The Coming Crisis in Care
Reprinted by permission of the Charlotte Business Journal (http://charlotte.bizjournals.com)
From the October 19, 2007 print edition
The coming crisis in care
Nursing shortage to challenge hospitals' ability to meet rising demand
by Aletha Hart, Contributing writer
Aging baby boomers are expected to soon put serious strain on the health-care industry. Serving that looming wave of demand will be a challenge because of the large number of nurses who will also be heading into retirement. What's now seen as a serious nursing shortage in the state will become acute in the next 20 years, healthcare officials say. While North Carolina is not experiencing the severe shortage seen in other areas, the state isn't exempt from supply pressures.
North Carolina faces a severe shortage of nurses because of a rapidly rising population and limited capacity of nursing programs. Here students at Queens University of Charlotte's nursing program learn patient care with a high-tech dummy.
The state is rapidly gaining population and is emerging as a retirement haven, boosting a senior population that's in need of care. Tina Gordon, executive director of the N.C. Nurses Association, says the ranks of nurses isn't rising fast enough. By 2010, North Carolina is expected to have a chronic shortage of nurses. The association projects a need for 108,000 nurses in 2020 but expects a supply of only 76,000. The issue is not a lack of interest in the field. Almost every nursing school in North Carolina has a waiting list of students. The real issue is a lack of faculty and a growing shortage of facilities in which to teach those willing students. "Honestly, (instructors) can make more money in clinical settings than in teaching, and a nursing program is more expensive than say, an English department, for a school to maintain," Gordon says. According to recent estimates by the N.C. Center for Nursing, the demand for faculty is already exceeding supply. In 1995, 15% of all RNs with a master's or doctorate were working as nursing educators. By 2004, that share dropped to 11%. By 2020, the percentage is expected to drop below 9% if current trends continue. "Technology pulls away many teachers," says Paula Vincent, chief nursing officer and vice president of patient-care services at Presbyterian Hospital. With health technology improving patient outcomes, many nurses find the lure of practicing their skills more enticing than teaching. Practicing nurses "get travel opportunities, and the salaries are incredible," Vincent adds.
In 2004, the state nursing association says the average salary for an RN was $52,450. The year before, the salary for a nursing instructor at a community college in the state averaged $36,778. Methods nursing schools are incorporating into their curriculum to ease the strain on facilities include distance education and simulation labs. Many hospitals are also offering financial incentives to get nurses to go back to school to get their master's to go into teaching. Tuition reimbursement, mentoring for new graduates, monetary incentives for achievement, and classes and programs available on hospital campuses are being offered to address the deficiency. "I have had seven faculty members go back to get their master's in the last two years with the help of Carolinas Healthcare," says Ellen Sheppard, president of Carolina's College of Health Sciences. "One good thing that we have going is a lot of students, people wanting to get into nursing. The Charlotte area did a good job of ramping up five years ago when the projections first came out. Many programs increased the number of students, accepting students twice a year instead of only once." Presbyterian is working with the nursing college at Queens University of Charlotte, Vincent says, where the median age of instructors is 55. The hospital is exploring the possibility of having some of Presbyterian's advanced practice nurses teach on the clinical side at Queens. "There may be some partnering you will see in the future to get enough instructors," Vincent says. Recruitment of foreign nurses to ease the shortage is not considered a major component of the hospitals' plans, Vincent and Sheppard say, but diversity is becoming vital. Marketing to both male and Latino nurses is a large component of many recruitment programs. Charlotte hospitals are fortunate because the average age of their nurses is lower than the national figure. "Our mean age is 37 years, so retention is a big component of dealing with the baby-boomer scenario," Vincent says. "Retention is the best tool we have. We're focused on the whole work environment, focusing on issues like shared governance -- giving nurses decision-making power on policies over practical and clinical issues. Collaboration is a powerful tool we have worked with, and there are many different programs we have put into place for professional growth for our nurses." Attitudes and perceptions about nursing have changed in the last 20 years as salaries have increased. That aids the recruitment process, which has become stiffly competitive, Sheppard says. A big change in light of the younger generation's desire for a work/life balance is the possibility of flexible scheduling, an unheard-of perk in the not-too-distant past. While the shortage of instructors is a readily identifiable problem, its solution is proving elusive, mainly because of the cost. Despite salary increases, efforts to provide education for nurses to become instructors and collaboration with nursing schools, the question still remains: Why teach when the paychecks are so much larger on the clinical side? "We need more faculty and we need to pay them better, period," Gordon says. "And we need to push Congress for better reimbursement for educational opportunities," Vincent adds.
SUPPLY AND DEMAND North Carolina is expected to have a shortfall of more than 30,000 nurses by 2020. Nursing officials say the shortage stems from a lack of instructors that limits the capacity of schools. Nursing salaries drive the shortfall. Instructors at community colleges in the state earn roughly 40% less than RNs. Nurses also say practicing medicine is more satisfying than teaching, further limiting the supply of teachers. Aletha Hart is a Huntersville-based writer who can be reached at firstname.lastname@example.org.
Queens University of Charlotte 1900 Selwyn Ave. Charlotte, NC 28274 phone 704 337-2200 fax 704 337-2403