Struggling to Fill a Dangerous and Growing Labor Gap

Hospitals across the country continue to hemorrhage nurses as many retire or leave the profession exhausted and stressed out after more than a year and a half of tending to sick and dying patients infected with the coronavirus.

Would-be nursing students appear eager to fill the gaps -- enrollment in nursing programs over all is rising -- but colleges and universities are struggling to meet the demand. They are hampered from expanding their programs by high costs and limited budgets, a shortage of nursing faculty members, and insufficient facility space to accommodate more students.

Enrollment in bachelor’s degree programs in nursing rose 5.6 percent last year, according to the latest enrollment data from the American Association of Colleges of Nursing. Enrollment in master’s degree programs rose about 4 percent, and in doctoral nursing programs it increased almost 9 percent.

“With the pandemic ushering in a period of unprecedented change and innovation in higher education, schools of nursing moved decisively to adapt their programs to ensure a steady supply of nurses needed to join the fight against COVID-19,” Susan Bakewell-Sachs, chair of the association’s Board of Directors, said in a press release.

While she and her colleagues were pleased to see “across-the-board increases in nursing school enrollments,” they’re also aware that the numbers could have been far greater.

The association also reported that nursing schools turned away thousands of qualified applicants last year -- more than 80,521 people at four-year institutions alone -- because of limited resources, faculty shortages and space constraints.

New and Ongoing Hurdles

Janie Heath, dean of the College of Nursing at the University of Kentucky, wants to double the number of undergraduate students enrolled in the nursing program, from about 300 to 600 students per year, but that expansion will require more classroom space, more faculty members and additional mental health support services, among other costs.

“All of us are looking at how we can step up and do more to address the shortage, and we need to start doing it yesterday and plotting that out over the next five years,” she said.

Heath noted that the pandemic exacerbated the challenges nursing schools were already experiencing as veteran nurses worked longer hours, witnessed record numbers of deaths and risked infection and death themselves -- all widely covered by the news media -- and left the profession in droves.

“You put that on top of those everyday challenges, working so hard day and night, shift after shift, weekends, holidays,” she said. “And the COVID patients just kept coming in and kept coming in. You just didn’t see any relief in sight. You can only do that for so long, that physical toll, that emotional toll.”

Community colleges in particular struggle to add seats to their nursing programs because of the expensive equipment needed to train students and competitive salaries required to attract new faculty members, said Frank Freidman, president of Piedmont Virginia Community College.

His college will expand its associate degree nursing program by 50 students each year starting in January, bringing the annual enrollment to 150. The increase was in response to a request by the University of Virginia Medical Center, and the goal is to graduate more nurses -- more than 200 people typically apply to the program each year -- and to have two graduation cycles, one in May and one in December, so hospitals don’t have to wait a full year for new graduates.

Freidman said the expansion would not be possible if the UVA Medical Center and an anonymous donor hadn’t contributed a total of $700,000 to pay for three years of start-up costs, which include a new nursing lab at one of the college’s satellite campuses and two new full-time faculty members.

“These are high-cost programs, and yet they’re very needed in the community,” he said.

Many health-care professionals and nurses themselves consider the national shortage dangerous to public health over all. Some hospitals have reduced the number of beds available to non-COVID-19 patients and postponed elective surgeries because their facilities are understaffed.

The American Nurses Association has called on the federal Department of Health and Human Services to declare a national nurse staffing crisis. The letter describes a “chronic” dearth of nurses that has lasted for years and is now so extreme that states such as Mississippi and Louisiana reported a loss of thousands of nurses and Tennessee had to call on the state National Guard to make up for a lack of hospital staff.

“Now, it is imperative that the Administration acknowledge and take concrete steps to address a more dire shortage: a crisis-level human resource shortage of nurses that puts our ability to care for patients in jeopardy,” Ernest Grant, president of the association, wrote.

Eileen Glover, department chair of allied health and director of the licensed practical nurse program at River Valley Community College in New Hampshire, said nursing shortages aren’t new, especially in states such as New Hampshire, where the population is older and many nurses are retiring.

“All the sudden, everyone is losing their minds,” she said. “We’ve known about this for years. It’s not like we didn’t know this was coming. But the COVID-19 pandemic certainly exacerbated it. Folks who have been at the bedside for a while said, ‘That’s it. I’m done.’”

The American Association of Colleges of Nursing released a survey in September that found that the national vacancy rate for nursing faculty positions increased to 8 percent from 6.5 percent from 2020 to 2021.

Part of the reason for the faculty shortage is that colleges offer less competitive salaries than clinical jobs, Glover noted. One faculty member in Glover’s program recently announced that she was leaving because she couldn’t afford to continue working at the college, despite her love of teaching.

“Nurses at the bedside can make an awful lot more money than we do in education,” sometimes as much as 40 percent more than full-time faculty members, she said. “And where nurses are in such high demand now, that wage gap between bedside nursing and education is going to continue to grow.”

Community colleges have the added challenge of competing not just with hospitals but also with universities, which can pay higher salaries, Freidman said.

Michael Hansen, president of the Michigan Community College Association, said community colleges in his state are facing what he considers a legislative barrier to addressing nursing shortages. Some community college leaders want their institutions to offer bachelor’s degrees in nursing, which are increasingly required by hospitals, but community colleges are prohibited from doing so by state law. Legislation passed in 2012 only allows community colleges to offer baccalaureate degrees in four subject areas, none of them in health-care fields. Legislators are currently preparing a bill, with help from the association, that would add nursing to the list in an effort to train more nurses.

Hansen believes some students aren’t applying to or graduating from four-year nursing programs because they cannot afford university tuition or they live in rural areas of the state that don’t have universities.

“We just don’t have the luxury anymore to have some of these artificial policy barriers in place,” he said. “We’re trying to cast bigger nets and catch those students who otherwise would have no other option.”

Taking Action

Despite the challenges they face, colleges and universities are forming new partnerships and securing new investments to grow their nursing programs.

The Southern Maine Community College Foundation, for example, received $500,000 from philanthropists to add a new, endowed nursing faculty position.

“As Maine faces a projected shortfall of thousands of nurses in the years ahead, it is imperative that we expand our training opportunities for people to become nurses,” Michael Nozdrovicky, chair of the nursing program, said in a news release. “This gift allows us to do just that.”

Elgin Community College in Illinois is hosting a health-care fields job fair this month. The college advertised that it has 10 open positions for health-care professionals, including a nursing program director.

Purdue Global School of Nursing announced a partnership with the Wellness Council of Arizona, a nonprofit that works with health-care providers and businesses to improve the health of employees and their families. The online affiliate of Purdue University will offer council staff and their immediate family members a 20 percent tuition discount on undergraduate nursing programs, a 14 percent discount on graduate programs and a 10 percent discount on doctoral programs.

River Valley Community College partnered with two other community colleges in other parts of the state to expand its licensed practical nursing program to regions where nursing shortages are most acute. The college offered the program at two of its own campuses and on the campus of Lakes Region Community College this academic year. River Valley will also start offering classes at a campus of White Mountains Community College. The program graduated its first cohort of 14 students in 2020 and will welcome a cohort of about 70 students, out of about 280 applicants, for 2022. It received 200 applications in 2021.

“In three years, we’ll have quadruped the size of the program,” Glover said.

Heath, of the University of Kentucky, said efforts to graduate more nurses are critical. She said if nursing shortages persist and higher education institutions can’t produce enough nurses, “the safety of our patients, our families, our communities are at risk.”