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.
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.
“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.”
When UnityPoint Health began exploring new inpatient care delivery models, D’Andre Carpenter, DNP, RN, chief nursing officer, wanted to go beyond the concept of team-based care to position nurses and other clinicians to practice at the top of their license.
The result was UnityPoint Health's Collaborative Care Model (CCM), rolled out earlier this year, which is meeting the needs of the health system’s workforce, as well as its patients.
Early indicators point to a marked decrease in call light usage, increased team member satisfaction, and an increase in patient communication with nurses, Carpenter says.
Carpenter spoke with HealthLeaders about the new care delivery model and its positive impact on patient safety, patient experience, and staff satisfaction.
This transcript has been lightly edited for brevity and clarity.
D'Andre Carpenter, Chief Nursing Officer, UnityPoint Health / Photo courtesy of UnityPoint Health
HealthLeaders: What circumstances made it necessary to create this new, collaborative care model?
D’Andre Carpenter: We are not uncommon to many other systems across the country that are looking at alternative care delivery models to deliver care more efficiently and more cost effectively, and how to leverage team members, from a labor perspective, to deliver care in a different way.
We went down a path of exploring and examining our own processes to see if there were an alternative model that we could come up with that would help improve the overall quality and safe care that we provide to our patients that can also make our ability to staff to the clinical needs more efficient—increasing staff and patient satisfaction—while also finding a more cost-effective way to leverage labor across our enterprise.
These were some of the initial guiding principles that went into our exploration work and some of the themes that we fit into our model as we as we started to mature it.
HL: What team members does each CCM care team consist of and how does it work?
Carpenter: You hear a lot in industry right now about team-based care, because many of the alternative models that folks are thinking about involve some aspect of team-care delivery. When we started thinking about this, we challenged ourselves to look above and beyond that. That concept, in and of itself from a clinician standpoint, can often be looked at as negatively and we wanted to push beyond it, which was to get to, “How do we position our team members to practice at top of licensure?”
We love seeing that in nursing, but we looked at that and tried to understand what that really meant and how to focus on the care delivery needs of our patients and how to align the best functional scope of the individual interdisciplinary team members to deliver that care.
It created for us an opportunity to create some flexibility in the model to get to that because not every care delivery need is like the other and not every unit is like the other. There are lots of considerations there. So, foundationally, we introduced two roles that are unique to our current, traditional model, the first of which is what we refer to as the attending RN, and this is the leader of the collaborative care group. This is the team member that is leveraging holistic leadership skills, and the ability to delegate among multiple team members to align the best scope of the individual team members to the care needs of the patient.
The other one is taking the traditional concept of our charge nurse and elevating that to the next level and creating this clinical lead RN who has the ability to have some oversight over multiple collaborative care groups, generally over multiple areas. It’s a bridge between what you would normally refer to as a house administrative supervisor and the unit charge nurse and so those roles in addition to a licensed role or flex roles can include an LPN or an RN.
There's a flex role that we've built into the model that is used, depending on the patient care needs that day. So, some areas that have higher acuity needs will often opt in the flex role. And then we've factored in a supportive role for the nursing team that is generally filled by a patient care technician or another individual with similar scope.
The underpinning of this is the enhancement of our virtual nurse program. The virtual nursing team is aligned to each collaborative care group and there's a sub-function of the scope at the registered nurse level that is augmented to the virtual nurse.
HL: What are some of the specific benefits to nurses that this model provides?
Carpenter: The ability to practice at top of license. The ability particularly for a lot of our new-to-practice RNs or new-to-practice nurses to have the expertise and the resource from more-tenured team members to create an environment where they are able to learn independently and within a group is something that we are also building into the model.
We are onboarding the majority of our nurses and most clinical areas are new to practice, and it creates a compression gap in terms of the knowledge base when you're trying to rapidly get these folks in and get them productive. So, this is a model that they can continue to learn and develop their practice, while also being able to deliver care as a clinician.
With some surveys that we've seen, it's improving staff satisfaction in terms of how they see themselves in clinical practice, whether that's creating a safer environment because of the complement of team members that are there, or the ability to work in a learning environment. Those are some of the things that we're starting to see as outputs.
HL: What data are you seeing so far from the CCM?
Carpenter: During the first 100 days of using the CCM in select units at several hospitals, UnityPoint Health has seen a positive impact on patient safety, patient experience, and staff satisfaction.
Some of those include:
A reduction of 1,500 call lights in one unit at our largest hospital during the first month.
Staff vacancy rates decreased in one unit by nearly 10% while using the same number of contract staff.
More than a 10% increase in patient communication with nurses using the model at two of our hospitals.
More than half of the staff nurses surveyed from one unit participating in the model felt that it has improved teamwork.
We are rolling out the Collaborative Care Model to other units within our hospitals over the next several months.
HL: How does this care model benefit patients?
Carpenter: This is the outcome data that is really exciting. For an overall patient experience, we've measured the HCAHPS and one of the primary drivers and questions around that is related to communication with nurses. We’ve seen a 16% increase over the collaborative care units as it relates to the model. We've also seen, from a safety perspective, a decrease in call light usage, as I mentioned. We know that the more attentive we are to our patients, the less times they have to call out for us, which also helps improve fall rates and other things that we typically see that are downstream impacts.
In the patient experience question around care providers working together, our data suggests a 17% favorable increase, which is something that we're working to continue to track with this first phase-one unit. So, there's a lot of patient experience components that we're starting to see as a benefit to the model.
What I love hearing are the testimonials that our team members are sharing with us from our patients around never feeling like they were unattended to, and always feeling like there was someone there who could meet their needs and answer their questions.
HL: What are some of the testimonials you're hearing from nurses?
Carpenter: The feeling of being supported. More specifically for our experienced nurses who are more often working in the attending and the lead role, they're feeling value that's associated with their expertise in their practice, because they are being identified and seen in the space as a leader.
HL: When nurse leaders are considering changes like this, how should they effectively adopt a new care model into their organization and achieve buy-in?
Carpenter: The No. 1 thing that I led into my conversations with our leaders is this whole phenomenon of tradition and “the way we do things.” I often use a quote: “I love nursing and I am proud to be a nurse because of the rich tradition and the history that the profession brings to our patients, but tradition more often is something that can sometimes keep us back a little bit.”
So, we went into this with the spirit that we're still going to promote best practice in nursing but we're also going to break a little bit of tradition, because we know we need to do things differently. We wanted to create something from a model perspective that was standardized, aligned, and structured enough that we could continuously benefit from the improvements that we built into the model, both quantitative and qualitative, but also be nimble and flexible enough for our team members to make autonomous decisions about how they were thinking about the care delivery needs of the patients, and still be efficient.
I would say to leaders that you want to create a model that's going to get you to a high level of efficiency by standardizing and aligning to process, but at the same time, create components within the model that are flexible enough for your team members to be able to autonomously think on the fly and make some of those key decisions that they need in order to ensure that you're flexing the model to your needs, but still gaining the efficiency from it.
Three educational tracks will be offered at a substantial tuition discount to Bassett employees by the Oneonta, New York-based college: a Master of Science in nursing education, certificate of advanced study in nursing education, and the accelerated (two-year) BS in nursing.
“We deeply appreciate our nurses and encourage them to expand their knowledge,” said Tommy Ibrahim, Bassett’s president and CEO. “This partnership between Bassett Healthcare Network and Hartwick College provides a great incentive to members of the Bassett team interested in advancing their careers in nursing and nursing education and benefits our patients. We hope many will participate.”
The need is considerable. More than 1.1 million new nurses will be needed in the United States by 2030, according to the U.S. Bureau of Labor, a staffing crisis exacerbated by the shortage of nursing educators.
“In a field as dynamic as nursing, we are committed to educating the educators, and equipping our nurses with ongoing opportunities to increase their knowledge,” said Angela Belmont, DNP, RN, NEA-BC, Bassett’s senior vice president and chief nurse executive. “This opportunity to learn and grow benefits not only Bassett employees, but our patients and our communities as well.”
The collaboration is the latest in a long history of partnership in higher learning for nursing and nursing education students between Bassett and Hartwick. In the late 1940s, Bassett established a four-year nursing program, with two years of didactic training at Hartwick, followed by one year of practical training at Bassett Medical Center in Cooperstown, New York, and nine months of training at Columbia University in New York City.
Bassett’s Partnership for Nursing Opportunities (PNO) was created in 2001 as a joint venture with Hartwick and State University of New York Delhi to help ease rural nursing shortages. That program, which allowed nurses to pursue an associate or bachelor’s degree while continuing to work, with Bassett paying the tuition in full, resulted in more than 100 new nurses within the decade.
"Hartwick College is deeply committed to positively impacting the region in which it sits,” said Darren Reisberg, president of Hartwick College. “This new joint endeavor with Bassett Healthcare Network, leveraging Hartwick's longstanding eminence in nursing and addressing such a critical need, is a tangible example of this commitment."
A pediatric charge nurse struggled to cope with critical patient events. What resulted is a more effective debriefing process.
A charge nurse at a pediatric hospital who struggled to cope with several traumatic resuscitations within a short time frame helped create a tailored debriefing process that resulted in increased levels of compassion.
The bereavement/wellness committee in the pediatric intensive care unit (PICU) at Lurie Children’s Hospital of Chicago, of which the nurse was a co-chair, changed its debriefing process from one in which critical patient events were clinically reviewed days, or even weeks afterward, to one that gave those involved an opportunity to reflect on the event, recognize each other’s efforts, and, in the case of a death, honor the patient’s life, before the end of the current shift.
“Many debriefing processes focus on communication and teamwork but neglect the emotional impact of critical patient events,” says co-author Courtney Nerovich, BSN, RN, a nurse in the PICU and a member of the committee. “We specifically added elements to reflect, to honor the patient’s life and recognize the team’s efforts.”
“These additions may have enhanced clinician, patient, and team connections while supporting mindfulness and reflection,” Nerovich says.
Changing the process
Before the R3 implementation, the standard practice at the 40-bed, high-acuity, high-volume PICU was to hold an event debriefing several days to weeks after a traumatic event. The process was inconsistent and often had poor attendance.
Additionally, staff members were leaving work with significant distress after critical events, the article notes.
“The team’s objective was to create a sustainable debriefing process that allowed time for reflection and encouraged team communication after critical patient events,” according to the article.
The team conducted a literature review along with several individual staff interviews, in which staff members identified talking with colleagues as a primary method for coping and expressed a desire for a more consistent mechanism to process critical patient events.
The team then created a single-page debriefing guide with scripted language and open-ended questions. The guide included three essential process components that aligned with staff needs:
A review of the patient event and team dynamics.
Acknowledgement of the event’s emotional impact on staff.
For events in which the patient died, a moment of reverence to honor the patient’s life.
The team sought feedback, which led to minor adjustments to the initial debriefing process, including development of a guide specific to the planned withdrawal of life-sustaining therapies, which was called R3-D.
The R3 process was designed to be completed voluntarily before the end of the shift with the expectation that after a critical patient event, an R3 champion would contact the primary medical team and determine a time to conduct a debriefing during the current shift, if possible.
Once the debriefing was scheduled, the champion would notify all staff members who were directly or peripherally involved in the event, with the goal of including as many of them as possible. During the debriefing, the champion read the guide and recorded the team’s responses, the article says.
“In the 12 months after implementation of the new process, the debriefings were integrated into the PICU culture and became expected and valued by staff,” the article reads. “It has since been implemented on other inpatient care units and has received overwhelmingly positive feedback.”
Texas leads the list of states with the most travel nurse jobs.
The most in-demand travel nurse specialties are in med-surge, emergency department, and step-down, says a new report that looks at current travel-nurse trends.
The Q1 2023 Jobs Report by Nomad Health, a digital marketplace for healthcare staffing, looks at the most in-demand travel nursing specialties based on the company’s own job data collected January 1, 2023-March 31, 2023, from more than 80,000 users, according to the report.
The report also reveals which states have the most travel nurse jobs, as well as which states travel nurses want to work in the most, based on their search behavior.
“This supply-and-demand data for travel nurse jobs is meant to help facilities, government bodies, and reporting bodies understand the latest employment trends in travel nursing and the impact it has on nurse staffing supply and demand,” according to the report.
These are the travel nurse specialties most in demand by healthcare facilities during Q1 2023, according to the report:
Med-surg: 17% of jobs
Emergency department: 8% of jobs
Step-down: 7% of jobs
Med-surg/telemetry: 6% of jobs
Medical ICU: 5% of jobs
Telemetry: 5% of jobs
Operating room: 5% of jobs
Labor and delivery: 2% of jobs
Rehabilitation: 2% of jobs
Psychiatry: 2% of jobs
Texas led the list for top states for travel nurse jobs, with 7% of jobs, most likely for two reasons, the report says. Texas is a large, rapidly growing state, but it also is a “compact state,” which allows travel nurses to obtain a multi-state license, speeding up the credentialing and employment process for travel nurses.
California and New York both came in second with 6% of jobs; Florida followed at third with 5% of jobs; Massachusetts, Pennsylvania, Illinois, and North Carolina tied for fourth with 4% of jobs; and Maryland rated fifth with 3% of jobs.
Nomad also looked at where travel nurses most wanted to work, based on states that they searched most.
“In this list, we noticed common factors that make these states appealing for travel nurses including an ample supply of jobs, low cost of living, and high quality of life,” the report says.
California and Florida were the most popular, both with 6% of queries, followed by Texas with 5%; New York, North Carolina, and Georgia each received 4%; and Arizona, Colorado, Virginia, and Massachusetts each received 3%.
Galen College of Nursing has multiplied its campuses nearly fourfold since HCA's acquisition 3 years ago.
When HCA Healthcare acquired a majority stake in Galen College of Nursing, one of the nation’s largest private nursing schools, in early 2020, the nursing school consisted of a handful of campuses.
Since the HCA acquisition, Galen has expanded to 19 campuses nationwide, plus an online program, with an enrollment of some 12,000 students. The newest campus, announced in April, will open in the latter part of 2023 in Salt Lake City, Utah.
Partnerships between hospitals or health systems and schools of nursing are becoming more common as healthcare leaders search for creative ways to bolster the number of nursing students, and thus, their nursing pipeline.
Sammie Mosier, DHA, MBA, BSN, NE-BC, CMSRN, HCA’s senior vice president and chief nurse executive, spoke with HealthLeaders about the health system’s supercharged approach to educating future nurses amid a national nursing shortage.
Sammie Mosier, SVP and CNE, HCA Healthcare / Photo courtesy of HCA Healthcare
This transcript has been lightly edited for clarity and brevity.
HealthLeaders: What have been benefits of HCA’s acquisition of Galen College of Nursing?
Sammie Mosier: Not all healthcare providers can offer degree programs like we can with our nursing school. One of the obvious opportunities is to ensure that we have a Galen College of Nursing in our markets, and that does a couple of things.
It introduces a supply of nurses and so it's an opportunity for us to recruit those nursing students early. Also, we have a nurse extern program that allows our nursing students to come into the hospitals and participate in that program. It gives them hands-on experience and exposure to healthcare, which has been something we've been challenged with over the last couple of years with some of our students. They have gotten out of school, and they passed their NCLEX but they didn't necessarily get a lot of hands-on training in their programs, so this is mitigating that barrier.
We have more than 5,500 nurse externs in our hospitals and that is allowing them to get hands-on opportunities with our patients, but then it also gives them exposure to different care areas so that they’re a little more familiar with the hospital environment and they also can determine which specialty they want to go in when they graduate. So, they're interviewing us just like we're interviewing them.
HL: How has Galen grown, and in what ways, since it became part of HCA?
Mosier: We’ve more than doubled in footprint. We're currently at 17 schools [Editors’ note: Two more campuses have opened since this conversation]. When we purchased Galen, it had four campuses and, I believe, was getting ready to open a fifth, so we’ve definitely helped expand that, and that's been based on market needs.
The school has about 12,000 students enrolled. We look at that and determine how many more schools of nursing we need. We do have some expansions planned over the next three years based on the enrollments that we're seeing, so Galen definitely has not been short on gaining students in every one of our markets. They actually have exceeded enrollment expectations, which emphasizes that it's not that people are not interested in nursing; it’s that there's a barrier for them getting into nursing school, so Galen is opening that up.
NCLEX testers since 2019 in the U.S. have numbered about 149,000 to 150,000 testers each year, and as we expand Galen, that's going to put more students with the ability to test, so we'll change the national statistics as we grow this program.
HL: You referenced barriers, and one barrier is that nursing schools don’t have enough instructors. How is how is Galen doing in filling those seats?
Mosier: This is where we have a really good partnership with Galen. They have a good culture with a positive and supportive environment, so they're able to attract talent. They have created a pathway that takes nurses who are passionate about education, and they teach them how to teach. They have unique training, where they take new faculty members and do extensive individual orientation with them that lasts about 12 months. Then they have additional programs and separate tracks so that those nurses who are becoming faculty continue to move from a novice to expert just like our nurses do.
We also have benefit where together we created a program for their master's program. They have a master's in education, and they have a master's in leadership. With the master's in education, they can build their instructor gaps with that, and the master's in leadership is where my pipeline comes into play as far as directors and ACNOs and CNOs for the future. So, there’s a good partnership there.
Galen also has invested heavily in resources to establish a common curriculum and assessment, so those 17 campuses don't look different. They're able to leverage the size and scale of Galen, to be able to help support their educators.
HL: How has the pipeline benefited HCA regarding filling staffing gaps? What percentage of Galen graduates go on to work in HCA facilities?
Mosier: We’re starting to get that data now because a lot of the programs that we opened are just starting to graduate students, so we'll have better statistics in the future to report on that. We're starting to see that, and that nurse extern pipeline is helping us think about the potential conversion rate there, too.
Obviously, our goal is to get them to convert to full-time nurses. I tell everyone that it's not a short-term strategy; it’s a long-term strategy when it comes to the Galen. Within the next year, we'll really start seeing the benefit of that in the markets that opened earlier and then that will continue to build.
6 out of 10 have seen or experienced racism from colleagues, data reveals.
Nearly eight out of 10 nurses have seen or experienced racism/discrimination from patients, and almost six out of 10 nurses said the same about racism/discrimination from colleagues, says a new report from the Robert Wood Johnson Foundation (RWJF).
RWJF examined nurses’ experiences and perceptions of racism and discrimination in both healthcare settings and nursing schools through a nationwide survey of nearly 1,000 nurses from March 2022 through April 2022 conducted by research organization NORC at the University of Chicago.
Although diversity, equity, and inclusion (DEI) efforts became primary focal points for the nation in the wake of the 2020 murder of George Floyd and the resulting racial justice movement, there has been little research on nurses' experience and witnessing of discrimination, according to RWJF.
The survey explored the extent and severity of racism and discrimination happening around nurses, how often it's reported, and the culture of the institutions where it occurs.
Among the key findings were:
Asian, Black, and Hispanic nurses are significantly more likely than white nurses to have seen or experienced microaggressions. Two-thirds of nurses have seen or experienced microaggressions due to race/ethnicity from patients, and nearly half (47%) of nurses said the same about microaggressions from colleagues.
Fewer than one in four nurses formally reported racism or discrimination they saw or experienced to workplace management. Although 40% of nurses discuss observing or experiencing discrimination because of race/ethnicity with their supervisors, only 23% formally report or document incidents.
Nurses say their organizations are prioritizing diversity, equity, and inclusion (DEI) initiatives, but more education and training is necessary. Nine in 10 nurses say equitable patient outcomes are a stated organizational priority at their current workplace.
Nurses say there was a culture of racism/discrimination in their nursing school and that more training/education is needed. More than half of nurses say that their nursing school taught about racially/ethnically sensitive bedside manner while with 60% of Black/African American respondents reporting racism/discrimination. Less than one-third said they were taught about racial bias/stereotypes or systemic racism in healthcare.
While most survey respondents say their organizations are prioritizing DEI initiatives, very little formal reporting occurs when nurses or their patients experience racism, the report notes.
Fewer than one in four (16%) nurses report discrimination they saw or experienced to human resources; instead, most nurses (57%) speak with their fellow nurses, nursing directors/supervisors/managers (40%), or other staff (37%). Black nurses are most likely (64%) to have discussed with other nurses discrimination or racism they’ve observed.
Among nurses who reported such observances or experiences, more than 50% say their relationship with supervisors, senior leaders, and fellow nurses was negatively affected, the report says.
Additional training and educational programs would be beneficial to addressing this problem, including at nursing schools where respondents reported a culture of racism exists, respondents suggest. More than half of nurses say their nursing school taught about racial sensitivity in caring for patients, but less than one-third were taught about structural racism in healthcare, a topic that could benefit patients and employees alike.
Most nurses (91%) say diversity and inclusion at the staff level is an organizational priority; 78% say that about having an ethnically and racially diverse leadership team.
Most of those surveyed (85%) say hiring ethnically and racially diverse nurses is an organizational priority, and most agree hiring practices would improve the ability to recruit and retain racially and ethnically diverse nurses.
Zero-tolerance workplace discrimination policies, clear consequences, and reporting anonymity would improve nurses’ workplaces’ ability to retain racially and ethnically diverse nurses, eight in 10 nurses say.
"If we are to truly provide just and equitable care to our patients, we as nurses must hold ourselves accountable for our own behavior and work to change the systems that perpetuate racism and other forms of discrimination," said Beth Toner, RN, director of program communications at RWJF.