The registered nurse shortage is again in full bloom here in South Carolina and in regions across the US. We now have an estimated 2000 RN vacancies across the state. This is the highest rate of shortage we have seen in the past decade. The shortage, especially significant for bedside nursing in hospitals across the Midlands, impacts our ability to educate new students, especially with reduced clinical site availability for the 1000+ clinical hours of training required of our students. Besides a critical shortage of bedside nurses, there is also a significant shortage of nursing faculty prepared at the doctoral level both nationally and regionally. The faculty shortage, along with the reduced clinical training opportunities for students, makes it even more challenging to increase the supply of future nurses.
How did we get to this point? Most experts agree that during the heightened recession beginning in 2007, nurses stayed in the workforce. Nurses delayed retirement and younger nurses who may have worked part-time, worked full-time to meet their family’s financial needs. As the economy has improved nurses have exited to retire, stay at home, work part-time, or explore other options away from bedside nursing. With the shortage the intensity and complexity of the clinical environment in acute care settings becomes even more difficult with nurses working harder with fewer resources, assuming additional patients/responsibilities and often burdened with overtime and additional shift work. Further, hospital based staff nurses are working side by side with an increasing number of travel (temporary) nurses at double the costs to health systems. Indeed, it will be essential to raise salaries of experienced bedside nurses who have other options in order to retain them at the bedside. Additionally, there is a need for higher salaries for nursing faculty (who typically earn lower salaries than their counterparts in clinical settings) to recruit and retain experienced educators.
How is the College of Nursing responding to help address this issue?
Our Center for Nursing Leadership, under the direction of Dr. Ronda Hughes, and our Office of Healthcare Research for Nursing collects and reports state level data on the workforce, both from the supply and demand perspectives. See links to these reports here.
We use this workforce data to message the shortage to key stakeholders, including the media, policy makers, legislators, and system level administrators across the state. Susan Outen, Ronda Hughes, and I are currently working on a collaborative legislative initiative with other Schools of Nursing and the SC Hospital Association to request faculty salary enhancements and new faculty from the state legislature. In the last month, we have had two media releases that highlight the shortage and need for nurses to work at their full scope of practice. The Center also hosted 20 top chief nursing executives across the state in February to discuss the nursing shortage and potential solutions.
With the leadership of our undergraduate faculty, Prof. Susan Beverung (Assistant Dean), Dr. Georgia Narsavage (Associate Dean) and other prior key administrators, we have revised our undergraduate BSN program to twice a year starts for upper division (summer and fall) to produce graduates twice a year (May and December). We continue to produce 200 – 220 BSN students per year, more than any other BSN program in the state. Besides the highest quantity, we have the highest quality graduates with the highest pass rates of other BSN programs in the state with a 96% NCLEX RN licensure pass rate in 2016.
The College is piloting unique simulation experiences in our simulation laboratory to enhance clinical training where clinical site availability is limited (i.e., behavioral health settings). Our new director of the simulation lab, Dr. Rachel Onello, is working with faculty on competency assessments for all clinical courses, to ensure patient safety and quality of care, at each stage of the student’s progression.
We are exploring the possibility of adding a new program-- an accelerated BSN program--in which individuals with a bachelor’s degree in another field can complete the BSN in four semesters. This option produces mature, second degree nurses more quickly for the workforce. This will be an addition to our current generic BSN programs in Columbia, Salkehatchie, and Lancaster, in which students enter pre-nursing as freshman and move to upper division nursing in their junior year. We are in the process of securing needed clinical placements for the accelerated nursing program, along with developing a business plan for operations, to determine feasibility of adding this new initiative.
We have reinitiated our RN-BSN program, under the leadership of Dr. Joy Rivers, which is offered online, with flexible scheduling and at a low cost to assist associate degree nurses to obtain their BSN. We currently have several matriculation agreements with technical colleges to offer a seamless transition from the ADN to BSN degree. We are working with our system partners, donors, and foundations for scholarships for these students and students in all of our programs to reduce their overall financial burden to return to school to enhance their education.
The College is working with our major clinical partner, Palmetto Health, to explore strategies to improve new graduate readiness for work, as well as improve retention and overall satisfaction with nurses’ work environment at the bedside. Academic and clinical leaders are working side by side to explore curricular innovations, technological advances and other process re-engineering strategies to assist with the overall efficiency and quality of patient care by a registered nurse. I now serve on the Board of Directors for Providence Health, which is also a significant partner for USC, and we are working together to increase clinical placements and scholarships for our students and strategies to retain nurses at the bedside.
Our graduate programs, including our MSN-Nursing Administration program, led by Dr. Carolyn Harmon, is preparing nursing managers and directors to effectively lead units and organizations
during these times of rapid change. Our DNP Nurse Executive program, led by Dr. Ronda
Hughes, is preparing Chief Nursing Officers and other high-level nursing administrators
to improve outcomes for nurses and patient centered care, especially with data driven
decision-making. Our clinical MSN and DNP programs-- led by Dr. Alicia Ribar, along with Dr. Sheryl Mitchell (Acute Care Gerontology NP and Family NP) and
Dr. Tena Hunt McKinney (Psych Mental Health NP)--are preparing nurse practitioners for primary care, acute care, and behavioral health settings, especially in underserved areas. We are training nurse practitioners in telehealth delivery in order to increase access for patients to primary care and specialty services, especially where clinical services are limited in rural areas in our state. Over the past 10 years, over 90% of our nurse practitioner graduates have remained in South Carolina to provide access to all South Carolinians to health care.
Our Partnership Board, under the leadership of Dr. Stacy Collier, is working with us to message the contributions of nursing to our community, extend our partnerships and raise funds for student scholarships.
We are adding new talent to our team, most recently with the addition of three new faculty: Dr. Gaye Douglas, Dr. Crystal Graham, and Dr. Rachel Onello. We are busy interviewing other faculty for key positions in our College with an expected 7-10 additional faculty joining us in the Summer/Fall, 2017. We have also increased nursing faculty salaries over the past 3 years to remain competitive with the clinical and academic workforce. However, there is still room for improvement and we hope to continue to optimize salaries of nursing faculty at all ranks.
Finally, we are working to promote more nurses on executive Boards and to be at the table for decision making and policy development where nurses live and work. In order to optimize nurses’ role and their work environment, we need a voice, data-based decision making and influence to shape our future.
There are many initiatives going on in the College and addressing the shortage of nurses is critical to our current mission. Please join us in messaging not only the shortage and its impact on patient care and nurses, but also on solutions and creative strategies to address this issue.
Jeannette O. Andrews PhD, RN, FAAN
Dean & Professor