As Nursing Jobs Go Unfilled, Crunch Getting Worse

Tameka House, left, Lindsey Richardson and Mariela Schleuse of UAMS in Little Rock.

Arkansas needs nurses, but as a severe shortage persists nationwide, there’s no simple call button to push.

So the health industry, educators and even lawmakers are uniting to confront a shortfall so deep it created a vicious circle: Nursing schools can’t keep enough teachers to train enough students to fill the void.

Instead, teachers are heading back into nursing, and reaping more pay.

“This shortage is very real, and part of the problem is that nurse educators don’t make the same salary as nurses in practice,” said Susan Gatto, director of the School of Nursing at the University of Central Arkansas. “I’ve been working at UCA for 30 years, and I’ve never had a nursing student graduate without getting a job. That’s 100 percent job placement.”

To open the nursing floodgates, employers and schools are offering bonuses, tuition and debt aid, and bounties for bringing in prospects. The state Legislature is also moving to end a ban on granting state nursing licenses to people who were brought to this country illegally by their parents.

A bill to allow licenses for graduates with Deferred Action for Childhood Arrivals status passed the state House almost unanimously and was advancing in the Senate as press time approached Thursday.

Nursing schools, long at capacity, are working to admit more students. Arkansas’ three dozen accredited nursing programs admitted 3,905 undergraduate students in 2017 but also turned away nearly 2,000 qualified applicants.

Nationwide, some 80,000 qualified students a year are declined by packed nursing schools, according to a 2012 study by the American Association of Colleges of Nursing.

“Part of the teacher shortage issue is salaries, but it’s also true that in the past, nurses who obtained higher degrees were most often employed by schools,” she said. “Now practice areas need those highly educated nurses.”

UCA will break ground soon on a $38 million, 80,000-SF Integrated Health Sciences Center designed in part for a major nursing school expansion. The project underscores a superheated job market that’s unlikely to cool as the population ages and nurses fill more specialized jobs in hospitals, private practices, community clinics, pharmacies and industrial and community health.

Houston Davis says UCA takes an interdisciplinary approach to prepare students for a competitive world. Learn more in this week’s Executive Q&A.

“If you live long enough, you’re going to encounter chronic conditions, which means you’re going to get help from nurses in managing those,” said Beverly Malone, CEO of the National League of Nursing, which represents about 1,200 nursing schools.

The Arkansas Department of Workforce Services ranks registered nursing second among high-skill positions on its 45 hottest jobs list, with 2017 mean wages of $58,810 a year.

The U.S. Bureau of Labor Statistics’ projections for 2014-24 put RN on its list of top-growing job fields, with a workforce expected to swell from 2.7 million U.S. jobs in 2014 to 3.2 million in 2024, a 16 percent increase. It predicts 649,100 replacement nurses will be needed by 2024, raising the total of openings due to growth and replacements to 1.09 million.

UCA plans to double its 400-student nursing enrollment over the next five years.

“We feel like this [the new health sciences building] is going to begin making some significant progress toward meeting those needs,” UCA President Houston Davis told Arkansas Business in January.

Dean Jimmy Ishee of UCA’s College of Health & Behavioral Sciences said that for every nursing student admitted, “I turn away about two students.”

Arkansas schools graduated 893 nurses with bachelor’s degrees in 2017, as well as 1,419 with associate degrees and 1,148 LPNs. The employment website Indeed.com listed more than 2,000 nursing job postings in Arkansas last week. The state has more than 70,000 licensed RNs and LPNs, according to the Arkansas Center for Nursing.

The University of Arkansas for Medical Sciences is offering $12,000 bonuses for qualifying experienced nurses, as well as bounties for workers who refer nursing candidates.

To reap the bonuses, applicants must work in designated critical areas, UAMS communications specialist Spencer Watson told Arkansas Business. “With one year of experience, that’s medical-surgical. With two years in the same field, that’s oncology and the operating room. So it’s not that every new nurse or a brand new grad gets a bonus,” he said.

The University of Arkansas at Little Rock and CHI St. Vincent are two years into a three-year project, the Pathway Program, to help fill the 700 or so nursing positions open at any given time in central Arkansas. In conjunction with nursing programs at Henderson State University in Arkadelphia and National Park College in Hot Springs, the project awards scholarships and guarantees two years of employment after graduation at a CHI St. Vincent facility.

The American Association of Colleges of Nursing says its members reported a 3.6 percent enrollment increase in entry-level baccalaureate nursing programs in 2016, but the increase won’t keep pace with demand for nurses, nursing teachers and certified nurse practitioners, who are taking an increasing role in primary care.

In 2018, Arkansas had 3,009 certified nurse practitioners; 799 certified registered nurse anaesthetists, who now perform nearly two-thirds of anaesthetic procedures once done mostly by doctors; 164 clinical nurse specialists; and 33 nurse midwives, according to the Arkansas State Board of Nursing.

Patricia Cowan, dean of the College of Nursing at UAMS, said the scope of 21st century nursing in constantly growing. “People have an understanding about what a bedside nurse does, but less about a CRNA [nurse anaesthetist] or nurse practitioner,” she told Arkansas Business. “A large proportion of anaesthetic care is now provided by CRNAs.”

Malone, who was a surgical staff nurse, college dean and president of the American Nurses Association before leading the National League of Nursing, got a global perspective as general secretary of the Royal College of Nursing in London, Britain’s largest professional union of nurses. She said today’s nurses work in every conceivable health setting: hospitals, nursing homes, schools, businesses, private medical practices, community clinics and even the local Walgreens.

“Nurses are bringing health care to the people, and the need is growing,” she said. “Nurses are working in psychiatric and mental health, gerontology, and even doing some of the operations in operating rooms.”

The health care industry is also working to develop more advanced practice nurses and nurses with bachelor’s degrees, “because better education has been shown to correlate with better outcomes for patients,” Cowan said. About 55 percent of Arkansas’ RNs have baccalaureate degrees, she said.

Nursing remains a valued profession, Malone and Cowan said. “Compensation has been an issue, and bedside nursing salaries have been relatively flat for RNs,” Cowan said. But sign-on bonuses and programs to help nurses continue their education have had an effect. “In the Little Rock area, hospitals are certainly hiring.”

Nationwide, RNs earn a median $69,789 a year, and nurse practitioners command more than $100,000, according to Kiplinger.com’s 2019 “Best Jobs for the Future.” And nurses generally feel fulfilled, Cowan said, with surveys consistently listing nursing as the most trusted profession in the nation. “Nurses care for people at their time of greatest need, and they understand the importance of that.”

Kiplinger found that 82 percent of nursing graduates feel a high sense of career meaning, the highest percentage of 102 college majors ranked.

“The biggest challenge is that it’s a physically and emotionally demanding job,” Cowan said. And like their patients, active nurses are aging. About 55 percent of the national RN workforce is 50 or older, and a million RNs are expected to reach retirement age within 15 years.

The United States imports nurses from foreign countries at a steady rate, Malone said, and American nurses work overseas. In the Arkansas House, Rep. Megan Godfrey, D-Springdale, pushed to let DACA recipients into the nursing workforce for several reasons, including basic fairness. But the nursing shortage helped make her case.

“At a time when our state is experiencing a shortage of nurses, we should do all that we can to recruit and retain nurses in Arkansas,” Godfrey said on the House floor.

J.R. Davis, spokesman for Gov. Asa Hutchinson, said the governor supports Godfrey’s legislation, House Bill 1552. “It’s just the right thing to do,” Davis said.

Nursing Supply in Arkansas
Nurses are the largest group in the health care workforce. Nurses practice with a wide range of credentials and in a variety of work settings. The nursing workforce in Arkansas includes:

Source: Arkansas Center for Nursing