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An abundance of well-qualified applicants compete for too few slots

By JULIE MINDA

This much is evident: There is a significant and long-running shortage of nurses; the pressures of the pandemic worsened the problem; and shortages are expected to grow.

Nursing student Emily Guttierrez checks vital signs on a medical manikin as students learn to hang medication on an IV pole last year. They were in a simulation classroom at the Sister Claire Tynan School of Nursing in Englewood Cliffs, New Jersey. The nursing school is affiliated with Holy Name hospital.

Credit: Jeff Rhode/Holy Name

Some administrators of Catholic nursing schools say there are intractable reasons that schools can't keep up with demand including a shortage of teaching faculty, which limits student enrollment. Generally speaking, nurse faculty members can earn significantly more money nursing than teaching. In 2020, 80,521 qualified applications were not accepted at schools of nursing due primarily to a shortage of clinical sites, faculty and resource constraints, according to results of a survey conducted by the American Association of Colleges of Nursing.

The association of nursing colleges says the nation's nursing schools are graduating more nurses than ever before, but it's not enough.

What is more, nursing shortages in hospitals have a cascading impact. Overworked and overwhelmed nurses are calling it quits at alarming rates, others near retirement have taken that option during the pandemic.

Nursing student Taylor Turman practices inserting a nasogastric tube on a trainer manikin in January 2021. Turman is a student of the St. Mary's School of Nursing and Health Professions in Huntington, West Virginia.

The nursing colleges association report warns: "Insufficient staffing is raising the stress level of nurses, impacting job satisfaction, and driving many nurses to leave the profession." It adds that nurse retirement and turnover rates are negatively affecting the quality of health care. For instance, a study cited in the report found that higher patient loads were associated with higher hospital readmission rates.

Same old song
Although the dynamics of the nurse workforce and nurse faculty shortage were amplified by the pandemic, the conditions are not new, says Mary Ellen Smith Glasgow, dean and professor at Pittsburgh's Duquesne University School of Nursing and vice provost for research for the university's Office of Research and Innovation.

Glasgow

She adds, "Nursing entered 2021 with a shortage, which has been exacerbated by the resurgence of COVID-19 worldwide and the resultant mental health strain on health care providers, the exodus of many providers, including nurses, and the growing public dissension related to the pandemic."

McKinsey & Company said 22% of the 400 frontline nurses participating in its 2021 Future of Work in Nursing Survey, conducted early last year, said they might leave their current job within the year. Six of 10 respondents in this group said they were more likely to leave since the pandemic began.

According to a May 11 article on the survey and on the nursing workforce published on the McKinsey website, the desire to move on is "driven by a variety of factors, with insufficient staffing, workload, and emotional toll (of the pandemic) topping the list." Of those nurses who said they may leave their jobs, over half said they were seeking another career path, a nondirect care role, or were planning to retire or leave the workforce entirely.

Trocchio

Julie Trocchio is CHA senior director of community benefit and continuing care, and she convenes the deans of Catholic nursing schools several times a year to network and share strategies. She says the nurse shortage problem is especially pressing in long-term care facilities, which can have trouble competing against acute care sites when it comes to pay. President Joe Biden said in his state of the union address that the White House is proposing new staffing requirements for long-term care sites, including increased nurse staffing.

Trader

Joey Trader is vice president of the St. Mary's School of Nursing and Health Professions and he directs the nursing school. The programs are affiliated with St. Mary's Medical Center of Huntington, West Virginia, part of the Mountain Health Network. Trader says many health care facilities must pay overtime and travel nurse salaries to fill out staff rosters.

He says despite challenges, he's not had a problem recruiting faculty or nursing students, thanks in part to Mountain Health Network's nursing tuition assistance program announced in late January.

Great prospects
Trader and other nursing school administrators say interest remains high in nursing as a career.

Yearwood

Edilma Yearwood chairs the department of professional nursing practice and is an associate professor in the School of Nursing and Health Studies at Georgetown University. She says, "We saw more applications last year than in prior years, though we are limited in how many students we can take in. As I talk with students, I hear them say that they feel very strongly that they are in the right place, and they are fully committed to do what they need to do as a nurse. The pandemic has unleashed a deeper commitment for the mission."

Trocchio, who is a graduate of Georgetown's nursing school, says when nursing is taught in the context of mission, both nursing and health care benefit.

Cannistraci

Patricia Cannistraci, dean of the Samaritan Hospital School of Nursing, says, "Our school is graduating a steady group of nurses who are workforce-ready, and we have had — even through the pandemic — an incredibly high pass rate for nursing boards." Samaritan is one of two nursing schools within St. Peter's Health Partners in Troy, New York. St. Peter's Health Partners is part of Trinity Health. Its other nursing school, St. Peter's Hospital College of Nursing, is affiliated with St. Peter's Hospital in Albany, New York.

The nursing colleges association found in a survey conducted in fall 2020 that there were significant increases in enrollment in entry-level baccalaureate, master's and doctor of nursing practice programs. (The report did not mention associate nursing degrees.)

Nursing programs offered at the baccalaureate degree levels and above have seen more than 15 years of continuous enrollment growth. The association said in a press release that "though interest in baccalaureate and graduate nursing programs is strong, thousands of qualified applicants are being turned away from four-year colleges and universities."

Feeder systems
Hospital-affiliated nursing schools were created to keep a steady flow of new nurses to replenish staff. Although it's the rare hospital that has its own nursing school now, the feeder system may be even more important as competition for nurses intensifies.

Before the pandemic, Cannistraci says, St. Peter's two nursing schools had forged a relationship with the College of Saint Rose in Albany, New York. Students attend St. Peter's schools to earn an associate degree. Those who choose to pursue a bachelor of science in nursing and enroll at the College of Saint Rose to do so can complete their clinical hours at St. Peter's health care facilities.

St. Peter's Samaritan also offers a 12-month program that leads to a licensed practical nurse certificate. "LPNs helped to bridge some staffing needs in the acute care setting during COVID," Cannistraci says. "Hospitals are now considering bringing LPNs back into acute care on a regular basis."

Administrators from Catholic nursing schools that are owned by or in the same system as hospitals say the movement of staff between the schools and hospitals has allowed for some protection from the more severe faculty and clinician shortages.

As hospital nurse shortages have worsened during the pandemic, the level of partnership between the hospitals and nursing schools has intensified. Cannistraci says staff and students at St. Peter's nursing schools — including Cannistraci herself — volunteered for shifts at the hospital. And the hospital and nursing school started a program that enabled students to work as patient care technicians in units strapped for clinicians. The students gained valuable experience — and confidence, says Cannistraci.

Similarly, faculty and students at the Sister Claire Tynan School of Nursing at Holy Name hospital of Englewood Cliffs, New Jersey, volunteered at the hospital at COVID screening sites, in the COVID intensive care unit and in monoclonal antibody treatment units, says nursing school director Donna M. Penn.

Matchmaking
CHA aims to play a role in encouraging relationship-building between Catholic hospitals and nursing schools. Loren F. Chandler, the association's chief operating and finance officer, says ministry chief executives report their systems are finding it difficult to match up with nursing schools looking for hospitals where students can complete practicums. As a result, their facilities are losing out on the opportunity to build connections with nursing students that could give them a leg up in recruiting new nursing grads.

CHA is convening Catholic health care executives to explore ways to establish a stronger pipeline between both Catholic and secular nursing schools and nearby Catholic health care facilities. They'll develop messaging that distinguishes Catholic hospitals from competitors. One goal of stronger school-hospital affiliations would be to grow the enrollment capacity of the nursing schools.

CHA's Trocchio says, "Connecting Catholic health care with Catholic and other schools of nursing is an important step toward addressing our workforce needs. In the years CHA has convened the deans of Catholic schools of nursing, many have expressed hope that the tie between education and practice could be even stronger."

Nursing schools maintain operations throughout pandemic

Amid the daunting nurse workforce challenges, it is important that nursing schools maintain and expand their capacity, say Catholic nursing school administrators who spoke to Catholic Health World.

They say their schools have been able to keep their nursing programs operating at capacity throughout the pandemic; and despite disruptions to normal operations, the schools generally were able to stay on track with graduation timelines and graduate rates.

Edilma Yearwood chairs the department of professional nursing practice and is an associate professor in the School of Nursing and Health Studies at Georgetown University. Reflecting the experiences of the other administrators, she says in March 2020 Georgetown's nursing school paused in-person learning and instead delivered lectures over Zoom. Faculty worked with simulation lab operators on-campus to create new simulations that were presented over Zoom to mimic the clinical experience.

In fall 2020, the school began offering the choice of in-person or virtual schooling, with mask rules in place for the students studying in-person. Yearwood says many students cheered the return to in-person learning.

Penn

Donna M. Penn directs the Holy Name Medical Center Sr. Claire Tynan School of Nursing in Englewood Cliffs, New Jersey. The state was an early epicenter of COVID-19 infection. Penn says a perpetual challenge since the pandemic's onset has been finding slots for clinical rotations necessary for nurse licensure. Senior level nursing students resumed training rotations at clinical sites in May 2020. First year students were able to start clinicals that fall.

Health care facilities have been limiting the number of students who can come in throughout the pandemic, and so there has been great competition among nursing schools for those slots. State nurse licensing boards do not always allow simulated practice as a substitute for in-person clinical rotations.

All the administrators say some instructors have been less stringent with schoolwork deadlines, to provide flexibility to nursing students who were dealing with their own challenges, including supporting the remote learning of their own kids whose classrooms had been closed to in-person learning.

But despite all the disruptions, the administrators say they have been able to keep the vast majority of their nursing students on pace to graduate on time.

— JULIE MINDA