The collaboration creates a pathway for students admitted to the U of M School of Nursing’s Doctor of Nursing Practice program to complete about 1,000 hours of required clinical training at Mayo Clinic hospitals in Minnesota and Wisconsin. The program begins in fall 2024.
"The U.S. is facing a maternal mortality and morbidity crisis that is particularly affecting rural areas," says Judith Pechanek, DNP, RN, CENP, assistant dean of the Doctor of Nursing Program at U of M. "Through this collaboration, we will educate and train nurse-midwives to meet the reproductive needs of women both regionally and across the nation."
Indeed, areas where there is low or no access to maternal care affects nearly 7 million women across the United States, according to the March of Dimes’ 2022 report on U.S. maternity care deserts. This unavailability is growing, with a 2% increase in counties that are maternity care deserts since the organization’s 2020 report.
"Mayo Clinic expects a significant expansion of midwifery services across the Midwest over the next decade," says Miri Levi, DNP, CNM, MBA, director of midwifery services at Mayo Clinic in Rochester, Minnesota. "This collaboration with the University of Minnesota facilitates the recruitment, training and hiring of the next generation of midwives across rural Minnesota and Wisconsin."
Courses will be taught by U of M faculty as well as Mayo Clinic-certified nurse-midwives, who hold adjunct faculty positions with the School of Nursing. The program’s hybrid structure is designed to maximize education while offering flexibility.
Collaboration between U of M and Mayo Clinic nursing dates to 2002 when the school first began educating Bachelor of Science in Nursing students in Rochester.
"We are seeking new ways to engage learners to build the workforce of the future," says Leah McCoy, DNP, CNM, incoming nurse-midwifery program director at Mayo Clinic School of Health Sciences.
"This collaboration will offer an innovative pathway for nurses interested in pursuing a career as a midwife," she says, "especially if they would like to practice in more rural areas of Minnesota and Wisconsin."
'Increasing the proportion of nurses with a baccalaureate or higher degree will significantly impact healthcare in South Dakota.'
Nursing education in South Dakota is getting a boost with two wide-reaching initiatives designed to grow the state’s healthcare workforce.
The first creates a statewide nursing agreement to simplify the process of transferring credits between higher education institutions for nursing students, according to the South Dakota Board of Regents, which authorized both moves.
For more than a year, the board of regents has met with the Board of Technical Education (BOTE) academic programming staff to explore ways to enhance their partnership and decided to implement a statewide nursing agreement.
The agreement enables nursing students to seamlessly transfer credits from technical and community colleges to South Dakota State University and the University of South Dakota where they can obtain a bachelor’s degree.
"The goal is to promote workforce development in healthcare, specifically for registered nursing and the Bachelor of Science in Nursing, which are critical for South Dakota's economic growth," according to the board of regents.
"We should applaud the technical colleges, university staff, and their administrations for their dedication to workforce development in our state," said Janice Minder, EdD, system vice president of academic affairs. "Increasing the proportion of nurses with a baccalaureate or higher degree will significantly impact healthcare in South Dakota."
The move also will expand consumer access to primary care through an increased number of advanced practice nurses and increase the critical faculty pipeline to prepare an adequate nursing workforce for the future, the board of regents noted.
New NSU nursing program
NSU will add nursing education to its offerings beginning in fall 2024 with a Bachelor of Science in Nursing degree.
The move will offset the loss of a previous nursing program in Aberdeen—a region already experiencing a shortage of nurses—with the closing earlier this year of Presentation College, which specialized in nursing, healthcare, and liberal arts programs.
Graduates of Northern's BSN will be able to practice as generalists who can provide safe and effective patient-centered nursing care. The program also specializes in telehealth and gerontology.
"Rural areas of South Dakota help drive our economy and we recognize the importance of providing quality healthcare in those communities for the continued growth of our state," said Tim Rave, board of regents president. "Expanding this program is another opportunity for our public universities to help fill this essential workforce need."
Ferrara is an actively practicing nurse practitioner (NP) with years of clinical and health policy development experience, from which he drew to help secure full and direct access to NP-delivered care for patients in the state of New York in April 2022. New York joined 24 other states and Washington, D.C., at the time in granting nurse practitioners full practice authority (FPA).
"Dr. Ferrara is widely known and respected," said AANP’s CEO Jon Fanning, MS, CAE, CNED. "As an AANP board of directors member over the past seven years, he has played an instrumental role in developing strategies to raise awareness of the high-quality, patient-centered care provided by NPs, while also advocating for full practice authority. We look forward to his leadership as more and more patients choose nurse practitioners as their healthcare provider."
In his role at Columbia, Ferrara is responsible for overseeing the NP primary care faculty practice located in New York City, where he teaches health policy in the Doctor of Nursing Practice program.
Ferrara is particularly interested in health information technology and the integration of evidence-based practice into daily practice. His doctoral work examined the impact of group health visits on the health of Type 2 diabetes patients and the extent that this intervention led to better health outcomes.
"I am proud to represent the voices of more than 355,000 licensed NPs nationwide and the lifesaving care we deliver in countless patient visits each year," Ferrara said. "As nurse practitioners, we play a vital role in healthcare delivery, and I am committed to fostering professional growth, advocating for our interests, and promoting our invaluable contributions to patient outcomes."
Ferrara has been honored with the AANP New York NP State Award for Excellence and inducted as a Fellow of AANP, the American Academy of Nursing, and the New York Academy of Medicine.
The challenge to effectively train nurses without enough preceptors led Singing River Health System to turn to technology to get the job done.
Singing River Health, a community-based, not-for-profit healthcare provider for the Mississippi Gulf Coast, piloted the customized Elemeno Health workforce empowerment app at its Pascagoula hospital a little more than a year ago for nurse training and orientation and recently deployed it in numerous departments throughout its entire health system, says Susan Russell, MSN, RN CCRN-CSC, the health system’s chief nursing officer.
The platform provides nurses with a resource hub they can consult for bedside care by delivering hospital best practices in readily digestible resource formats such as interactive guides, how-to video clips, concise updates, and intuitive checklists.
HealthLeaders spoke with Russell about how the technology is benefiting Singing River’s nurses.
This transcript has been lightly edited for brevity and clarity.
Susan Russell, CNO, Singing River Health System / Photo courtesy of Singing River Health System
HealthLeaders: Please explain what the technology does for your nurses.
Susan Russell: With high turnover rates, it's been an enormous challenge to get people in and get them trained because we have less people with experience to help train new nurses. Elemeno fits in electronically to meet the need of not having as many preceptors as needed—not having preceptors around the clock.
With the app, we’re able to replicate the best preceptor you ever had and have them available as many times or anytime you need it. Say I am that less-experienced nurse on night shift and I'm not familiar with gastric tubes. I learned virtually in school but maybe I just haven't seen it. Theoretically, you would have a preceptor, an expert clinician, who is there to walk you through every step of what you need to know, what you need to do, what you need to look out for, and what needs further action.
That's what we're able to get with this Elemeno product. Where we used to lean on human resources is now available in electronic format. It really does support our frontline staff on ongoing knowledge and the best evidence-based practice.
HL: How do you ensure that the nurses know how to use it?
Russell: It is so simple. They just hit the icon and anything they need to know is available. They put in the search word—gastric tubes—and it immediately takes them to the lesson for the training or the education that has been built around gastric tubes. It’s also not what you see in a prebuilt platform; it’s our gastric tubes that we use, it’s our equipment, and our supplies. So, it looks very much like what you would expect it to look like if there was a trainer there showing them the ropes and how to use things.
HL: How did you determine what information to include in the app?
Russell: What we're seeing is many staff members who recently graduated or have been hired since COVID did not get trained as well, whether it was in school or after they got out and came into the healthcare system, so we're going back to the drawing board with some of the things that we take for granted that nurses would know, but they don’t; they don’t have the experience that previous nursing generations had.
HL: How did Singing River pilot it before making it available to the entire health system?
Russell: During COVID, there wasn’t as much surgery to do—everybody is aware that many surgeries were completely curtailed during the pandemic—so that seemed like a good place to start because there are so many specific things to train somebody on in surgery.
Every single nurse needs to be trained when they come into a new health system. Say I’m a 20-year nurse; I’m still going to have to have orientation, and some areas take a lot more orientation and surgery is one of them. Our surgery department embarked on having that training placed into an electronic platform so that it can be used 1,000 different times.
They got it up and built about 1½ years ago, and with the platform, they were able to address some of the things that come up in surgery that you don’t see that often along with some of the things that are fundamental that you need to go over time and time again.
We’re also able to give ongoing assignments. Say you’re six months into your nurse training, there will be additional assignments for you to build on, and then I'm going to teach you more things over those six months. This allows you to continue to grow and develop while you’re on orientation or even if you're not on orientation. If there's a new product that comes out or something that we’re seeing as a system that people are missing or not doing correctly, we can send a lesson assignment out. We're going to go step by step and give them everything they need for clarity and consistency.
HL: How have the nurses responded to it?
Russell: Well, they don’t have to go to class Wednesday morning at nine o'clock after they’ve worked the night shift or if they’re off that day. This is available 24/7.
We used to have workshops and seminars, but the GenXers don't really like that as much. They prefer social media and electronics—that's what they grew up with. They want to be in control of their environment and their home environment, so they don't want to come in for mandatory in-service: "Tell me what I need to know and send it to me so I can look at it when I want to look at it. And if I want to break it up into two different viewings, let me break it up into two different viewings. Don't tell me how to learn; let me decide how I want to learn."
What we're hearing from them is it allows them to reinforce some of the information they got during orientation. Orientation can be overwhelming and maybe someone didn't exactly understand the section on central lines; it allows them to go back and find all the unique parts and pieces of central lines. They can do it when they need that information. If you tell them during orientation, they’re not actually doing so it doesn't gel as much, but if they look at that information and they’re about to use it, the information really is going to be more hardwired.
The goal of the partnership is twofold: to retain RNs at Duke by granting them more opportunities to instruct at the bedside and to recruit more nursing students to DUHS.
Alliances between hospitals or health systems and colleges are becoming more common as healthcare leaders search for creative ways to bolster the number of nursing students, and thus, their nursing pipeline.
Duke nurses will provide clinical instruction at Durham Technical beginning July 1, and the health system will equip the college with funding, simulation, and nurse aide training resources.
This agreement comes at a critical time. North Carolina is one of 21 states that will fall short of filling the demand for qualified registered nurses by at least 1,000 nurses by 2026, a Mercer Report study found. The state currently has a shortage of 13,112 RNs.
"We see this collaboration as an opportunity to advance greater economic stability and economic mobility within the communities we serve," said Craig Albanese, MD, CEO of Duke University Health System. "The agreement will promote career awareness, career readiness, and education as well as increase the number of registered nurses, licensed practical nurses, and certified nurse aides entering the workforce at DUHS."
Duke nurses will prepare students by teaching advanced classes, providing mentorship, and sharing feedback and support.
"We are fortunate to have a strong community partner in Duke that helps create outstanding career pathways for our students," said J.B. Buxton, president of DTCC. "We are proud of the work we do to develop robust talent pipelines for employers in our community, and this new collaboration showcases just how well we can do that to benefit the region."
'The AMA is again adopting policies encouraging laws and regulations that impede competition and help their bottom line.'
Nursing groups are denouncing the American Medical Association's recent policy amendment calling for advanced practice RNs (APRNs) to be licensed and regulated jointly by the state medical and nursing boards.
The policy amendment was passed by the AMA's House of Delegates (HOD), the policy-making body of the organization, during its annual meeting last week in Chicago.
The National Council of State Boards of Nursing (NCSBN) "strongly opposes" the recommendation, given that U.S. nursing regulatory bodies (NRBs) have regulated the practice of nursing for more than 100 years, the NCSBN noted in a statement.
"They have the unique experience and expertise to license, regulate, and discipline nurses at all levels of practice from licensed practical/vocational nurses, to registered nurses to APRNs," according to the NCSBN. "The Consensus Model for APRN Regulation, the nationally recognized and longstanding model for APRN regulation, calls for regulation of APRNs by NRBs."
"At a time when the healthcare industry is facing a critical workforce shortage and patients' access to care is in jeopardy, the AMA has chosen to focus on ‘fixing' a problem that does not exist," Angela Mund, DNP, CRMA, president of AANA, said.
The American Association of Nurse Practitioners (AANP) also weighed in: "The AMA has once again dusted off its old protectionist playbook and demonstrated its commitment to put profit and powerplays ahead of patients and their access to high-quality healthcare," the organization said.
Adding state medical boards into the mix could negatively affect care, said Maryann Alexander, PhD, RN, FAAN, chief officer of nursing regulation for the NCSBN.
"In the interest of public safety and protection, best practice dictates that regulation of APRNs should be within the purview of NRBs," Alexander said. "Adding the needless oversight of state medical boards does nothing to enhance patient protection but has the potential to add unnecessary bureaucracy that may actually slow down the regulatory process and impede access to care."
Additionally, research has identified that in those states with the most restrictive laws and regulations—such as this new AMA policy—access to care is adversely affected, according to the NCSBN.
"The only appropriate regulatory entities to oversee nursing licensure and practice are state boards of nursing," Fanning said. "Not only is the model proposed by the AMA flawed, but it has also been soundly rejected by 46 states and the District of Columbia. In the handful of states where NP practice is regulated outside the exclusive oversight of the board of nursing, the restrictive involvement of the board of medicine directly contributes to healthcare access challenges, resulting in continued low health care rankings, geographic disparities in care, and unnecessary regulatory cost in these states."
'Stuck in the past'
The AMA and other physician groups have long argued that collaborations are needed for patient safety, though some question their motives.
"The AMA has historically supported policies which restrict APRNs practicing to the top of their education and certification despite decades of evidence demonstrating APRNs provide safe, high-quality care," according to the NCSBN.
"The Federal Trade Commission has repeatedly cautioned against state legislative proposals that recommend regulation of APRNs by physician-controlled boards, urging lawmakers to ‘consider whether to allow independent regulatory boards dominated by medical doctors and doctors of osteopathy to regulate APRN prescribing, given the risk of bias due to professional and financial self-interest,'" the NCSBN continued.
Mund was a bit more direct.
"The AMA is again adopting policies encouraging laws and regulations that impede competition and help their bottom line," she said. "As a CRNA and a member of America's most trusted profession, I feel it's incumbent upon us as healthcare professionals to be honest and transparent about healthcare policy."
Mund charged that the AMA's proposed policies put physicians, rather than consumers, in control of patients' healthcare decisions.
"The AMA is simply stuck in the past," she said. "As frontline providers during the pandemic, CRNAs, as well as all APRNs, proved once and for all they have the training and clinical competence to provide safe, high-quality care without restrictive physician involvement."
"We urge our medical colleagues to join us in our movement to put patients first by supporting a modernized healthcare system that looks to the future, not the past."
AANP also called for the AMA to "put patients first."
"Unfortunately, the AMA's tactics are not new. AANP will continue to fight for patients," according to AANP. "AANP calls on the AMA to stop the rhetoric and resolutions that undermine patient choice, access and truly coordinated care. The AMA’s ongoing fearmongering and physician-protectionist resolutions are negatively impacting the health of our nation. It’s time the AMA retires its dated tactics and put patients first."
Editor's note: This story has been updated to include AANP comments.
NLCs are 'one tool in the toolbox' for broader workforce discussions, NCSBN official says.
Nurse Licensure Compacts (NLCs) may be “one tool in the toolbox” to help ease chronic nursing shortages reaching into every state and practically every health facility, says Nicole Livanos, director of state affairs at the National Council of State Boards of Nursing (NCSBN).
The compact allows RNs and licensed practical/vocational nurses (LPN/VNs) to have one multistate license, with the ability to practice in person or via telehealth, in both their home territory/state and other NLC states.
The NLC has been operational for more than 20 years, though a new and modernized version of the language was drafted and approved by boards of nursing in 2015. Since then, 38 states and two territories—Guam and the U.S. Virgin Islands—have enacted the NLC legislation.
HealthLeaders spoke with Livanos about the benefits of the NLC, why some states haven’t enacted it, and how it could help with nurse staffing shortages.
This transcript has been lightly edited for brevity and clarity.
HealthLeaders: Washington is the latest state to enact the NLC. What finally pushed it over?
Nicole Livanos: Washington has been attempting to enact the NLC and had numerous efforts since around the time that the first compact was enacted, so we’re thrilled with Washington's enactment. This sends a broader signal to the other states that are not yet in the NLC that the NLC can be part of broader workforce discussions in looking at how to shore up the existing nurse workforce, how to modernize the existing workforce, and how to make sure that your state remains competitive when recruiting nurses.
In Washington this year in particular, lawmakers were looking at several issues dealing with the nursing workforce, and NLC was seen as part of that solution to a lot of the workforce challenges that Washington was facing.
HL: How likely are the remaining states to follow suit?
Livanos: As director of state affairs, I am hopeful, and I know that the work that we're doing is working. We are encouraged to see that, especially coming out of the pandemic, states are looking at and addressing the real issue of the nursing workforce shortage, seeing the data that's coming out, and seeing how it's impacting at the individual facility level, at the patient level, and at the nurse level.
The states that we might have thought would be number 49 or 50 are seriously taking into consideration the NLC and the benefits that it can provide. And again, it's a tool in the toolbox and so many times we are seeing it proposed alongside other nursing workforce packages.
HL: Why are the rest of the states holding out from joining the compact?
Livanos: Over the past several years, we have had 40 jurisdictions that had 40 unique challenges—that's the beauty of state government—and the remaining jurisdictions have unique challenges to each of them, so it’s not a “one size fits all.” However, there are two common denominators between many of these states.
One is that there are still states that are not familiar with and have not started to adopt healthcare licensure compacts, whether it be for nurses, or physical therapists, or physicians, etc. There are some states—Hawai‘i, Connecticut, Alaska—that have either just begun enacting interstate compacts in the last year or so, or they're still exploring and learning about how these will impact healthcare in their state.
The other common denominator between some of those states is that they have opposition from nursing union leadership. Many different unions represent nurses, and each state has its own challenges and concerns that those unions would raise. Some nursing unions have expressed concern about how the NLC may impact their bargaining power during times of strike when facilities have to bring in nurses quickly to care for the patients.
There are other concerns about public safety in bringing in nurses from other states and whether an unsafe nurse can continue traveling between states to avoid disciplinary action and being caught. We are very comfortable with the safeguards within the compact that were built and drafted by boards of nursing whose mandate is to protect the public. We know that those safeguards work and that the NLC provides additional requirements for boards of nursing for them to share information across state lines to ensure that type of scenario does not happen and is properly managed.
HL: From a hospital or a health system’s perspective, what are the benefits of NLCs?
Livanos: For those that may have telehealth or they may be looking to grow a telehealth program, the NLC offers the opportunity to create nursing jobs for those roles where they can reach patients across state lines.
We travel across state lines all the time and a provider needs to be licensed in the state where we, the patients, are located, so the compact allows for these facilities to ensure that they can take care of their patients, no matter where their patients are in the country.
HL: What does a nursing compact state mean for nurses?
Livanos: We know that nursing is not purely traditional nursing at the bedside. Nurses are case managers that communicate with patients that cross state lines all the time, so if they're not in a compact state, they need to obtain and maintain up to 50 licenses to properly care for the patients that they are assigned to.
The NLC provides two opportunities. One is to relieve the nurse of the burden of holding and maintaining licenses, which might be every year or on a two-year cycle depending on that state’s board of nursing.
The other is to look at what a nurse can do when they have a multi-state license versus a single-state license and the opportunities it opens up to them to be a travel nurse or if they want to join and remain competitive in a telehealth workforce.
The U.S. Department of Defense is a huge supporter of compacts and has invested in drafting a lot of them because of the benefits to military families when they're relocating every two years. If their spouses are nurses, they're having to obtain and maintain multiple licenses each time they move, which creates a financial burden not only in having to get the license, but also a delay in when they're able to get to work because they need to wait for new licensure every time they move to a new jurisdiction. So, we know it's not a “one size fits all”—every nurse could benefit from the NLC in a lot of different ways.
HL: All governors issued executive orders to allow nurses to freely work across state lines during the pandemic crisis, but a crisis remains in nurse staffing. Could expanding the NLC to all 50 states help alleviate some of the high costs of travel nurses?
Livanos: Again, the NLC is a tool in the toolbox, so while there is a nursing shortage of this magnitude, the NLC isn't going to suddenly create nurses, but it is going to allow facilities that might have an acute shortage in one of their units to recruit a nurse for that unit or shift around their resources if they're an interstate facility and moves nurses between different states.
We saw during COVID where 34 states at the time that had the NLC operational were able to have an immediate workforce to call upon when hotspots were appearing in different states across the country, whereas those that weren’t in the NLC had to rely on these executive orders. They all operated it in slightly different ways; some were blanket waivers, while others required temporary licensure or registration requirements or that you work within a certain type of facility in responding to COVID.
It created this patchwork regulatory environment, which did not promote the ease of mobility that the NLC provides for.
NAPNAP Cares is an online continuing education course for pediatric-focused nurse practitioners.
Pediatric-focused nurse practitioners (NPs) are responding to what many call a pediatric mental health crisis with an extensive education program focused on mental health for young patients.
The National Association of Pediatric Nurse Practitioners (NAPNAP) is launching NAPNAP Cares, with online continuing education (CE) courses designed to support pediatric-focused NPs and advanced practice RNs (APRNs) as they respond to the growing need for mental health care among young patients.
While the volume of pediatric patients requiring mental health support increases, access to specialists is becoming more limited. NAPNAP Cares will help strengthen the provider network by equipping pediatric-focused NPs with the tools to screen, assess, and diagnose patients in their practice setting, according to NAPNAP.
The U.S. is facing what many describe as a pediatric mental health crisis, with approximately one in five children and young people reporting mental health concerns.
The pandemic has had a negative impact on the mental health of children due to such factors as social isolation and caregiving disruptions, and about one in five children and young people report mental health concerns, according to NAPNAP.
“The increase in children experiencing extreme anxiety and depression has led to an increase in suicidal ideation, with more young people aged 12 to 25 presenting to the emergency department (ED) for suspected suicide attempts,” according to ECRI’s report.
And at emergency departments, the most common diagnoses for pediatric mental health visits with a length of stay greater than 24 hours were suicide, self-injury, and depressive disorders, according to a study late last year published by the Journal of the American College of Emergency Physicians Open.
“Too many kids and teens today are struggling with mental health issues in the face of stresses at school, on social media, or in their relationships,” says Jennifer Sonney, PhD, APRN, PPCNP-BC, FAANP, FAAN, president of NAPNAP.
“When pediatric-focused NPs are able to confidently address these issues, it can be life-changing for young patients and help alleviate some of the strain on mental health specialists. NAPNAP Cares enables earlier intervention, which often leads to better outcomes for these young patients,” she says.
NAPNAP Cares will launch 30 online courses during the next 12 months, all of which will be accessible at no cost to NAPNAP members for up to one year and available for purchase by non-members. The first 10 courses are available now on PedsCESM with 10 additional courses launching in both December 2023 and June 2024.
Learners will set their own schedules and follow courses comprised of recorded sessions, presentation handouts, and other resources designed to expand their knowledge of pediatric mental health and their ability to apply lessons in a real-world setting.
“NAPNAP Cares is an important tool,” says James H. Wendorf, executive director of NAPNAP, “that will help pediatric providers build their knowledge base to identify, treat and/or refer patients to the specialized care they deserve.”
Newly approved legislation helps to address the 'dire shortage of healthcare workers in our state,' governor says.
Working certified nurse aides (CNAs) in Hawai'i who want to make the leap to become a licensed practical nurse (LPN) are getting a boost with legislation that Gov. Josh Green, MD, signed into legislation.
In addressing that statewide shortage of healthcare workers, Green signed legislation that appropriates $130,000 for instructional costs for the Certified Nurse Aide-to-Practical Nurse Bridge Program at University of Hawaiʻi Maui College, and $200,000 to provide student aid to participants in the CNA-to-LPN Program at the school.
The appropriation includes funds for tuition, fees, supplies, and related costs, according to a press release from the governor's office.
The program is designed particularly for working CNAs and other healthcare professionals who want to become LPNs, to enhance the quality and provision of healthcare services on Maui.
"This funding contributes to a robust education system in providing health workforce education and training, to enhance the quality of healthcare in our community and address the dire shortage of healthcare workers in our state," Green said.
The program partners with Hale Makua, ʻOhana Pacific Health, and Kaiser Permanente Hawaiʻi and provides eligible Maui and Oʻahu healthcare professionals with the opportunity to become LPNs while they are working.
"This is a proud day for UH Maui, as we will be able to contribute greatly to helping our state's healthcare system staff up, while at the same time, affording certified nurse aides an opportunity to advance their careers through the bridge program," said Lui Hokoana, chancellor of UH Maui College.
Green also signed additional legislation authorizing up to $20 million in bonds to build a new hospital—West Maui Hospital and Medical Center—in the county of Maui, including any necessary infrastructure.
"These two bills came out of the community and were actually driven by the community," said state Sen. Gil Keith-Agaran. "[The CNA-to-LPN bill] was probably one of the easiest bills to move through the legislature this year … because the expansion will also provide more healthcare positions on Kaua'i and O'ahu. This is helpful for healthcare throughout the state."
Nurses want flexibility and health systems aren't giving it to them.
Nearly all—94%—of 100 health system executives surveyed described the severity of the nursing shortage in their health systems as “critical,” and 68% indicated they don’t have enough nurses to manage another large-scale health crisis, a new report says.
That may be because health systems aren’t delivering what nurses want.
The 2023 Healthcare Executive Report, released today, is the first-ever public study of health system executives by healthcare career marketplace Incredible Health and reveals the challenges that healthcare organizations face.
It revealed three areas that identify a misalignment between health systems and nurses.
1. Average nurse tenure and experience are at issue in hiring.
More than a quarter of nurses in their system have less than a year of experience, reports 40% of the surveyed executives. That contrasts with what hospitals are looking for when hiring nurses, with previous experience and qualifications tying at 43% for the top factor they consider.
They also reported that 53% of nurses had an average tenure of less than five years at their institution.
2. Disconnect between health systems and nurses.
What nurses look for in an employer and what employers offer to hire and retain nurses are misaligned, the report says.
Health systems reported 80% of younger nurses requested more flexible scheduling, yet only 11% of health system executives surveyed actually offer more flexible schedules. Instead, hospitals are focusing more on compensation rather than flexibility as a hiring differentiator, the report says.
Similarly, though one-fourth of nurses point to limited career advancement training and opportunities as a reason they would leave nursing before retirement, many health systems are not prioritizing these programs and opportunities as a hiring and retention method.
Sign-on bonuses continue to be the primary method to attract nurses, with 35% of hospital executives saying they are still offering them, followed by increasing salaries for nurses (26%), and improving patient-to-staff ratios (16%).
With the U.S. nursing workforce made up of four generations—baby boomers, Gen X, millennials, and Gen Z—with an average age of 52 years, it’s not surprising that 95% of health system executives have noticed generational differences in their approach to work and career growth.
While 35% point to conflicts between generations on teams, most differences lie in what younger and older generations request from their employers, the report notes.
Besides far more flexible schedule requests from younger nurses, large gaps also exist in:
Compensation demands: 78% of younger nurses request increases vs. 48% of older nurses
Seeking more specialized roles: 54% vs. 14%
Requiring more career advancement opportunities: 74% vs. 8%
Nearly 80% of executives noted a reduction in loyalty and tenure with younger nurses, in contrast to 21% in older nurses.
Travel nurses remain a go-to solution
Nearly all (93%) of health systems employ travel nurses to keep up with patient demand, with 75% of respondents saying that temporary nurses make up a quarter of their nursing staff. Executives are eager to change this dynamic, as costly temporary staff significantly affects the health system’s bottom line, along with the culture in nursing units.
Some 96% of the executives reported plans to prioritize permanent nurse staff over temporary staff, with 55% of respondents not increasing the number of travel nurses within their hospital systems over the last year.
“The good news is that healthcare executives, specifically those charged with hiring nurses,” said Iman Abuzeid, MD, co-founder and CEO of Incredible Health, “are embracing the opportunity to change their hiring and retention methods to improve patient care and the nurse experience.”
