"How can we take care of public health in the event of a catastrophe when we can't take care of that many patients during the flu season?" asked Dr. Robert Bass, executive director of the Maryland Institute for Emergency Medical Services Systems.

Maryland's nurse vacancy rate, which has been climbing for the past three years, stands at 15.6 percent, up from 13.9 percent in 2000. This translates to more than 2,000 open nursing positions, according to the Maryland Hospital Association.

Bass delivered a presentation on hospital preparedness to the Maryland Security Council, which advises the governor on state readiness for a catastrophic emergency.

"A hospital bed assessment on Sept. 11 (2001) showed that Maryland hospitals could only take about 400 patients, and that was a good time of the year. During the flu season it would have been a lot less," said Bass.

Maryland's 22 urban hospitals should be able to admit at least 100 patients, a yield of a minimum of 2,200 beds, Bass said.

"It is hard to assess how many nurses are actually needed to help in the event of a crisis, but it would be a lot of nurses," he said.

"I've seen more than one nursing shortage, but this one is different," said Anne Arundel Medical Center Nurse Recruitment Coordinator Sharan Bidle. "It's linked into an aging workforce, soon there isn't going to be anyone to take care of us."

The average age of a registered nurse in Maryland is 46, near the national average of 45, according to the 2000 Department of Health and Human Services' National Sample Survey of Registered Nurses.

Maryland hospitals are trying to compete with other states to beef up nursing staffs though incentive packages including tuition reimbursements, loan relief and bonuses.

Anne Arundel Medical Center, for example, offers new nurses liberal sick leave and vacation policy, free parking, scholarships, bonuses, free life insurance and long-term care.

"Back then it wasn't seen as a business, but now even if we aren't out to make money we have to be competitive to survive. I know when I was a nurse I paid for parking, and simply offering free parking is something that can bring new nurses," said Bidle.

Holy Cross Hospital in Silver Spring has a different philosophy.

"Our major focus is retention," said Holy Cross spokesman Mike Hall. "Everyone sees it as throwing money at the issue, but what we're trying to do is reward nurses who have been here. A one-time bonus might get you nurses, but it will not get you nurses for the long haul."

The Nurse Reinvestment Act passed by the U.S. Senate in early August is a federal effort to recruit new nurses. The bill promises help to recruit more people into the profession by offering scholarships and loan repayments to nurses who locate to shortage areas.

Sen. John Kerry, D-Mass., sponsored the bill with support from the American Nurses Association and the Service Employees Industry Union. "This is a critical step, said Kerry spokesman David Wade. "Now it's up to Congress to fund these efforts every year."