It is as predictable as high pollen counts and thunderstorms in the spring. Every few years Georgia — and the rest of the country, for that matter — experiences a severe shortage of nurses.
Only this time it’s different, experts say. This time there are no easy solutions — no way to import nurses from other countries to practice in the state; no way to open up more slots at nursing schools and technical colleges to crank out more registered nurses to help ease the shortage.
“We have a lot of qualified people applying for admission [to nursing programs],” said Fran Beall, president of the Georgia Nurses Association. “But we don’t have the faculty to teach them.”
For instance, the University of West Georgia School of Nursing, one of a handful of schools that significantly expanded their programs after a similar shortage 10 years ago, had more than 500 people apply to become students in its last call for admissions. But because it doesn’t have enough faculty, and lacks both classroom and clinical space, the school was limited to accepting only 120 students this year, said Kathryn Grams, the school’s dean.
Georgia hospitals say the nursing shortage isn’t as bad as previous years because of the economic downturn. “When the unemployment rate increases, the [nursing] work force shortage improves,’’ said Kevin Bloye, a Georgia Hospital Association vice president.
Still, what makes the critical gap in supply versus demand different this time is that about 33 million more Americans — including hundreds of thousands of Georgians — will get access to health insurance under reforms created by the 2010 Affordable Care Act. And while numerous studies have shown that the supply of primary care physicians may be inadequate to handle the influx of newly insured patients in 2014, relatively little research has focused on the shortage of nurses. But the gap clearly exists, even if exact numbers are hard to come by.
Beall said one step Georgia could take immediately is to create a nursing work force clearinghouse, through a state or private agency, that would keep better track of where nurses are practicing (in rural, urban or suburban areas, for instance), the level of their education, and how much longer they plan to work. Other states routinely gather detailed information about nurses when they renew their licenses, she said. (Nurses in Georgia have to renew their license every two years.)
The licensing board for the state shows about 106,000 registered nurses hold licenses in Georgia, but trying to determine how many of them are practicing involves combing through labor supply data, annual hospital and nursing home employment questionnaires, and a lot of guesswork. Almost two-thirds, or 65,000 nurses, are thought to be working in the state.
Estimates vs. reality
Using this and other numbers, including population and aging data, the state University System did a study in 2009 that projected a shortage of 26,300 nurses in Georgia by 2015 and 37,700 nurses by 2020. The supply of new nurses would not even keep pace with the exodus of those leaving the field, the state said, much less be able to keep up with the additional demand placed on medical providers as the baby boom generation begins to grapple with chronic diseases and acute conditions.
But it hasn’t exactly turned out that way. As the economic recession began ravaging household incomes over the past two years, many nurses put off retirement and stayed on the job. Others reactivated their licenses and returned to work, easing the shortage. The effect is likely to have been temporary, though, experts believe.
An improving economy will elevate retirement as an option for many nurses — especially those who have been working in the field for 30 or more years, Beall said. And hospitals, which employ about 63 percent of the state’s nurses, are treating more acutely ill patients, requiring them not only to increase their level of nursing support, but also seek better-educated nurses, Grams said. Numerous studies over the past two decades have pointed to lower mortality rates in hospitals where the majority of the nursing staff has at least a four-year degree.
“The patients we care for now in hospitals are there with more complex, acute conditions,” Grams said. “And hospitals are rightly demanding higher level training from their nursing staffs. They’ve increased their demand for baccalaureate degrees, and they are more and more interested in nurses with advanced practice degrees.”
Northside Hospital, with campuses in Atlanta and in Forsyth and Cherokee counties, says there is greater demand for nurses with particular skill sets, depending on specialty.
Emory Healthcare says the demand for experienced hospital nurses is higher for areas such as critical care, oncology, and the operating and emergency rooms, with new nursing graduates unable to meet the needs of more complex patients.
The Institute of Medicine, the medical arm of the National Academy of Sciences, issued a report last year calling for higher levels of education for American nurses so that they will be able to perform a range of health services that once were exclusively the domain of physicians. Policy analysts and experts believe that nurses must play a crucial role in working with physicians in primary care, especially in rural and underserved areas.
But extending the role of nurses in Georgia has never been easy. Consider that it took more than a decade for Georgia nurses, even those working under supervision of a physician, to be able to write a simple prescription or order tests for patients suffering from common conditions. (Georgia was the last of the 50 states to approve these practices, in 2006.)
To ensure a higher quality of care in hospitals and clinics alike, at least 80 percent of RNs should have a four-year degree as a prerequisite for practicing, the Institute of Medicine recommended. Nationally, only about half do now.
Training for Georgia nurses
In Georgia, the best estimate is that about a third of the RNs working in the state have a baccalaureate degree or higher. About two-thirds of all Georgia nurses get two-year or associate degrees — usually at technical colleges — or a diploma issued by a hospital-based program.
(All candidates for a RN license, regardless of training, must pass a nationally standardized exam. A licensed practical nurse, or LPN, generally has only a year of schooling and takes a different exam.)
State nursing schools and technical colleges have been trying to streamline coursework that will make the transition easier for nurses with an associate degree to complete a bachelor’s degree. Some schools are also setting up “second degree” programs for students who graduated with a bachelor’s degree in biology, chemistry or other related field, to be able to get a nursing degree in 18 months or less.
Similarly, nursing schools are trying to make it easier for four-year students to take online courses and enroll in accelerated graduate work so that they can qualify for advanced practice licenses, Grams said. Adding more doctoral level nurses will mean more nurses available to teach others wanting to enter the field.
Still, that’s been a tough sell among nurses. Many hate to give up practicing to go back to school, and there has never been much of a financial incentive to do so. (A recent survey found about 66 percent of nurses in Georgia said they have no plans to increase their current level of education.)
“Unfortunately in our profession, you don’t get richer by getting more schooling,” Beall said. “That’s why we have to get really creative at looking how we educate our work force. We can’t do it like we did in the 1970s and ‘80s and think it will work for us today.”