Our nurse supply is running out

In the early days of the pandemic, we heard repeatedly about hospitals hitting capacities. Medical staffs were slammed, with no relief in sight. Today, we’re seeing medical facilities hit their capacity limits again, only the cause isn’t overwhelming Covid cases. There simply aren’t enough nurses.

“Up until Covid, I think the attitude for many was that there was an inexhaustible supply of people who wanted to work in the health care field,” said Terry Buxton, chair of the Department of Nursing at Metropolitan State University of Denver. “Kind of like how the lumberjacks thought they’d never run out of trees in Seattle. Only we did.”

In Colorado, the recently passed HB22-1401 requires hospitals to create, implement and evaluate nurse-staffing plans. While this is a step in the right direction, said Christopher Looby, affiliate professor in the Department of Health Professions at MSU Denver, it doesn’t address the underlying problem: a lack of nursing teachers.

Buxton made it clear that plenty of qualified people are applying to the Nursing program, but due to a lack of educators, the program can accept only a fraction of them, about 75 students per year.

Part of the problem is that clinical faculty members must have a minimum of a master’s degree. What’s more, preceptors (licensed clinicians who oversee Nursing students during their clinicals) must have a bachelor’s degree. “So if somebody has an associate’s degree from a community college, they can’t really precept our Nursing students. So that makes it hard,” Buxton said.

Also, salaries for Nursing faculty members aren’t nearly as high as salaries for practicing nurses, who can pick up additional shifts or work overtime. Nurse educators might not even make enough to cover their school loans. Working in education is often a labor of love.

“We’ve been wrestling with being able to get Nursing faculty for a while because of the requirements for our profession,” said Buxton, who’s also the co-chair for the Colorado Council on Nursing Education, a statewide organization of deans and directors of nursing programs.

“To have well-educated Nursing students, you have to have a cadre of well-educated faculty members who can teach those students,” she added.

Nursing and the supply chain

Looby teaches in the School of Business at MSU Denver as well as the Department of Health Professions. He specializes in predictive analytics, i.e., helping hospitals forecast patient volume and suggesting the right level of labor supply to meet expected demand.

During Covid, he said, the labor supply ran out, just as you might run out of water, coal or other resources. “We ran out of bandages; we ran out of masks; we ran out of people,” he said.

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Part of the problem, he said, is that hospitals can get stuck on treating each patient as totally unique versus part of the whole. “There’s an underlying belief in the health care industry that every individual who seeks care is completely unique,” he said. “And they are. But how do you aggregate that?”

Generally, he said, systems need to see that there’s “more sameness than difference” among patients seeking care so that appropriately skilled staff can be scheduled to handle similar patient-severity levels.

Accurately predicting nursing labor-supply needs is one step in the process. But Looby also agrees with Buxton’s assessment that there’s an underlying problem. “We have a supply-chain issue of teaching people to be nurses,” he said.

Buxton’s goal is to raise the educational level of the existing nursing workforce so that those who are interested in education can get involved and those who want to be nurses can be admitted into a nursing program. And she has already made progress toward that goal.

MSU Denver students who graduated from 2019 to 2021 passed their NCLEX (National Council of Licensing Examinations) tests, the standardized test for all graduating nurses around the country, at a rate of 88% to 100%. The national pass rate is 83%. “We didn’t just perform — we outperformed compared to peer programs,” Buxton said. “And we will continue to do so.”

What’s more, she believes that the more applicants MSU Denver can accept, the more diverse, equitable and inclusive the profession will become. It’s going to take more than just changes within one nursing school, though.

“To assure that we always have a well-educated, steady workforce, I believe it will take cooperation and collaboration among all of the nursing schools in Colorado,” she said. “Not just now but well into the future.”