s payrolls will spring ahead of 2007, which posted the largest number of temps to that time.

While economists predict that as employers gain confidence in the recover some will convert temps to full-time workers, more employers than ever will maintain and even grow their temp staff as a permanent part of their overall workforce strategy.

A recent survey of independent workers showed nearly 70 percent of them expect the flexible workforce trend is going to continue, regardless of the speed — or lack of — of economic improvement.

In last week’s government jobs reports several other sectors also showed strong growth. Healthcare topped the list with 61,000 new hires. Hospitals added just over a third of those new healthcare jobs, with ambulatory care facilities — doctor’s offices, outpatient facilities and the like — adding 28,200 positions.

The private sector created 233,000 jobs (which was offset by 6,000 job losses in government). Only in construction, down 13,000 jobs, and retail, down 7,400, were there significant private sector losses.

In addition to the employment services area and healthcare, there were big gains in manufacturing and leisure. Leisure and hospitality jobs grew by 44,000, most of that in the restaurant industry. Manufacturing added 31,000 new positions, with slightly more than a third of the workers hired for metal fabrication jobs.

Among the biggest losers were retail jobs in department stores. Some 25,000 jobs were cut there, not unexpectedly however, as stores completed inventory. That number was counterbalanced by a nearly identical growth in retail jobs in January.

The nursing shortage may be easing, but demand for other healthcare professionals is growing with no letup in sight.

In the 12 months from January 2011 to January 2012, the healthcare industry added 312,500 jobs. That’s almost a sixth of all the new jobs the economy created. Hospitals alone accounted for some 96,000 of the new healthcare jobs. The number of jobs in physician offices — and that includes positions from receptionist, to billers, records clerks, physician assistants, technicians, patient counselors — grew by almost 65,000.

While hiring is keen across the board, one often overlooked area is suffering from a shortage of candidates. Healthcare management positions are expanding along with the industry, in part due to the aging population, but also to prepare for the federal health insurance program that will provide care to millions of now uninsured Americans.

Another factor making demand keener still for managers is the impending retirement of senior and mid-level managers, many of whom are in their 50s and 60s.

Two years ago CNN/Money’s Top Jobs list ranked hospital administrator positions 36th. The median salary in the CNN report for an experienced administrator was $98,000. More senior positions, according to CBSalary.com, pay an average of $414,390, with the top 25% earning over $549,634.

Medical office managers have also seen their earnings increase. The Bureau of Labor Statistics offers this list of salaries for managers in specialty practices: $54,314 in gastroenterology; $54,201 in dermatology; $58,899 in cardiology; $48,793 in ophthalmology; $44,910 in obstetrics and gynecology; $51,263 in orthopedics; $51,466 in pediatrics; $48,814 in internal medicine; and $47,152 in family practice.

Naturally, the top pay goes to the most experienced professionals. However, even first-time manager salaries are increasing, as the industry recognizes the impending shortage of administrators.

At the entry-level, experience in the specific area is the number one requirement. To move up the ladder, business administration, finance or similar higher-level coursework is not only desirable, but a requirement of many employers. For the more senior positions, an MBA or advanced degree in hospital management is indispensable.

Women are especially in demand, as hospital administration has been a typically male-dominated industry.

“The majority of top management positions in healthcare administration are held by men, even though women outnumber men in the profession,” note the authors of one study of the gender disparity. Since that article was written, recruitment efforts by schools and employers have increased the number of women in administrative and managerial positions.  At Johns Hopkins School of Public Health, female students outnumber their male counterparts by two-to-one.

Could be that the days of in-house R&D by the big pharmaceutical companies are waning, and outsourcing (in a sense) the development of new drugs is rising.

That’s more or less what Sanofi CEO Chris Viehbacher told journalists during the CED Life Sciences Conference last month. In a novel — for Big Pharma — deal, Sanofi partnered with a venture capital firm to launch a biotech firm. Warp Drive Bio will develop natural product drugs while Sanofi may handle the licensing and marketing.

The industry is closely watching what the European drug giant is doing and how the unusual collaboration will turn out. Viehbacher, however, told journalists that business models are changing and Big Pharma is not immune to the changes.

“What Sanofi is doing is reducing its own internal research capacity,” Viehbacher is quoted as saying. “The days when we locked all of our scientists up in a building and put them on a nice tree-lined campus are done. We will do less of our own research.”

R&D costs are a factor, he explained, but the primary driver behind investing in early stage firms is that is where the smartest people are.

“The reality is the best people who have great ideas in science don’t want to work for a big company. They want to create their own company. So, in other words, if you want to work with the best people, you’re going to have go outside your own company and work with those people.”

As might be expected, industry bloggers and others jumped all over Viehbacher. Derek Lowe, who writes the durg industry blog, In The Pipeline, sarcastically commented, “So, if you’re one of Sanofi’s dwindling number of internal scientists, at least now you know what you’re being treated the way you are. It’s because you’re, well, you’re not the sharpest tool in the shed.”

Whether Viehbacher intended to suggest his own scientists and researchers are not as good as those launching their own firms, or he was simply tone deaf to how his words would come across, his meaning was just what the tech industry discovered long ago. “Big companies, and not just Big Pharma, big companies I believe, are not any good at doing innovation,” he added. “There has to be some element of disruptive thinking to have innovation and I can tell you that big companies do everything to avoid any disruptive thinking in their companies.”

His vision of Big Pharma’s future business model is to partner with equity investors, providing some of the financing, but certainly the administrative and regulatory know-how to vet a drug, and, very probably, the marketing and licensing prowess.

“Every venture capitalist I’ve ever talked to is interested in this model because they clearly see opportunities.”

Big pharma is going through so profound a marketplace change that alone in the life sciences industry the sector views the future with uncertainty, hesitant to take the plunge on training and performance management to achieve the customer-centric approach its leaders claim they want.

Hay Group consultants say that even after making deep cuts in their sales force the last few years, half of all pharmaceutical companies believe they are still overstaffed. Many report plans to make further reductions ranging from 6% to 15%.

A report in Pharm Exec by Hay Group practice leaders and authors of the 2011 Annual Study of Sales Force Effectiveness talks about the “dramatic structural change” in the pharmaceutical marketplace and Big Pharma’s response.

“While smaller, more specialized companies appear to be aggressively hiring, Big Pharma is still fixated on continual cuts and retrenchment, as these organizations seek to find their way in an uncertain world,” says the introduction to the lengthy article.

Among the changes to the historical sales scenario identified in the article are the decrease in direct physician contact, the widening part played by generics, and the diminishing number of new blockbuster drugs coming to market. Though there is no universal agreement on how to change, there is an emerging sense that product differentiation and focusing on new customer groups may be the way to go. The Hay Group study found more companies last year intent on adopting a customer-centric sales approach.

Yet, in comparing what the Big Pharma companies were doing with regard to recruiting, training, and incentivizing their sales staffs, the study found a disconnect. “Integral organizational elements (for example, training and performance management programs or hiring priorities) may be lagging and possibly not providing appropriate support to these strategies,” the authors of the Pharm Exec article wrote.

“By far,” they note,”Companies prefer to hire from their competitors’ field sales forces, only infrequently tapping other departments within the company, or sales professionals outside the industry…  The finding that the dominant criteria used in hiring sales reps remains ‘years of pharma industry sales experience’ reinforces the concern that the commercial organization may not really be ready or willing to move in a new direction.”

Training for sales reps, the Hay study found, is still mostly focused on product knowledge, selling skills, and the like, with only 40% of the respondents to the survey reporting any effort at teamwork development. In-person training, and coaching/mentoring is the preferred method, though a shift toward the use of more e-learning and technology-driven techniques is discernible. It’s a trend the authors suggest may not be entirely positive.

However, in the area of compensation, they bemoan the slow adoption of qualitative components in determining the performance-based portion. Comp plans, they report, were primarily based on prescription volume (a primary factor according to 55% of the respondents), revenue (21%) and market share (21%).

Base salaries in 2011 averaged $84,700 for sales reps. With their 2010 bonuses included, the total payout averaged $114,300. District managers total payouts averaged between $185,800 and $188,900 for those considered “senior” or “advanced.”

However, such qualitative elements as teamwork, territory development, and especially customer satisfaction accounted for less than 10% of the overall performance measures. “Alarmingly, among the 13 qualitative measure options listed in the study, “customer focus/satisfaction” landed in 11th place,” the authors note. (For some types of jobs in the overall life sciences it did rate much higher; in first place for hospital regional  managers.)

“Certainly the commercial function lives and dies on its sales figures—and quantitative measures are expected to dominate,” agree the authors who advise, “But it may be wise for companies to invest more on the qualitative side, both in the incentive portion allotted to these measures and their choice of what to emphasize there.”

While the study, which benchmarks the industry annually, found companies are making changes, the article warns: “the pace of change is leisurely enough to suggest that companies opting for a truly radical shift in practice will end up changing the competitive game — in their favor.”