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LINCOLN, Neb. (AP) — Nebraska's prison system is facing a staffing crisis that it may not be able to overcome amid a statewide nursing shortage and the state's relatively low wages.

The Nebraska Department of Correctional Services is struggling to fill 14 of about 65 nursing positions, including seven registered nurses, two nurse practitioners, two nurse supervisors and three licensed practical nurses.

State nursing leaders said filling those positions will be difficult thanks to high demand for nurses throughout the state and the fact that many nurses would rather work in a hospital or clinic rather than a prison.

In 2011, the Nebraska Center for Nursing, a group created by the Legislature to seek ways to reduce the nursing shortage, predicted there would be 3,838 vacant registered nursing positions by 2020.

Since then the center has taken steps to recruit younger nurses and track current and future demand.

Though federal data suggests the national trend is shifting toward a surplus, Dr. Liane Connelly, associate professor of nursing at the University of Nebraska Medical Center and chair of the Nebraska Center for Nursing, said the state shortage persists. Factors for the shortage include a lack of faculty at Nebraska nursing schools, increased demand for nurses under the Affordable Care Act and an aging nurse population, which now averages 43.6 years old.

As the pool dwindles, nurses gravitate toward the most lucrative jobs and salaries, Connelly said.

Besides pay, those who choose to work in prisons also must realize some of their patients will have issues with trust and following rules, making the already stressful job of nursing more difficult, said Mary Andersen, a nursing instructor at the University of Nebraska Medical Center in Norfolk.

"You have to have a really strong mental stamina to be in there," she said. "It isn't that you should just be scared and clinging to the wall and not able to move. You shouldn't be paralyzed with fear, but you need your eyes open and a healthy awareness of what's going on around you."

Andersen said some nurses are cut out for a corrections setting, but as a general rule she would caution a just-graduated 21- or 22-year-old nurse with little life experience to think carefully before taking a prison job.

"They would not have the nursing experiences. They would not have the experience dealing with the population," she said. "Maybe they would have a bad experience or are taken advantage of, and then it could ruin them for all nursing, and they'd say 'that's it, I'm out of it completely.'"

It's difficult to draw medical providers to the department at all, said Dr. Mark Lukin, a corrections department psychologist, because the state must compete with higher wages offered by hospitals or private practice.

In 2014, the average pay for a registered nurse was $28.59 per hour in metro regions and $26.58 in non-metro regions. The advertised pay for a registered nurse in the corrections department is $20.71 an hour, which is subject to experience.

Andersen said state benefits can offset some, but not all, of the pay differences.

Andersen suggested a bonus after working in the department for three or more years. The Legislature is considering a proposal by Syracuse Sen. Dan Watermeier to give the department an extra $2.5 million to provide incentives for veteran workers.

"What you're doing now, you're not getting them in and they're not staying anyway," Andersen said. "So if you could get somebody to stay for two or three years, that could at least help you for that time. And if you can get somebody who would want to stay, out of 10 people, that would at least be a positive."

Dr. Randy Kohl, the corrections department's director of medical services, says the agency currently relies on overtime and nurses from private sector agencies to maintain around-the-clock care.

Amy Miller, legal director for ACLU Nebraska, told state senators at a hearing Thursday that unless the department takes action to address medical and mental health staffing issues, it could face a federal lawsuit.

Miller said the ACLU has found responses to inmate requests for prescriptions and medical consultations have lagged up to 45 days, which she assumes is due to limited medical staffing. Courts have ruled that three weeks delay is enough to qualify as a constitutional violation, she said.

"We've reached our crisis point to this problem," Miller said.

The department changed its recruitment efforts last year, said spokesman Andrew Nystrom, adding advertising on digital billboards, radio and TV ads, and social media campaigns. Last summer, the state also began attending more job fairs and adding automatic postings to colleges' job boards.

Both Lukin and Kohl said pay incentives would help, but they added that providers who continue to work in corrections usually share a desire for public service.

"The trade off to me is, the reason I'm still here, is I get the thrill of public service," Lukin said. "That sense of commitment and duty is a big driver for people who work here and stay here and help make this place run."

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