On this episode of Kentucky Health, host Dr. Wayne Tuckson speaks with Sonya Hardin, Ph.D., dean of the University of Louisville School of Nursing, about the nursing shortage in Kentucky and work opportunities in the field.
A Dwindling Workforce for an Essential Job
The massive changes brought by the COVID-19 pandemic cast a new light on many aspects of modern life, including the health care system. Within a matter of days, the role of nurses in caring for critically ill COVID patients became readily apparent as news media reported countless stories of overworked nurses risking their own lives to help others.
The pandemic also highlighted some long-term challenges to nursing. As it continued for months on end, a growing number of nurses nationwide – and even more so in Kentucky – departed the profession. Dr. Hardin, a nurse practitioner and professor, says the workforce shortage goes beyond front-line nursing workers to include those in managerial positions and in nursing education.
“When I first came here (to UofL) three and a half years ago, I did a Google search like so many other people do because I wanted to see what jobs were out there, and there was around 1,200 nursing positions, and I was kind of blown away by that, oh my goodness, it was way more than it should be,” she says. “And this past December, I had looked again, and it had doubled. There were over 2,400 jobs out there in nursing.”
Hardin says lack of compensation is not behind the decline. Nurses have come a long way from the $6 per hour she made when she started; now, they command between $26 and $30 per hour. Many nurses are also receiving pandemic bonuses, which can boost the overall annual salary to more than $75,000 per year. Hardin says those with advanced qualifications, like nurse practitioners, can make over $125,000 per year.
Burnout is a well-reported factor in the nursing shortage. Hardin says that it’s not surprising to see some nurses decide that another career would be better for them in terms of long-term physical and mental health.
“There are individuals who have been working five 12-hour shifts per week trying to fill in and help during this surge of people in our hospitals,” she notes.
Another major concern is the advanced age of many nurses. In 2022 alone, approximately 500,000 nurses across the U.S. are expected to retire. Kentucky doesn’t have nearly enough nursing students in the pipeline to offset those retirements, and that imbalance threatens to grow larger in the coming years.
While the supply of nurses grows tighter, demand for their services is increasing as Baby Boomers age in to their senior years. That vast patient population will require extensive medical care and attention over the next several decades. Hardin says that will put a major strain on the health care system unless more nurses become credentialed and are hired. It could have an even greater impact on patients in rural areas where health care services are already scarce.
Hardin says the greatest misconception about nurses derives from traditional stereotypes about the job and how nurses are portrayed in movies and TV. The modern nurse is a multi-tasking health care provider who is able to process and analyze information quickly, she explains.
“And they’re individuals that are going to be honest,” she adds. “Nurses have been voted for the 19th year in a row as the most honest of the health care professionals. When you ask a nurse a question, you’re going to get an honest answer.”
Steps to Build Back Nursing in the Commonwealth
According to Hardin, the group of nursing students at UofL is diverse, comprising people of different ages and career stages. Around 10-20 percent of students are men.
“We’ve had lawyers, bankers, and veterinarians all come back and decide that they too would like to be a nurse,” she says.
To get more nurses into hospitals as fast as possible without sacrificing rigorous study, Hardin says UofL has an accelerated program available to persons who already have earned a B.A. in another field. If admitted, those students will attend class for six semesters to earn both a B.A. and an M.A. in nursing with a focus on leadership. For new students, Hardin says UofL is starting an accelerated B.A. program in 2022 whereby students attend for four semesters and get their degree.
“We made this decision because we really want to try to increase the number of nurses that we’re putting out there in the workforce,” she says.
Those who enroll in the accelerated programs can take all of their classes online, Hardin says. They can also meet all of their clinical requirements during evening and weekend shifts, with options to fill those hours in community health centers around Louisville.
“We’ve set it up so that if you are employed somewhere with a degree, and you would like to come back and be a part of a great profession, there’s an opportunity to do that,” she says.
Even with the multiple paths to a nursing degree, Hardin says UofL still has difficulty filling all available student slots. As of early 2022, she says they could easily accommodate about 50 more students who want to pursue nursing as a career.
One particular need that the UofL program is addressing is the shortage of critical care nurses, Hardin explains. She and colleagues created a critical care course in the program designed specifically to train nurses on the unique and demanding set of skills that is required to work in what she calls “high acuity environments” such as an ICU or trauma center.
Hardin also says nurses’ roles in hospitals and clinics are being redefined in ways that both ease their workload and increase their supervisory responsibilities. She discusses the Planetree model implemented in Colorado, which brings in a patient’s family members to help administer basic care. In Kentucky, Hardin says several different workflow models are being considered that could increase responsibilities for licensed practical nurses (LPNs) in a hospital setting.
“Even individuals who deliver your tray of food can have really great assessment skills and be able to walk in and look at a situation and get a nurse if one’s needed,” she says.
Perhaps most importantly, Hardin says that continued advances in technology will help nurses do their jobs better and with less stress. She notes that many facilities already have centralized monitoring of patients’ vital signs where one person is overseeing patients across several units rather than a designated nurse for each unit. Communication via mobile phone and pager is also far more precise and patient-specific, Hardin adds.
“Even our documentation is getting streamlined, where we now chart by exception, which means everything that is normal is kind of a ‘check box,’ and what we’re documenting is what we see as abnormal in the patient,” she says. This allows nurses to spend less time recordkeeping and more time providing direct patient care.
The role of nurse practitioners is becoming more important within the modern health care system. NPs have advanced qualifications such as a M.A. or Ph.D. plus certification and assume many duties of a physician.
Training to become a NP is rigorous, Hardin says. Most NPs have spent years working as nurses even before they begin the advanced training, and they are required to work 1,000 hours in clinical settings to become a NP. Kentucky state law allows NPs to open up their own businesses, and those that do so often help underserved patients. For example, UofL’s nursing school and a horse racing nonprofit operate a NP-managed clinic that cares for backstretch workers at Churchill Downs.
“I will say that if you are going to go see a family provider (physician) you’re going to see very similar care delivered with family practice and with NPs,” says Hardin. “The studies out there show the outcomes are the same – there’s no significant difference.”
