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In a word, yes. Today hospitals are dealing with a constant need for qualified
nurses. It’s a theme we’ve been hearing about for years, but the reality
is the shortage is getting worse. According, to Sharon Mawby, MSN, RN, BC, Clinical
Nurse Specialist at Shands Jacksonville, “There has been a nursing shortage
for as long as I can remember — more than twenty years. The new added dimension
is our population is getting older.”
The data backs up what Sharon and other Jacksonville nursing leaders are saying
about the shortage of qualified nurses.
By the year 2020, there will be an estimated shortage of 800,000 nurses nationally.(1)
In Florida, the number will be 61,000.(2)
Florida is projected to need 34,000 additional nurses by 2006. (3)
The average age of the nurse in the hospital unit is 47 and the average age
of college nursing faculty is 57. (4)
The timing couldn’t be worse. Just as Baby Boomers are getting to the
age when they will need more care from hospitals, there will be fewer nurses
to deliver it. The state of Florida has one of the highest percentages of elderly
residents in the country, so this state will face a more severe nursing shortage
than other states.
In reading the nursing shortage statistics, an important point to remember
is that the person who provides the majority of the care in the hospital is
the nurse. They are the ones who are with the patient 24 hours a day. The physician
provides the orders, but it is the nurse who actually administers the care.
“Nurses come from a knowledge base and skill set that is different from
that of doctors and other professionals. They represent a vital part of the
healthcare team,” says Mimi Holman, M.S., R.N., B.C., Owner, AKH Inc.,
(Advancing Knowledge in Healthcare) an accredited provider of continuing education
for licensed healthcare professionals. It is this set of skills that helps the
patient’s health improve in the hospital setting.
Sharon Mawby explains the importance of the nursing role, “Nurses are
the eyes and the ears of the physician. They are the ones at the bedside talking
with the patients and the families. Physicians depend on the nurses to communicate
the patients’ needs.”
Blue Cross and Blue Shield of Florida (BCBSF) understands the critical role
of nurses from both the quality and cost perspective. “Nurses are the surveillance
system for the hospital and patients. They are there to identify issues and
resolve them early. They play a valuable role in getting patients stabilized
and back to leading healthy lives,” adds Catherine Kelly, Vice President
Community Relations, BCBSF. “Nurses enhance the quality of care, and by
helping reduce medical injury and incidence, they even reduce medical costs.
We consistently hear from hospital CEOs that a nurse’s advanced problem
solving and critical thinking skills can help reduce errors, which in turn helps
reduce medical liability costs.”
Nursing leaders throughout Jacksonville are all acutely
aware of the critical nursing shortage.
Today, there are more choices for young women professionally. “Years ago
women were at home, and if they went to work, they were nurses, teachers or
secretaries,” notes Sharon Mawby, Shands. “Now women have limitless
opportunities.”
Not enough College Nursing Faculty.
If there are no faculty to teach students, then nursing applicants cannot be
accepted to school. Last year the University of North Florida received approximately
1,200 applications, but only 120 students were accepted. A key component to
this small percentage of acceptance was not enough faculty.
Of the 10,923 qualified nursing applicants for fall semester 2004, 4,630 were
accepted and 6,293 were turned away. (5)
The root of this faculty problem is two-fold: the amount of required education
and poor pay levels for college faculty. (6)
First, to address the additional education issue, one must understand that
all college nursing faculty must be masters level or higher (preparing for a
doctorate). There are not many of these nurses. “This past year we had
three positions we could not fill because the applicants’ specialties were
not what University of North Florida (UNF) needed. There are certain subspecialties
that are very hard to find with Ph.Ds,” says Li Loriz, Ph.D., A.R.N.P.,
B.C., G.N.P., Director for the School of Nursing at UNF. “Another issue
in relation to education is that nursing school is very challenging.”
When considering the challenge of nursing school, one may decide it best not
to work and go to school full time. But quitting a paying job (which often pays
for the tuition) to go back to school full-time for a faculty position —
that pays less than what they are earning currently — is not an attractive
alternative either.
This issue brings the faculty issue full circle — the salary is either
comparable or less than what a nurse earns in the hospital setting. “Our
new graduates from the nursing program can earn as much as college nursing faculty,”
concurs Barbara Darby, EdD, President of North Campus, Florida Community College
at Jacksonville (FCCJ). “The nursing faculty salary is not competitive.
A masters prepared nurse gets paid well in the clinical setting, but not in
the academic setting.”
For the last ten years, faculty salaries have not grown at rates equal to
those of other workers with advanced levels of education. (7)
College nursing faculty average age is 55. Who is going to teach the nursing
students in ten years?
Accreditation bodies require college nursing faculty to have a certain percentage
of Ph.Ds, so to increase enrollment the school must have additional Ph.D faculty.
Only by meeting this requirement can we accept additional students,” says
Leigh Hart, PhD, RN, CCRN, Dean of School of Nursing at Jacksonville University
(JU). “Just as the full time nurse struggles to get a masters level degree
while working, so do college faculty working on Ph.D. The faculty member is
responsible for teaching, clinical work and research, and then also studying
for a doctorate creates a significant challenge.
Lack of clinical rotation space for nursing students.
“Having the access and space to do clinical rotations is a big issue,”
according to Dr. Loriz at UNF. There are several schools that utilize clinical
space in Jacksonville: UNF, FCCJ, JU, St. John’s River Community College,
University of Florida and Florida State University. There are only so many sites
to host these students. Scheduling can become a huge challenge. “The clinical
settings are saturated with students Monday through Friday,” adds Dr. Darby,
FCCJ.
Nurse education programs continue to report turning away thousands of qualified
applicants because of shortages of faculty, classroom space and clinical sites
for students. (8)
Nurses burn-out and leave the profession.
“Working twelve-hour shifts in which you barely have time to eat or use
the bathroom gets harder as you get older,” notes Marge Thorne, RN, MSN,
MBA/HCM, Senior Director of Internal Medicine at Shands Hospital. According
to Dr. Loriz, UNF, “If all of the qualified nurses were working as nurses,
there would not be a shortage. As it is now, there are a number of nurses who
work for a few years in the hospital and then quit.”
Greater demand for nurses.
Dr. Darby from FCCJ explains this concept perfectly, “There is a decline
of people seeking the profession at a time when the greatest number of people
are going into retirement.” Remember, it’s the older age group that
is one of the biggest users of healthcare.
Experienced nurses are unwilling to change jobs.
“Experienced nurses, who are few years away from retiring, are not usually
willing to change their place of employment. We have had Mayo nurses retire
in certain specialties and we are struggling to replace them. Generally our
patients are sicker, and may be going to Mayo as a last resort, and so this
causes us to need more experienced nurses in certain specialty areas,”
says Leah Brown, Chief Nursing Executive, Mayo Clinic Jacksonville.
So, who is going to take care of our aging population? That is a good question,
as only nine percent of nurses in the hospital are under age thirty.
There is some good news. Leaders throughout the Jacksonville area have been
working to address this problem. Let’s look at some specific solutions
to the problems mentioned earlier.
ISSUE:
Today, there are more choices for young women, and men, professionally.
SOLUTIONS:
Companies like Blue Cross and Blue Shield of Florida see the nursing shortage
as an issue that is critical to all of us. They know the nursing shortage has
an impact on patient safety, patient satisfaction and healthcare costs. As part
of their strategic philanthropy effort, they created a program called Generation
RN. In this program, one of their efforts is to reach out to groups that are
underrepresented in the nursing profession. By reaching out to men and minorities,
who may not be thinking of nursing as a possible career, they are helping to
improve the “cultural competence” of nursing.
In fact, the typical nursing student is not a young woman anymore. Instead,
many nursing students are older people who are going into nursing as a second
career. This group wants to get through the course of study sooner, especially
if they already have a bachelor’s degree. Accelerated programs, which can
be completed in as little as fifteen months, are attracting more people back
to the classroom.
Area nurses have gotten involved to raise awareness for nurses through the Great 100 Nurses of Northeast Florida Celebration. This event, which occurs every year during National Nurses Week, enhances the image of nursing, honors nursing and provides a considerable amount in scholarship funds.
Through efforts such as this, nurses are working to improve the visibility
of nursing as a career.
ISSUE: Not enough college nursing faculty due to non-competitive pay levels
and additional required education.
SOLUTIONS: College leaders are acutely aware of this problem and are working
aggressively to solve it. Here are some exciting examples:
Local Hospitals Directly Funding Faculty Positions
Florida Community College was able to raise nursing faculty salary levels from
$33,000-$35,000 to $45,000 when Dr. Barbara Darby and Dr. Steven Wallace, President
of FCCJ, created partnerships with local agencies to secure funding. Baptist
Health, Brooks Rehabilitation Hospital, Mayo Clinic, St. Luke’s Hospital,
St. Vincent’s Medical Center and Shands Jacksonville joined resources and
are donating a combined $380,000 to FCCJ’s Nursing (R.N.) program. The
donation, to be delivered over the course of three years, will help retain current
nursing faculty and aid in recruiting new nursing faculty.
Memorial Hospital Jacksonville, Orange Park Medical Center and Specialty Hospital
Jacksonville have provided funding totaling $250,000 over a three year period
to support FCCJ’s Associate Degree Nursing Program.
“The multi-year plan, without which the College would be unable to attract
qualified master’s prepared nursing faculty, is a strategy to ensure that
FCCJ can continue to prepare nurses and address the nursing shortage that is
impacting healthcare locally,” said Dr. Barbara Darby, President of FCCJ’s
North Campus.
The plan projects the cost to retain current faculty and to recruit new faculty
at a competitive salary. It also anticipates that community college funding
will be able to sustain the increased nursing faculty salary levels in five
years.
Hospital partners include Baptist Health, Brooks Rehabilitation, the Mayo Clinic,
Memorial Hospital, Orange Park Medical Center, St. Vincent’s Health System,
Shands Jacksonville and Specialty Hospital, who in 2002, pooled resources supporting
the UNF School of Nursing in expanding the number of graduates.
Private Endowments Funding Professors Returning to
School
Jacksonville University (JU) has six faculty members in doctoral programs. Three
faculty members are receiving tuition assistance through a combination of the
SUCCEED grant and private support.
In addition to scholarships, Dr. Hart talks about the atmosphere for faculty
at JU: “We have a very supportive environment and work with faculty to
help them meet all of their requirements.”
Blue Cross Creating Statewide Partnerships to Leverage
Investments
Blue Cross and Blue Shield of Florida has invested considerable dollars to the
nursing programs throughout the state. According to Catherine Kelly, VP Community
Relations BCBSF, “The exciting news is that not only has BCBSF given to
the schools, but in partnership with others, we have leveraged our donations
to create even more support. When BCBSF gets involved, it lends credibility
to the cause and draws other philanthropies to give.” For example, BCBSF
gave $2.5 million to the Florida Community Colleges Foundation, which was, in
turn, matched by the State of Florida, for a total of $5 million. In addition,
a challenge was issued to the 26 community colleges in the state to seek additional
private funds and those dollars would be matched. “We are not going to
solve all of the problems, but we are funding capacity that will endure over
time, not just in the short term.”
Blue Cross and Blue Shield of Florida supports accelerated RN to masters degree
to Ph.D programs. By increasing the number of instructors, the schools can accept
additional students. “Lack of faculty is hampering the number of students
that can enroll, as many qualified applicants are having to wait or rather deciding
to pursue other careers,” cites Ms. Kelly.
To help address this problem and support additional faculty, University of
North Florida received $600,000 in October 2005 as part of the SUCCEED Grant,
which was supported by Blue Cross and Blue Shield of Florida.
Lack of clinical rotation space for nursing students
North Florida graduates 700 new nurses each year. Each of these students needs
time in a variety of clinical settings before they graduate. Scheduling the
students is a significant challenge, and considering the goal is to increase
the size of the area nursing programs, this issue of clinical space will only
worsen.
SOLUTIONS:
Scheduling Database Software Program
University of North Florida submitted a grant to the State of Florida to purchase
a scheduling database program to maximize the use of clinical settings. All
of the area schools would have access to it. Each school would enter their needs,
and then the program would create schedules. UNF was awarded this grant and
currently is undertaking steps toward the purchase and pilot of the program.
Evening/Weekend Tracts Being Expanded
FCCJ started an evening/weekend school tract in 1988. In this program students
take classes and perform clinicals in the evenings and on weekends, when there
is less demand for clinical space, according to Dr. Darby.
Utilizing Technology to Train — Mannequin Simulators
Mimic Real Patients
University of Florida Shands is making more mannequin simulators available to
nursing students. Here, the student can practice their skills as the mannequins
talk and have the physical elements of a real person — heart rate, blood
pressure, etc. The nursing student can insert IV lines; perform intubations,
tracheotomies and the Heimlich maneuver; treat wounds; detect arrhythmic heartbeats;
and even listen to bowel sounds. These software-driven, programmable mannequins
can duplicate different medical situations, all pulses and physiological data,
and log every procedure done — and not done — on them during a training
session.
Issue: Nurses burn-out and leave the profession
Area hospitals use scheduling efforts to attract a variety of nurses to their
organization — shorter shifts, flexible work hours, weekend shifts equal
to forty hour work week, etc.
According to area hospital leaders, these efforts are good, but other issues
are important to helping nurses fight burnout.
SOLUTIONS:
Providing a Supportive Environment for the Nurse
Mayo Clinic Chief Nursing Executive Leah Brown says, “Mayo tries to provide
an environment for nurses that lets them know, ‘I have the education, support,
equipment and resources to support my efforts to do a good job.’ Our goal
is for nurses to be satisfied that they are in a meaningful career.” In
addition, Mayo nurses know there are a variety of opportunities for them to
advance — in education, management, clinical research, transplant coordinators,
etc.
One additional point Leah Brown brings regarding burnout is that some veteran
nurses grow weary of training new nurses. “We want the orientation process
for new nurses to be as good as possible for everyone involved, and training
new people while caring for patients is additional work. We limit the number
of new nurses so our experienced nurses do not burnout,” she notes.
Offering a Variety of Career Options for a Life-Long
Career
At Baptist, the varieties of positions span across five campuses. “There
is a lot of opportunity at Baptist — you can come here and stay your whole
career. You can work at the beach, in town or on the southside, and in tertiary
care, community, pediatrics, administration, etc., reports Beth Mehaffey, Vice
President Human Resources. “The Baptist culture is about developing people
— offering resources and support so they will spend their whole career
here.”
Recognition goes a long way to retain excellent nurses
St. Vincent’s knows that attracting and retaining excellent nurses involves
recognition. In September of last year they created a new Clinical Practice
Development Program, which recognizes and compensates staff nurses who excel
in their clinical skill performance. It is based on a model that recognizes
four levels: Novice, Competent, Proficient and Expert. Nurses received awards
and bonuses when they achieve the two top levels. When staff nurse Joe Alexander,
RN, BSN, CGRN, was asked what it felt like to be acknowledged for the work he
is doing, he said, “It feels good.”(10)
Cross-training assists the nurse in a new career transition
Shands Jacksonville offers a sixteen-week critical care fellowship for internal
and external nurses who want to work in critical care at Shands. Participants
are paid their regular salary to get additional training, all during work hours.
Three classes have graduated, each with twenty to 25 people. Critical Care nurses
are paid at a higher level — a real win-win for the hospital and nurses
seeking a change.
“Shands is not boring. There are a lot of innovative projects and the
teaching environment means it is a great place to learn,” observes Sharon
Mawby, MSN, RN, BC, Clinical Nurse Specialist, Shands Jacksonville.
Involving nurses in decision making leads to better
job satisfaction
“As an academic medical center, Shands is a huge attractor of nurses. We
take an interdisciplinary approach that orchestrates the care of the patient.
Nurses have autonomy and their input is taken into account. They are not just
taking orders; they are involved.” Tracee Holzendorf, RN, BSN, Nursing
Special Projects Manager, Shands Jacksonville.
Another exciting announcement for the nurses at Shands is that the institution
is seeking the MAGNET Certification. Only about 150 hospitals in the country
have this designation. Magnet™-designated facilities consistently outperform
non-magnet organizations, delivering better patient outcomes, shorter lengths
of stay, lower mortality rates and increased patient satisfaction rates. For
the nurses in a Magnet Institution, it means they will be involved and Shands
will become an even greater place to work.
Additional education is what nurses say they want
Every hospital in Jacksonville provides training to their staff. This issue
is very important for licensed employees, as they are required to have continuing
education units to keep their licenses current.
Memorial/ HCA Healthcare surveys their nurses and asks them what they want,
and education is a top choice (right after equitable pay level). Also, Memorial
has a Clinical Ladder Program available to staff nurses, which is to recognize
and further develop the nurse wanting to remain at the bedside. Memorial has
initiated a new Nursing Leadership Development program for nurses who want to
explore the administrative side of nursing. This two year program has 25 nurses
enrolled.
Issue: Greater demand for nurses
SOLUTIONS:
Breakout Stat: 27% of Florida hospitals are recruiting foreign nurses to fill
vacant positions, with a majority recruiting from the Philippines. (11)
Nurses from overseas
St. Vincent’s has joined other hospitals in expanding their recruiting
efforts overseas. According to Jan Lipsky, Senior Vice President of Human Resources
at St. Vincent’s, “The Philippines is the number one place to recruit
from, as nurses there are not finding jobs.” In fact, Jan has been to Manila
and seen the situation first hand. She is confident that St. Vincent’s
is doing a service for that country. “The houses are made of corrugated
tin and are stacked three high. It is absolute poverty.”
St. Vincent’s is working through organizations, such as Sisters of Mary
Order, Daughters of Charity and Girls and Boys Town. A man by the name of Father
Al Schwartz brought everyone together to pull children out of the slums there.
St. Vincent’s sees this effort as a unique way to address the nursing
shortage as it brings together philanthropy and strategy. By no means is this
program a quick fix. It will take years to get young people through the process.
First, St. Vincent’s hand selects students that will be a good match since
it takes a lot of hard work and persistence. Then, the students go to nursing
school and get licensed in the Philippines; most of the curriculum and testing
is in English. Next, they begin the immigration process to the United States.
The nursing licensing exams in the US are rigorous for foreign graduates, including
proof of written and spoken English language proficiency. St. Vincent’s
is committed to helping fund sixty students — ten students a year for six
years; the first ten will graduate in February 2006.
In addition to this philanthropic recruiting effort, St. Vincent’s is
recruiting current nurses from the Philippines. Recently, four nurses flew to
Jacksonville together. They were met at the airport by a group of St. Vincent’s
nurses who took them to their homes for dinner. According to Jan, “These
people are moving a world away from everything they know, but to them coming
here is a dream come true.”
Overall, Jan recognizes this recruiting effort will not solve the nursing shortage
at St. Vincent’s, but the effort supports the hospital’s Catholic
values and it is “one more tool in the tool kit” to increase the number
of qualified nurses.
Issue: Experienced nurses are unwilling to change
jobs.
SOLUTION:
Of all the pertinent issues, this one came up the least in conversation with
area nursing leaders, but is an important one. As more experienced nurses retire,
the ones that are left working will be sought after even more.
One interesting idea regarding this issue came from Mary McElroy, RN, BSN,
MS, Senior Vice President and Chief Nursing Officer at Memorial. She said she
sees one of the biggest challenges as “adapting the work environment for
older nurses who still want to work in the hospital.” This point poses
a great question for area hospital leaders.
Overall Solution To The Nursing Shortage Issue:
Creating partnerships
Dr. Barbara Darby, President of FCCJ North Campus, made a wise comment about
this solution when she said, “We are all partners in the preparation of
the healthcare workforce.” The amount of teamwork among “competitors”
is amazing as they work together to solve this problem. When Baptist South opened
its doors, the other hospitals were invited to come and see it.
Pam Chally, PhD, Dean College of Health at UNF, helped spearhead the Nursing
Solutions Group. According to Mary McElroy, Chief Nursing Officer and Senior
VP, Memorial Hospital, “Everyone is represented — hospitals, public
health, colleges. We try to break down the problems and deal with each one as
workgroups.” The group is still relatively new as it was started about
six months ago, but it is an exciting way to solve problems and create opportunities
— through partnerships!
It is because of these partnerships, and the impact they are having in filling
a critical need, that University of North Florida President John Delaney named
the School of Nursing the University’s first Flagship Program. The designation
means additional funding for the program, which is well on its way to becoming
a national model.
How can you help solve the issue of the nursing shortage?
Give to the Foundations of the local colleges to support nursing education (make
your monetary gift unrestricted within the nursing program).
Jacksonville University: www.ju.edu
Florida Community College at Jacksonville: www.fccj.edu
University of North Florida: www.unf.edu
University of Florida: www.ufl.edu
Jacksonville needs to support nursing to ensure this city continues to have
excellent healthcare.
Bibliography
(1) Buerhaus, P.I., Staiger, D.O. & Aurebach, D.I. (November 2004). New
signs of a strengthening U.S. nurse labor market? Health Tracking, 526-533
(2) Florida Hospital Association Survey: Nurse Staffing in Florida: The Challenges
Continue: A Survey of Florida Hospitals (January, 2005) www.fha.org/nursing2005.pdf
(3) Ibid
(4) Ibid
(5) Ibid
(6) Ibid
(7) Nursing Education in Florida (January, 2005) A report summarizing the findings
of the Nursing Faculty Supply and demand Survey conducted by the FCN during
January 2005.
www.flcenterfornursing.org
(8) Southern Regional Educational Board. Faculty Salaries in Colleges and Universities:
Where do SREB States Stand?
www.sreb.org/main/Benchmarks2000/facultysalaries.asp
(9) St. Vincent’s website news release:
www.jaxhealth.com/NewsEvents/WhatsNew
(10) Ibid, Nurse Staffing in Florida report