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Number of new nurses not expected to keep pace with those leaving the profession

By BECKY GILLETTE

The number of new Registered Nurses in the U.S., including both associate degree and baccalaureate nurses, is expected to grow 16 percent between now and 2024. But it is predicted that is not going to be enough to keep up with the pace of the number of nurses who are leaving the profession in the same period, said Lachel Story, Ph.D., RN, associate dean, College of Nursing and Health Professions and director, School of Leadership and Advanced Nursing Practice, University of Southern Mississippi.

Lachel Story

A primary reason the number of nurses working today is expected to decline is that many are expected to retire at the same time greater numbers of people are needing care because of the aging baby boomer population. There are also nurses exiting the profession because of stress and dissatisfaction.

“A lot has been attributed to millennials,” Story said. “They have different expectations out of their job. Shift work and the typical schedule of the nurse may not be as appealing to the average millennial nurse. A lot are leaving nursing altogether.”

Story said the nursing shortage is expected to spread across the country by 2030 with the South and West being hit the hardest. 

Only about 55 percent of RNs in the U.S. have bachelor of science degrees. The Institutes of Medicine recommended increasing that number to 80 percent in their recent “Future of Nursing” report.

“Higher educated nurses, the thinking is, will provide better care and have better patient outcomes,” Story said. “When that report came out and asked for that increase, it meant nursing schools needed to increase enrollment. We have seen a growth in nursing school enrollment of 3.6 percent. But that is not nearly enough to meet the demand. The reasons for limited space in nursing schools is the insufficient number of instructors, lack of classroom space, access to clinical sites, a shortage of clinical preceptors and budget constraints. 

“The Institutions of Higher Learning in Mississippi and many other states have experienced budget cuts in recent years. Budget cuts prevent the programs from growing. Most nursing schools turn away qualified applicants every year. It is unfortunate we have to turn away really strong students because we do not have enough faculty to teach them or enough clinical spaces. The real serious thing to impress here is that nursing shortages impact patient care. If we do not have enough nurses, the quality of patient care declines. Nurses are taking care of more patients or working more shifts. Saving nurses saves lives.”

Story said the shortage of nursing faculty is critical.

“Without the nursing faculty to teach them, we will never have the number of nurses we need,” she said. “Accreditation standards set faculty student ratio requirements. We have an aging faculty and a large number of faculty eligible to retire. We also see budget constraints. Right now, the national faculty vacancy rate is 7.9 percent. It is expected to double or even triple in the next few years. In addition to those ready to retire, we have an issue with nurses being able to make more money in practice and the private sector. Until we can address the nursing faculty issue, we will not make a significant improvement in the nursing shortage and it may even get worse.”

Kim Hoover, Ph.D., RN, dean and professor, School of Nursing, University of Mississippi Medical Center, agrees there are concerns about having adequate faculty to teach nursing students. Another issue is scholarship budget cuts.

“IHL has been responsible for making available and tracking scholarship loans for those who want to obtain a bachelor’s or higher degree in nursing,” Hoover said. “Schools of nursing across the state are advocating for the restoration of those funds by the legislature.”

There are two camps with regards to the nursing shortage issue, Hoover said. One is that the nursing shortage is real and another is that there are enough nurses, but that they aren’t distributed evenly across the country.

She said while projections show the shortfall of nurses across the nation progressively worsening in the next few years, some research that drills down to regional areas finds the number of nurses increasing in Mississippi and neighboring states.

“The latest research shows there will be a significant increase in the East and West South Central areas compared to other parts of the nation,” said Hoover, whose school graduated 425 nurses in the past year. “We need to constantly evaluate if there is a shortage versus a mal-distribution. For example, in the Delta or rural areas of the state, there is often a mal-distribution because of pay, the economy, the school systems, and whether spouses can get jobs. We have a lot of other factors other than just supply and demand.”

Hoover said her school has the largest number of specialty programs for nurses in the state.

“While we do train nurses who are new to the workforce, we also prepare nurse practitioners) and other graduate level nurses to provide quality care,” Hoover said. “Our primary care is inadequate in Mississippi. We have rural areas where people don’t have access to the care they need and NPs will often to go and stay and practice in those areas, collaborating with physicians to do this. Mississippi has great a need for geriatric NPs, psychiatric NPs and pediatric NPs. Additionally, our NPs are using telehealth to reach into the schools and rural areas. We have a telehealth innovation lab in the school.”

Nurses are also trained at each of the Mississippi community colleges to become a Licensed Practical Nurses (LPN) or an Associate Degree Nurses (ADN). 

“Like other community college programs, our nursing programs provide small student-to-teacher ratios, dedicated faculty, and great clinical partners,” said sources at the Mississippi Community College Board. “It is also worth mentioning that because of the outstanding work done by our nursing programs, admission into each one is competitive with a waiting list for all programs. One of the main advantages of community college nursing programs is the time it takes to earn a degree.  The LPN program lasts one year, and the ADN program lasts two years. The one and two-year programs allow graduates to quickly enter the workforce or serve as a bridge towards a four-year degree while continuing to work in the nursing profession. Another benefit of shorter time to degree completion is the student has less debt because of program length.”

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