The numbers are sobering. It is estimated that by 2025, there will be a shortage of 500,000 nurses in the U.S.
“Our vacancy rates of about 7% today will go to at least 29%, and the result will be hospitals having to close beds and nurses becoming even more overworked,” says Ricki Garrett, executive director of the Mississippi Nurses Association. “We are making progress in Mississippi by successfully lobbying for a $12,000 pay raise for nursing faculty, which has enabled us to keep the faculty we have and better recruit from out of state. With the average age of faculty being 58, however, we could potentially lose a fourth of our faculty within the next year or so. A shortage of faculty is one of the primary reasons for not being able to produce the numbers of nurses we need.”
More needs to be done to avert the nursing shortage. Garrett says salaries need to be increased further, and more nurses need to be recruited into the teaching profession.
“We need to retain more of the students who begin nursing school, and we also need to continue to develop new ways of educating nurses whether through technology or providing shortened routes for those who already have a baccalaureate degree in another field,” Garrett says. “Schools of nursing are also developing online programs, particularly for those with a two-year degree who want to pursue a baccalaureate degree or higher.”
There is a trend to develop programs for those who already have a degree in another field, but want to become a nurse. And, more and more schools of nursing are using simulators to teach students.
“We are asking the Legislature for funding to develop a feasibility study to place simulators in regions around the state, which could be used by the schools of nursing as well as the hospitals in the area,” Garrett says.
Martha Catlette, DSN, RN, director of nursing education, State Institutions of Higher Learning, says simulation laboratories use computerized models where scenarios are programmed and students interact in real-life situations where they must “think on their feet.”
“They then critique the experience with a nursing instructor to help them critically think back through what just went on,” Catlette says. “This will not replace taking care of real patients, but will provide enhanced educational opportunities that focus on safety in patient care.”
The simulation labs are very costly. Mississippi is presently planning to conduct a feasibility study for a state or regional simulation laboratory system.
One piece of good news is that the number of graduates from Mississippi schools of nursing is up 98% from the low in 2001.
“Schools are operating at maximum capacity,” Catlette says. “Some schools wish to increase their enrollment by 10 students if they have funds to hire additional faculty. We are hopeful that the Legislature will provide for that this year. Progress is being made, but more dramatic changes will need to occur to meet the demands that are being projected 20 years out. Nursing leaders in Mississippi are discussing ways to develop innovative models to address the projected needs.”
Legislative and public support is needed to provide an environment conducive to the implementation of innovative ways of providing nursing education that preserve the quality of instruction while addressing the shortage. Catlette says one of those methods is providing externship programs for nursing students while they are in school and providing residency programs for new graduates.
“These programs provide the experience and support needed by new nurses to help them adapt, grow and improve in their nursing practice,” Catlette says. “Hospitals are working very hard on this. Many hospitals provide funding for nursing student scholarships and fund nursing faculty positions in local schools of nursing.”
Wanda M. Jones, MS, RN, executive director of the Mississippi Office of Nursing Workforce, says it is significant that the state has doubled its number of RN graduates since 2001 from 820 to 1,532.
“This has been due to intensive recruitment campaigns, additional faculty positions (some funded by hospitals) and a focus on student retention,” Jones says.
But meeting the demand for nurses is a moving target because of several factors:
• The average age of nurses is between 45 and 50, and many are in their 50’s and 60’s resulting in increasing numbers of retirees annually.
• Large numbers of Baby Boomers are retiring and will require more healthcare services.
• Life expectancy is increasing and people in their 80’s are the fasting-growing age group.
• Increases in healthcare technology result in decreased deaths, but individuals may live with more and more chronic illnesses requiring additional care.
• The healthcare delivery system is very diverse with increasing venues of outpatient clinics, home health and hospices, all requiring additional nurses.
• The hospital in-patient acuity levels are higher with patients having shorter and shorter lengths of stay, resulting in a lower patient-to-nurse ratio, and more nurses are needed to care for the same number of patients than in the past.
• Some nurses, trained and licensed in Mississippi, may choose to do “travel nursing” for various reasons, i.e., higher salaries, adventure, etc.
“In general, we will need to continue to prepare more and more nurses due to the increasing retirements and increase in demand,” Jones says. “We need additional state funding to add faculty positions to the schools of nursing so they can admit more students and funding for ongoing faculty development. We need more creative and effective methods to support nursing students while they are in school, i.e., stipends, financial counseling, study and time management skills, psychosocial support, child care and health insurance.”
Hospitals are becoming more aware that creative and expensive recruitment tactics are fruitless if the nurses are not retained. Some hospitals boast a low RN turnover rate, while others are quite high.
“There are exhaustive research studies that demonstrate what nurses want in the work environment to commit to staying such as respective collaborative practice, input into decision making, lower patient-to-nurse ratios, opportunities for ongoing education, consideration of family and personal life, flexibility in scheduling and leaders who exhibit transformational leadership traits,” Jones says. “Many hospitals are including nurses in decision-making of major organizational policies, especially those related to patient care.”
A major recruitment and retention strategy that more hospitals are beginning to employ is the implementation of nurse residency programs. The Mississippi Office of Nursing Workforce received a grant from the Health Resources Services Administration to develop and implement residency programs in three Delta hospitals, and is now replicating the model at a fourth hospital. The outcomes of the project are showing RN vacancy and turnover rates cut in half and millions of dollars of savings from reduction or elimination of travel nurses and overtime.
Contact MBJ contributing writer Becky Gillette at firstname.lastname@example.org.