NEW HANOVER COUNTY — Healthcare professionals and leaders from the local level to the federal government have a large problem on their hands — the national nursing shortage.
It’s a problem cited by officials at Novant-New Hanover Regional Medical Center, which serves a seven-county region. The health provider has largely attributed lack of sufficient staff to the national shortage, with leaders frequently touting they are not alone.
The hospital has faced problem after problem this year and was placed in immediate jeopardy of losing its Medicare contract in June for hospital conditions that caused — or were likely to cause — serious injury, harm, impairment or death to a patient. NHRMC’s status has since been restored to compliance with the Centers for Medicare and Medicaid.
Crystal Tillman, chief executive officer of the North Carolina Board of Nursing, which issues nursing licenses, provided a more optimistic picture to Port City Daily.
“In the last two years, our numbers, the percentages, just keep going up for nurses,” Tillman said.
Since 2020, when Tillman started in her position, she said the number of nurses renewing their licenses — required every two years — has gone up by 3.9%. Students completing the licensure exam rose 5.2% since last year. And the number of endorsements, or nurses moving from other states to work in North Carolina, went up almost 13% since last year.
Tillman shared New York, Ohio and Pennsylvania were the top three states from which nurses were relocating. They add to the 153,000 licensed registered nurses across the state.
Still, research shows the state faces a deficit of nurses, an issue that existed before Covid-19 sent the shortage into overdrive.
According to N.C. NurseCast, a study led by the UNC-Chapel Hill Sheps Center, N.C. Board of Nursing, and Strategic Modeling Analysis and Planning, the state will have a 12,500 nurse deficit by 2033.
The issue has now attracted more attention from the federal government.
Last week, North Carolina’s U.S. Sen. Thom Tillis co-introduced the bipartisan National Nursing Workforce Center Act to Congress, along with senators Jeff Merkley (D-OR) and representatives Lisa Blunt Rochester (D-DE) and Young Kim (R-CA).
Under the Health Resources and Services Administration, the legislation would establish a three-year pilot program to fund existing state-based nursing workforce centers, while also potentially creating them in states currently without one.
The act also gives HRSA the authority to establish a nursing-focused research and technical assistance center.
Both initiatives would be tasked with examining nursing issues and compiling data for state and national leaders to use in policymaking.
“Resolving existing nursing workforce challenges, which have been compounded by the pandemic, the increased demand for healthcare services, and the aging workforce, requires innovative approaches that support and strengthen every aspect of the nursing workforce pipeline,” Tillis said in an announcement sent to media.
Dennis Taylor, nurse practitioner and former president of the North Carolina Nurses Association, told Port City Daily the association and other organizations have been warning state leaders of the impending shortage for decades.
“We knew that there was going to be a pretty large group of folks that would be exiting the job market,” Taylor said. “And we knew that we needed to have what we needed to prepare for that.”
Tillman explained nurses of all ages experiencing burnout also left high-stress environments, like acute care and emergency departments.
“[Staff experiencing] high stress in the hospital settings, especially in the ICU, emergency departments — nurses are getting burned out, and they’re, they’re leaving to go to something else,” Tillman said.
Nurses started departing just as more patients and an aging-population filled more waiting rooms and appointment slots. Now, as the world emerges from the pandemic, people that put off care are finding medical conditions have worsened, leading more people to the ER. Compound those patients with people that cannot afford routine medical care, and healthcare facilities are regularly operating near capacity.
Novant officials called it the “perfect storm.”
Still, the provider continues “aggressive” recruiting efforts, hiring 140 nurses from June 22 to Aug. 31. However, in a press conference with media on Sept. 9, John Gizdic, executive vice president and chief business development officer of NHRMC, said North Carolina is expected to be the second-most impacted state when it comes to the nursing shortage.
Gizdic was citing research from Mercer, an asset management company, that found North Carolina is currently lacking around 4,000 registered nurses with that number tripling to 13,000 in 2026. The only state projected to suffer nursing shortages more than North Carolina is Pennsylvania, according to the data.
Taylor said what’s evident, and what nursing organizations knew 20 years ago, was the state needed to increase enrollment.
“The Sheps Center says that we’re going to need somewhere between eight [thousand] to ten thousand new nurses every year just to meet the demands of those nurses leaving the workforce,” Taylor said. “Our educational systems are only graduating about five to six thousand nurses a year.”
New Hanover County has two institutions that offer nursing programs — Cape Fear Community College and UNCW. Both schools have increased enrollment in the last four years to make more nurses available to the state’s workforce.
UNCW’s RN-BSN program has a cohort of 50 students that graduate in December and May. The college increased its admission allowance to 60 students in fall 2020. Over the last four years, the program has graduated around 400 students.
CFCC had an RN cohort between 60 and 75 every year since 2019, graduating 268 nurses. These nurses tend to employ closer to home, with 175 students accepting local jobs, according to Sonya Johnson, vice president of marketing and community relations.
The data shows UNCW students branch out more, with many choosing to take positions in the Triangle.
Novant also hired 88 nurse graduates who started work at NHRMC on July 11, with 31 scheduled to begin employment by the end of August.
Both Taylor and Tillman told PCD the real chokehold on enrollment is the lack of instructors to meet the demand of students that seek a degree.
The nursing board requires schools to maintain a 1:10 teacher-to-student ratio and instructors must have a master’s degree, sometimes even a doctorate. To graduate more nurses, an institution needs more qualified faculty, also experiencing a shortage due to better pay offerings in other sectors.
“Nurses who go to get a master’s degree, they’re not wanting to get it in nursing education,” Tillman said. “They’re willing to do it in administration, nurse practitioner, midwife, nurse anesthetists. They won’t do that for an advanced degree because in nursing education, you don’t make that much money.”
Johnson explained CFCC experiences some challenges competing in a high-demand nursing market. Salary demands can be difficult to meet, for instance.
“Most nursing faculty choose to work in educational settings because they enjoy working with students and helping the next generation of healthcare professionals prepare to work in the field, but they can’t ignore the financial incentives available in the private sector,” Johnson said.
CFCC has been able to increase some salaries with retention funding provided by the state, she confirmed.
Tillman said attracting nurses to a facility is one thing, but the problem arises in retaining them. Increasing pay and improving working conditions helps keep hospitals staffed with experienced nurses, according to Tillman, especially in areas that experience high levels of turnover.
Taylor added that salary discrepancies between new positions and nurses who have been in the profession for years also plays a role.
“If I have worked somewhere for five or 10 years, sometimes some places are bringing people in as new grads, making it as much as someone who’s been there for five or 10 years. So that, clearly, does not help with employment loyalty,” Taylor said.
To replace them, many hospitals, especially Novant NHRMC, have to rely on travel nurses. After cutting back on travel contracts in May, exacerbating problems leading to the hospital’s “immediate jeopardy” status, Novant is increasing travel contracts to staff NHRMC.
However, at the September press conference, Gizdic said its level of travel contracts is not “financially sustainable,” as travel nurses are typically paid more, sometimes double or triple, than staff nurses.
Taylor agreed with Gizdic’s assessment and added, while it amends issues in the short-term, it can also damage efforts to preserve permanent employees.
“For the nurses that are currently working at your institution,” she said, “they’ve been there — they’re loyal employees, and now you bring in a temporary person and you pay them sometimes two to three times what regular employees are getting paid. It’s a huge dissatisfier.”
In the conference, Gizdic said the hospital is working on a plan to eventually move away from NHRMC’s heavy reliance on travel nurses once again. He said the facility is exploring building care teams consisting of nurses and other positions, like nurse aides of licensed practical nurses.
Tillman noted more LPNs, which typically work in long-term care facilities, are moving to hospitals to assist.
Taylor said he is seeing more innovative care techniques in facilities to respond to employee scarcity and increased patient acuity. It includes shifts in care, moving from hospital settings to more home-care initiatives and mobile clinics to address patient needs before emergencies arise.
“I think what you’re beginning to see now is a little more creative utilization of people and allowing them to practice at the top of their license,” Taylor said.
The next step for the state legislature is supporting policies that allow healthcare workers to use their highest skill sets and facilities to utilize all of their resources, according to Taylor. It’s the main proposal behind the NCNA-backed SAVE Act, introduced to North Carolina lawmakers last year.
“We really believe that most of the significant improvements that need to be made will eventually have to be something that is run through the General Assembly,” Taylor said.
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