ASHEVILLE N.C.

It was Cynthia Busche's first day as a nurse in the Mission Hospitals emergency department, but she is no stranger to the nursing world.

The 48-year-old Candler resident has been working in nursing for 25 years, and said she has seen nursing shortages throughout her career.

"The projections are even scarier for three years from now," she said after she wheeled a patient down the hall. "Those of us who've been in nursing so long are getting older, and with the baby boomers getting older we have deals between the nurses about who's going to take care of whom."

Western North Carolina's nursing shortage may not be dire now, but it could get worse as more nurses like Busche reach retirement age. Combined with an aging population, a nursing supply that can't meet anticipated demand and a lack of nurse educators, experts say the region could face a severe shortage of nurses in the coming years.

Hospitals and other health care facilities will be forced to deliver care despite the shortages, but it may come at the cost of quality, said Brenda Cleary, director of the N.C. Center for Nursing.

"Compared to all other states in the Southeast, North Carolina is doing better, but that doesn't mean we can just be complacent," she said. "In terms of the nursing shortage, the thing that keeps me awake at night, is even if we're doing good, we're going to need to increase these numbers dramatically in the next few years."

Nursing shortages are already a reality in WNC, although vacancy rates are not as high as they are in other parts of the country. Mission Hospitals has a 7 percent nursing vacancy, up from 3 percent in 2004. The nurse vacancy rate is about 4 percent at Haywood Regional Medical Center, and Park Ridge Hospital has two open nursing positions.

The average vacancy rate is about 8 percent for hospitals statewide, compared with a national RN vacancy rate of 8.5 percent. North Carolina also has the highest nurse-to-population ratio in the Southeast.