Ideas to resolve a bottleneck in nurse education

Two ideas emerge from recent interviews with Washington State health care leaders that could help address the state's chronic shortage of nurses:

1. Industry “loaning” large numbers of senior nurses on a rotating basis to teach in nursing programs, and
2. Industry creating incentives to retain current and future nurses in the workforce.

Perhaps not a coincidence, the Washington Legislature has recently passed legislation addressing similar issues (see SB 5236 and 5582).

Like many states, Washington suffers from a prolonged shortage of credentialed health care workers, particularly nurses. Although, this shortage applies to many other entry-level healthcare career pathways, too.

Through a series of stakeholder assessments with community colleges around Washington State, we've documented many reasons for the persisting gap; they all seem to collapse into one of two root causes:

1. Hard to become a nurse: Limited number of nursing program graduates
2. Hard to keep nurses in the workforce: Low career pathway retention

The clients of this research are community colleges, so we’ve focused our data collection and analysis on what our clients have control over, i.e., the first root cause: limited number of graduates. This focus led us to develop ideas and solutions to increase the number of graduates from nursing and other allied health programs:

1. Building awareness of the nursing and allied health professions among likely potential students and
2. Resolving “gatekeeper” dynamics like scheduling barriers, tuition costs, application processes, and rigorous (and often abstract) courses like math and chemistry.

While we developed some important and helpful ideas, none really addressed the heart of the problem: many community college nursing programs cannot respond to student enrollment demand and workforce demand for graduates. For example, a recent community college client produces approximately about 20 nursing graduates per year, serving a regional workforce in which there are more than 400 unfilled nursing jobs annually. As a side note, it would be interesting to explore how many of these graduates are from out-of-state and likely to return to their home state to work as a nurse (i.e., not helping solving the nurse shortage in Washington).

The chronic shortfall of graduates exacerbates issues like burnout of currently employed nurses, escalating financial losses by hospitals having to rely on “travel nurses,” and increased potential of diminished quality of care.

So, why can’t community colleges produce more nursing graduates? There is huge student enrollment demand, nursing career pathways offer strong living wages, and there is clearly no shortage of available jobs for credentialed graduates. The answer is a combination of three limited resources:

1. Faculty to teach the courses,
2. Clinical rotations for nursing students, and
3. Preceptors to supervise students in clinical environments.

A widely-reported factor is that a nurse employed by a hospital or health care system are paid significantly more than a nurse educator enployed by a community college.

Interviews with a number of hospital and health system leaders reveal a possible solution to boost the capacity of these community college programs: set-up a large, long-term nurse educator program in which a senior nurses (with >5yrs experience) spend half a year as a provider and half a year as an educator, all the while being employed by their health care employer without a decrease in pay or disruption in benefits.

In addition to boosting a community college’s capacity to produce more graduates, these hospital and health system leaders see several upsides to this possible solution.

• Rotating nurses from clinical environments to the classroom could help reduce burnout,
• Keeping nurse educators active in the field (through rotations) ensure current experience with the workplace,
• Similar arrangements already in place in medical education can guide and inform implementation of this solution, and
• Stronger recruitment opportunities of current students and soon-to-be graduates.