The pandemic-induced havoc on hospitals around the country still ricochets across systems today. A dire trend accelerated and emerged: a shortage of nurses. That shortage, prompted by burnout, puts a shrinking pool of nurses at risk for even more stress as they handle higher patient loads.
It’s a potentially dangerous cycle that health care and education professionals are trying to unwind and slow.
Novant Health New Hanover Regional Medical Center isn’t unlike other hospitals around the nation hurting for nurses.
Today, the hospital could hire about 400 additional full-time nurses, according to chief nurse executive Amy Akers. Half of those represent the traveling nurses the hospital would like to turn full-time, Akers said. In all, Novant Health NHRMC employs about 1,700 nurses, the most common profession among the hospital’s employee base of roughly 7,000.
In the next couple of months, Akers said the hospital will soon launch a market float pool of about 100 nurses to help balance staff where they’re needed most among Novant’s coastal hospitals, Novant Health NHRMC, Novant Health Brunswick Medical Center and Novant Health Pender Medical Center. This pool of nurses will be offered a bit higher pay for their flexibility.
In 2020 and 2021, about 50 nurses retired each year, “which was a fairly large number for us,” Akers said. This loss was more than just in numbers, but also in the experience of seasoned industry veterans. In the past several months, the hospital created a new role it’s calling a nurse emeritus position. So far, the hospital has re-hired about 10 formerly retired nurses into this role, which serves as a coach and mentor for nursing graduates entering the field. They aren’t involved in direct patient care, but they can work that in if they so choose, Akers said.
Over the past year and a half, the hospital has offered market adjustments and perks to its employees, she said. “There’s been a lot of focus around compensation and benefits as a whole.”
Michael Vaccaro, senior vice president of acute inpatient nursing for Novant, oversees the system’s nursing activity across the state. “I’ve been a nurse for over 25 years,” he said. “And this is certainly unlike anything I’ve ever experienced from a nursing leadership perspective.”
The pandemic accelerated trends in nursing that the industry already saw coming, Vaccaro said. By 2033, N.C. Nursecast predicts the state will encounter a shortage of 12,500 registered nurses and 5,000 licensed practical nurses (LPNs).
No one solution is going to fix the problem, Vaccaro said. Work is already underway to digitize and streamline aspects of a nurse’s day to maximize their use of time, he said.
And from an education perspective, Novant has taken steps to ensure nursing students have plenty of opportunities to work at clinical sites. “We’ve worked on throwing the doors open,” Vaccaro said.
On any given day (depending on the time of day or year), between 30 and nearly 300 nursing students train in Novant Health NHRMC in a 24-hour period, Akers said. It’s a balancing act to ensure students are scheduled in an efficient manner, she said, between the multiple schools that use the hospital as a clinical site: the University of North Carolina Wilmington (UNCW) and three community colleges – Cape Fear, James Sprunt and Southeastern.
Matthew Gallek, interim director of the UNCW school of nursing, said certain departments of the hospital, like pediatrics and mother-baby, lack the volume of patient activity to meet the demand of students in training. “There’s not enough clinical sites,” he said. “It’s kind of a bottleneck that limits what we can do.”
To alleviate its reliance on the hospital, Gallek said the university is experimenting with amping up its use of its 10,000-square-foot simulation lab, which can account for up to 50% of students’ clinical training time. This facility uses mannequins and community volunteers to act as patients, and runs through situations that might be less common, but can help later when nurses eventually encounter them in real life.
“There’s tons of benefits for simulation. The first is you can make mistakes,” Gallek said. “It’s a safe environment … they can talk about those mistakes and debrief and figure out how to prevent those mistakes in an actual clinical setting.”
Another limitation to how many students the program can accommodate is a lack of nursing teachers. “We have more applicants and more people interested in becoming nurses than we can train because of the faculty and clinical site shortage,” he said, adding that about half of applicants make it into the pre-licensure program.
The main reason for a lack of nursing faculty is pay, Gallek said. “As a nurse, you can probably make more in the clinical setting… compared to an academic setting.” Pay is also a problem across all skill levels in nursing, he said. “I feel nurses are underpaid,” he said. “Increasing pay would help.”
Despite the existing constraints, the university has bulked up its enrollment to respond to market needs: UNCW’s pre-licensure program, which offers undergraduate students a four-year path to obtain a bachelor’s degree in nursing (BSN), recently increased its cohort size from 50 to 60 students. This fall, the first cohort of 60 students will graduate.
In the summer of 2024, UNCW will launch a new nursing program to provide individuals who already have a bachelor’s degree in another field a 16-month path to obtain a BSN. The fast-tracked program will begin with about 25 students, Gallek said. “It isn’t a new idea, but it’s new for the Wilmington area to get nurses into the pipeline,” he said.
UNCW’s highly rated online RN to BSN program has about 1,500 students enrolled. This program doesn’t produce new nurses, but it does provide existing nurses with additional training that has been shown to lead to better health outcomes for patients, according to Gallek.
Mary Ellen Naylor, dean of health sciences at CFCC, said the community college has already increased enrollment by 33% this year, with plans to continue adding numbers over the next two years. “Due to the increased demand for nurses in our region, CFCC is currently seeking all available resources to increase enrollment,” she said.
Last year, CFCC graduated 68 students with its associate degrees in nursing (ADN) and LPN to RN programs. Of those students, 49 reported they would remain working in the area.
One challenge to recruiting students can be money, Naylor said. “Many nursing students struggle financially. Balancing program requirements, family obligations and work can be challenging.
“Many would like to continue to work, but given the constraints on their time and the program's rigor, it is difficult,” she said. “CFCC continually seeks scholarship funding for nursing students and ways to make the nursing program more accessible for those who want to advance in the field.”