Medical community, educators exploring options. Nurses have been called the heart of health care, and it’s not hard to see why.
“When you’re in the hospital, the person that you’re seeing the most is the nurse,” said Dennis Manley, chief nursing officer for Mercy Hospital Joplin. “It’s typically the nurse who will be with you at the bedside, taking care of your needs.”
They are often the “eyes and ears” of providers, continually checking in and assessing patients. They also are the people who offer comfort and compassion to patients and their families when things become difficult.
“To say they are an important part of the health care setting is not reflective of the work that they do,” said April Bennett, vice president of nursing services at Freeman Health System. “Nurses are an integral and necessary part of the health care setting.”
Nurses also are in more demand than ever before. Workforce vacancies are on the rise at hospitals across Missouri, and nowhere is the shortage felt more acutely than in nursing. This year’s workforce report from the Missouri Hospital Association shows that the vacancy rate for nursing positions is nearly 16 percent — an all-time high — with more than 5,700 open slots and approximately 30,600 filled slots.
And the shortage is expected to persist because of rapid growth in the field. Registered nursing is among the top occupations in terms of job growth, with projections taking the number of positions from 2.7 million in 2014 to 3.2 million in 2024, according to the Bureau of Labor Statistics. More than 1 million job openings in the field are expected by 2024 as a result of growth and replacements.
Why is there a shortage?
The nursing shortage has always existed nationally to some degree, local hospital officials say, but the problem has become more critical in recent years with several factors contributing to the shortage:
• The general population is aging, requiring more from the health care system for their medical needs. The number of Americans older than 65 is estimated to be 83.7 million by 2050, almost double what it was in 2012, according to statistics from the U.S. Census Bureau.
• Growing numbers of nurses are needed in response to the Affordable Care Act, which was enacted in 2010 and provided health care access to millions more Americans, the American Nurses Association said.
• A significant portion of the current nursing workforce is nearing retirement age, which will open even more vacancies in the future. More than half of registered nurses are older than 55, while more than 1 million of them will be old enough to retire in the next 10 to 15 years, according to the American Association of Colleges of Nursing.
• The role of nursing has expanded, leading nurses to pursue employment in institutions beyond traditional hospitals. Manley, of Mercy Hospital Joplin, said nurses can be employed by places such as clinics, local health departments and private corporations, often leaving vacancies in hospital positions. Those jobs also typically come with a standard daytime shift, which many employees prefer over the nighttime or holiday shifts that can be required of them in hospitals, he said.
• Caring for acutely ill patients can lead to high stress levels among nurses, causing burnout, said Bennett, of Freeman Hospital.
• Enrollment in nursing programs at colleges and universities isn’t keeping up with the demand for employable nurses. American nursing schools turned away 64,067 qualified applicants from baccalaureate and graduate nursing programs in 2016 because of the insufficient number of faculty, clinical sites and classroom space, as well as budget constraints, the nursing colleges association said.
Response from hospitals
Mercy Hospital Joplin hired 36 new nurses from the 2017 graduating class, but the hospital “always” has openings for nurses, Manley said. Specialty areas, such as critical care, the emergency room and operations, typically see the highest number of vacant positions, he said.
To recruit nurses, the hospital has created internship and externship opportunities for college students who want to practice their craft before graduation. To retain them, nurses are offered competitive salaries and benefits as well as sign-on bonuses for those who are employed in certain sectors, he said.
Mercy also has established a residency program wherein new nurses are partnered with experienced nurses for about a year, allowing them to hone their skills to become better at their work, he said. But recruiting and retaining experienced nurses is another ballgame.
“There’s constant pressure there because everyone is vying for the experienced nurse,” he said.
Freeman focuses on retention, Bennett says, through initiatives such as shared governance, which ensures that nurses have a role in the decision-making process; comprehensive orientation programs with simulation lab experiences; and frequent celebrations.
“At Freeman Health System, we continue to focus on recruitment of nurses, but also on retaining our current workforce who provide exceptional quality care to our patients,” she said.
The nursing shortage affects more than just hospital administrators and human resources departments; research suggests that inadequate staffing levels contributes to a lower quality of patient care. A 2013 study published in BMJ Quality & Safety suggested a link between high patient loads among nurses and high hospital readmission rates among patients, while a 2011 study published in Medical Care found that higher staffing levels of nurses were connected with lower deaths, fewer infections and shorter hospital stays among patients.
Officials from both hospitals say they do everything they can to keep the shortage from affecting patient care. That can include offering incentives to current staff members in order to fill open shifts and hiring traveling nurses on a temporary basis as needed to ensure that their nurse-to-patient ratios are sufficient.
“We’re going to fill those vacancies no matter what to make sure our patients are getting taken care of,” Manley said.
Role of higher education
Much of the burden for addressing the shortage in an immediate sense falls to colleges and universities, which literally supply the employees needed by hospitals. Marcia Fletchall-Wilmes, chair of the nursing program at Missouri Southern State University, said dialogue between higher education institutions and hospitals revolves around improving health care access through building up the local workforce.
“We would like to provide more students, and the health care system would like to have more graduates,” she said.
As a result of the demand, the Missouri Southern nursing program plans this year to begin admitting students to both a fall and spring cohort, rather just a fall admission, and to up its total number of students admitted per year to 90 from 60.
The proposal has been presented to the Missouri State Board of Nursing, and Fletchall-Wilmes is hoping that everything else — financial resources, facilities, faculty — will fall in line. Educating future nurses is expensive, she said, because of the need for qualified faculty members and adequate training labs and equipment.
“Yes, I have a plan filed with the state board, but from our side, it’s scarce resources,” she said.
Across the state line in Kansas, Pittsburg State University also is responding to the demand for more nurses. Its Irene Ransom Bradley School of Nursing recently announced that it will move an existing program for registered nurses to obtain their bachelor of science in nursing degree to a completely online format.
Officials there say they hope the change will encourage more nurses to seek advanced education to better serve their patients.
“As our population ages, the demand for qualified nurses is becoming more intense,” said Cheryl Giefer, director of the PSU school of nursing, in a statement. “Working RNs generally don’t have time to travel and physically sit in a classroom. Moving the RN-to-BSN program online will allow RNs throughout the nation the flexibility to take classes when it fits their schedule.”
Although it acknowledges there are no immediate solutions to fixing the nursing shortage, the Missouri Hospital Association has some ideas.
The state could collaborate with branches of the military, just as the Missouri State Board of Nursing recently has done with the U.S. Air Force, to make it easier for qualified enlisted medical personnel to become licensed nurses in the civilian sphere. Missouri lawmakers also could alter regulations that restrict the scope of practice for advanced-practice registered nurses.
Third, a scholarship program offered through the hospital association could be expanded to continue to provide reimbursement for employees who pursue advanced training or certification in nursing.
“One size will not fit all,” officials with the hospital association said in their 2017 workforce report. “All stakeholders — government, academia and employers — must continuously collaborate to identify innovative policy solutions and strategic investments to best deliver the health care workforce of the future.”
The American Association of Colleges of Nursing projects that nurses in the future will be increasingly called upon to coordinate care and provide preventive services in addition to their current role of caring for patients. Officials with the association say the U.S. needs to invest in its workforce to ensure that nurses are well educated and equipped for the challenge.
“Health care cannot be transformed without foundational support for the programs that hold the system up,” said Deborah Trautman, the association’s president and CEO. “Congress will ultimately be responsible for passing a budget, and we are committed to working with them to ensure that federal funding underscores sustainability and progress toward a healthier nation.”
Bennett, of Freeman, suggested that colleges, universities and other training programs, such as those promoted by employers, need to be prioritized in order to build up the pool of employable nurses.
“Continued focus needs to be on training highly qualified nurses for the workforce,” she said.
Manley, of Mercy Hospital Joplin, echoed the sentiment that governments and higher education institutions should increase their funding for nursing programs to help graduate more students into the field. From an industry standpoint, he recommended that hospitals and other employers launch programs to recognize nurses for the role they play in the health care system.
“Nursing is one of the most respected professions, and I think we need to elevate (nurses) as they contribute to the nation,” he said.
Southwest Missouri has weathered the nursing shortage better than other regions of the state. While a shortage still exists here, hospitals in this area experienced a decrease in both registered nurse vacancies and turnover from last year, according to the Missouri Hospital Association.