Between January and early May of this year—four months—Mary Washington Healthcare hired 106 new nurses.
“We hired approximately 49 new graduate resident RNs [registered nurses] in March of 2019 and are on target for a class the same size starting in July of 2019,” said Darla Burton, director of physician and associate recruitment for MWHC.
Despite all these new hires, there were 172 open RN positions at MWHC as of mid-May.
Germanna Community College graduates between 130 and 140 new nurses each year.
“You would think 140ish a year would fill up any demand, but we did a study and found there is still tremendous need,” said Patti Lisk, dean of nursing and health technologies at Germanna.
According to a 2015 Chmura Economics and Analytics study conducted for Germanna, the local health care and social assistance sector will need more than 11,000 new workers over the next 10 years.
It’s not just a local problem. The United States is in the midst of a significant nursing shortage that promises to get more pronounced in the next 10 to 15 years. According to the Bureau of Labor Statistics, more than 438,000 new RN jobs are expected to be added to the workforce by 2026.
Several factors contribute to the nursing shortage.
Nationwide, just under 40 percent of all adults are obese, and obesity-related conditions such as heart disease, stroke, type 2 diabetes and certain types of cancer are the leading causes of preventable death. Skilled nurses are needed to care for patients with these conditions, as well as the health care needs of aging baby boomers.
“We as a society demand highly acute care,” Lisk said.
Another cause of the shortage is that women now have more career choices.
“It used to be that teaching and nursing were basically the two careers available to women,” Lisk said.
While the numbers of male nurses have increased, men still make up only 12 percent to 15 percent of the nursing workforce, Lisk said.
And that workforce is starting to age.
“The average age of a nurse is 45 to 50,” said Eileen Dohmann, senior vice president and chief nursing officer at MWHC. “When we get old and retire, we should have people in the wings to take over.”
According to a July 2017 article in the Journal of Nursing Regulation, 1 million RNs will retire by 2030. In 2019, the article estimates, the nursing workforce will lose more than 2 million years of experience—the number of retiring RNs multiplied by the years of experience for each RN.
“The departure of such a large cohort of experienced RNs means that patient care settings and other organizations that depend on RNs will face a significant loss of nursing knowledge and expertise that will be felt for years to come,” the article states.
Dohmann said some nurses employed by MWHC have been there for 40 years.
“When someone like that, who’s very seasoned, walks out the door, who do you replace them with?” she asked.
Janet Atarthi–Dugan, director of the University of Mary Washington’s Bachelor of Science in Nursing completion program, said that when she started her nursing career in a Chicago intensive care unit in 2001, she worked with two or three nurses who combined had about 60 years of experience.
Though it depends on the hospital and unit, this is no longer the norm in most facilities, especially in medical-surgical units, she said.
Medical-surgical nurses care for adult patients hospitalized for a broad range of reasons. Working in the medical-surgical unit was traditionally an entry-level position considered a stepping stone to specialty units.
“What I see is nurses stop practicing at the bedside and go back to school for advanced nursing,” Atarthi–Dugan said. “Before, we had people at the bedside with way more experience.”
According to the Bureau of Labor Statistics, the job outlook for advanced practice registered nurses—nurse anesthetists, nurse practitioners and nurse midwives—is expected to grow by 31 percent between 2016 and 2026.
That’s double the rate of job growth for registered nurses, which is 15 percent, and more than four times the average job growth for all occupations.
Though the need for specialty nurses is increasing, the need for experienced nurses at the bedside isn’t going away.
“When you don’t have an educated nursing presence, it impacts how we advocate for our patients,” Atarthi–Dugan said.
In 2014, the National Institutes of Health found that for every 10 percent increase in hospital nurses with bachelor’s degrees, there was a corresponding 7 percent drop in patient mortality.
The same study also found that when nurses are overworked, patient mortality increases. Researchers estimated that each additional patient in a hospital nurse’s workload increased the likelihood of a patient dying within 30 days of admission by 7 percent.
“So the question is, how to bring new nurses in and when they are in, how to keep them?” Atarthi–Dugan said. “How do you create a nurse who is empowered? It’s an investment to retain nurses. It needs to be intentional.”
Educating new nurses is one way to solve the nursing shortage, but this is difficult when there aren’t enough nursing schools, nursing faculty or sites where students can get clinical experience.
“The pipeline gets plugged up,” Lisk said.
Nurses in clinical settings command a high salary—$71,730 per year for RNs and $113,930 per year for advanced practice registered nurses, according to the Bureau of Labor Statistics. Academia doesn’t offer that same salary.
“Moving to academics can mean a $30,000 per year pay cut,” Atarthi–Dugan said. “Some don’t want to take that pay cut or they might have family to support and not have a choice.”
Dohmann said nursing schools across the country have to turn applicants away because there is not enough faculty.
Nursing students also have to do a certain amount of clinical hours—usually about 520—and clinical sites are limited.
“There are only so many hospitals and they’re busy,” Atarthi–Dugan said. “Some schools travel 45 minutes to an hour to clinical sites.”
This is more difficult in some parts of the country, especially rural areas where some hospitals are closing.
Dohmann said the Fredericksburg area is “different and unique” in that there are several facilities—Mary Washington Hospital, Stafford Hospital and Spotsylvania Regional Medical Center—that can support nursing students.
“Last year, over 700 students did rotations at Mary Washington Hospital,” Dohmann said.
Mary Washington Healthcare works closely with local nursing programs at Germanna and UMW to ensure there is an educated workforce to fill its needs, and the nursing programs are working to remove barriers that might prevent students from entering and achieving their degrees.
Students can become Licensed Practical Nurses, or LPNs, in about 18 months and RNs in two years. Lisk said Germanna has redesigned its nursing curriculum with Mary Washington Healthcare to make moving from LPN to RN “seamless.”
“The push is for nurses to be prepared for a [Bachelor of Science in Nursing], which is then only 30 more credits at a university,” Lisk said.
Germanna is in the final stretch of raising funds for a new Allied Health Center at its Locust Grove campus. An additional $2.9 million is needed, said Mike Zitz, communications and marketing director for Germanna.
It will have the same footprint as the existing health building but will be “more efficient so hopefully there will be more space that we can use more wisely,” Lisk said.
Germanna also recently expanded its nursing program to Stafford County.
“There are 20 students there now who are very excited to be there,” Lisk said.
Lisk said Germanna’s nursing program is “very highly regarded,” with an average of 98.9 percent of graduates passing the nursing licensing exams.
UMW started offering nursing programs in 2014. The one-year Bachelor of Science in Nursing completion program for RNs was initially funded by a grant from the Mary Washington Hospital Foundation. It is designed to complement Germanna’s program.
UMW also offers concurrent enrollment to students in Germanna’s RN program who want to get a start on their BSN coursework. Students can take summer classes at UMW at part-time tuition rates and are then guaranteed admission to the BSN completion program upon graduating from Germanna.
“It is to meet the needs of students who from a financial or practical standpoint can’t be in school full-time,” Atarthi–Dugan said. “The goal is to reach a diverse economic population. People want to be cared for by people who look like them and have shared experiences.”
For younger students who want a more traditional college experience, UMW and Germanna offer a four-year dual degree program, in which students live on campus and take classes at UMW and Germanna for the first three years, after which they become RNs and complete BSN coursework the last year.
This program is also designed to remove financial barriers, Atarthi–Dugan said.
Eastern Virginia Career College, a for-profit college in Spotsylvania that opened under a different name in 2000, works to meet the nursing shortage by preparing students to become LPNs in less time than other schools—just under a year, campus director Abdullah Johnson said. The school also offers an “advanced standing” program that prepares LPNs to become RNs in another eight months.
“Our program is very accelerated,” Johnson said. “It’s rigorous. Their schedule is 8 a.m. to 2:30 p.m. Monday through Friday, not including clinicals. I tell them it’s a temporary sacrifice to get where you want to be.”
EVCC, which graduates between 80 and 85 new nurses each year, sees itself as helping students with a passion for nursing who might not see themselves excelling at traditional two- or four-year institutions.
Toward that end, the school works to develop strong relationships with the career and technical education programs at local high schools, Johnson said.
“We don’t look at it as competing with other nursing programs. We want students to know there is another option,” he said.
Once new nurses enter the profession, however, it can be a challenge keeping them there.
“It’s a shock to go from nursing school to actual nursing,” Atarthi–Dugan said. “There is a workplace environment challenge.”
At graduation, Dohmann said, new nurses “know enough to pass the test,” but translating that to caring for actual patients is hard.
“People are not at their best in the hospital,” Atarthi–Dugan said. “They’re vulnerable.”
In 2013, MWH established a residency program for new nurses that is helping to ease the transition from school to the workplace.
New hires meet on a regular basis with a facilitator, who is a clinical nurse specialist, and also check-in monthly with the other new hires in their cohort to talk about how things are going.
When the new hire program started, one group of 15 recently graduated nurses was brought in once a year. Now, new groups start four times per year.
Since 2013, nurses who go through the new hire program are staying with MWH at a rate of 92 percent, Burton said.
“We are constantly looking at how we are recruiting and how to seek the experienced nurses we need,” she said. “We have to pay attention to the level of experience per shift, per floor, per day. It requires a lot of work from the hospital’s side.”
MWH also offers a scholarship to qualified RNs to pay for their BSN coursework while they work.
In addition, Dohmann said the hospital is making use of “creative staffing” to meet the shortage.
In 2018, MWH partnered with an organization that sponsors nurses from other countries and brings them to the U.S. to work.
“The nursing shortage is not international,” Dohmann said. “These are nurses with 15–20 years of experience who can’t find work in their home countries.”
Forty-seven international nurses—both men and women, from countries including Jamaica, the Philippines, India, Canada, Egypt, Syria and Sri Lanka—are now employed at MWH and are going through the process of becoming U.S. citizens.
“Our hope is that they’re here to stay,” Dohmann said.
The hospital is also invested in helping empower its nurses, she said. The Advancing Clinical Excellence program gives nurses the opportunity to take on a project, such as leading the implementation of a new medical procedure or piece of equipment.
Nurses can advance through four ACE levels.
“The whole intent is empowerment,” Dohmann said. “You want nurses making decisions about their practice.”
Atarthi–Dugan said she thinks nurses recognize the role they play in improving patient outcomes, but she doesn’t think the wider public does.
“We’re not just taking orders from doctors,” she said. “We change lives. We save lives.”