Educators work to find ways to train more nurses

BOULDER — The numbers are staggering.

• Hundreds of thousands of new nurses are needed to meet current patient demand — 203,200 openings for RNs nationwide will exist each year through 2031.
• Numbers of registered nurses declined by more than 100,000 in one year, 2020-2021.
• Nursing schools turned away 91,938 qualified applications from baccalaureate and graduate nursing programs in 2021 because there weren’t enough instructors or clinical resources to teach them.

Nursing, it seems, is in a proverbial Catch 22. More nurses need to be trained, but there aren’t enough trainers. Working conditions on the hospital floor, meanwhile, become so intolerable that nurses quit or retire, making the problem worse.

A significant number of nurses quitting the profession are under the age of 35, according to a study that the Policy Analysis and Research Team conducted for the Western Interstate Commission for Higher Education, or WICHE. The report was released this month. WICHE is a collaborative organization bridging multiple Western states. It provides access to in-state or less than out-of-state tuition to students wanting to study in a state other than their own as well as being a primary research organization on educational issues affecting the West. 

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The issues identified in the nursing study included a large number of nurses approaching retirement age — the average age of a registered nurse is 52; a wage disparity that serves as a disincentive to nurses gaining higher degree levels in order to teach; a challenging work environment made worse by the pandemic; and the aging of the population seeking care.

Particularly troublesome to filling gaps in a nursing workforce is that insufficient numbers of working nurses are willing to gain advanced degrees for the purpose of joining nursing school faculty. And why would they? The median salary of educators is $45,200 less than the salary for other advanced practice nurses, the study reported.

Meanwhile, about a third of the nursing faculty workforce plans to retire by 2025.

Citing a study reported in Health Affairs, the WICHE report said that the loss of 100,000 registered nurses in one year was the largest drop ever observed, and most had been working at hospitals. That year coincided with the first year of the pandemic when nurses worked in even harsher conditions than normal because of the precautions that COVID-19 required, and when patient families were restricted from seeing loved ones — situations that often became volatile for health care workers.

Nurses thinking of leaving the profession say that pay is a primary factor “followed by better support for work-life balance and a more reasonable workload,” the report said. 

The American Nurses Foundation and American Nurses Association was quoted in the WICHE report as saying that nurses are considering leaving “due primarily to insufficient staffing, work negativity affecting health and well-being, and inability to deliver quality care. … 60% of acute care nurses report feeling burned out and 75% report feeling stressed, frustrated and exhausted.”

Health care professionals are calling for increased education for RNs. Employing baccalaureate-prepared nurses results in better outcomes, lower readmission rates and lower mortality for patients, the study noted. More highly trained nurses also may lower the stress level, the report said.

“Increasing a nurse’s patient load by just one patient was associated with higher rates of infection,” the study quoted from an American Journal of Infection Control report.

The Institute of Medicine would like to see numbers of baccalaureate-prepared nurses increase to 80% from its current 65.2%.

Solutions

The issue isn’t as easy as simply training and hiring more nurses. Nursing schools can’t produce nurses fast enough to meet the need.

“Not one college of nursing has figured it out,” said Colleen Falkenstern, the senior research analyst with the Policy Analysis and Research division of WICHE. “A suite of solutions or different solutions” is coming forward, she said. Among them:

Federal legislation around scope of practice laws and incentives for preceptors — the front-line professionals who oversee student nurses as they train. Falkenstern pointed to federal funding from the Department of Health and Human Services and from the Department of Labor. “Almost every state in the (WICHE) region is involved in collaborative, multi-state academies to foster training for clinical nursing instructors and preceptors. It takes a fair amount of training to move from nursing to teaching,” she said.

Encouraging innovation in nursing programs including fast-track programs. Falkenstern said the industry is moving toward uniform training shared across different colleges of nursing so that best approaches can be captured across the country. “In terms of just the scale to learn,” she said, referencing nurses who need to work while studying to teach, “if you have a proven training model to step into, instead of piecemealing the skill set” it helps smooth the process. She also said two new programs to fast-track the conversion from RN to BSN will be announced in a couple of weeks.

Use of NursingCAS, a centralized nursing school application service operated by the American Association of Colleges of Nursing, helps to assure that all slots nationwide are filled in nursing schools.

Financial aid and loan repayment programs. “The difference between the salary of an advanced practice nurses and nurse educators is a disincentive” for nurses to make a shift to teaching, she said. “A lot of states are investing … into nursing facility salaries. New Mexico invested $15 million — some to help recruiting nursing faculty. Washington also has something similar; it invested $40 million into community college nursing faculty,” Falkenstern said. Colorado provides tax rebates for preceptors, particularly those in rural areas of the state. Some hospital systems also provide bonus pay above standard hourly wages for nurses who train other nurses. 

Loan-repayment programs have also been put into place in some states. Some private employers have programs to pay workers to advance their skills, and government programs including one in Colorado helps nursing educators repay loans they may have incurred to advance their training.

Nurse-run clinics also are part of the strategy to train and maintain numbers of teaching nurses. Nursing instructors have to maintain their licenses, which requires work hours. Nurse-run clinics provide front-line medical attention to patients so that teaching nurses can accumulate clinical hours and earn an additional income while helping to train the next generation of nurses. 

Falkenstern said WICHE’s work on this issue isn’t done. Two additional reports will be issued soon. These reports will examine the nursing shortage problem from the perspective of students trying to access nursing programs and also examine the shortage of clinical placement locations where students gain hands-on experience prior to graduation.