Sunday, April 9, 2017

Some hospitals in Kentucky can't find enough nurses

Editor's note: A longer version of this story was published April 4.

Highlands Regional Medical Center nursing interns
By Melissa Patrick
Kentucky Health News

Studies show Kentucky will have a surplus of registered nurses in the next decade, but many of the state's hospitals are struggling to hire enough nurses to care for patients.

"We are feeling it in our facilities," Susan Ellis, the vice president of patient care services at Highlands Regional Medical Center in Prestonsburg. "You really can't run your facility without your registered nurses; they are at the patients' bedsides."

Most of the state's critical-access hospitals, which usually have fewer than 20 patients at a time, haven't been hit by the shortage. But at any given time larger Kentucky hospitals may have between a 10 percent and 40 percent vacancy rate, Ellis said.

Highlands is a 184-bed facility that needs about 120 registered nurses in its clinical area and is about 24 short, or 20 percent.

Chandler Medical Center, University of Kentucky (UKHealthCare)
The University of Kentucky, which operates a 569-bed hospital, also struggles with the shortage. UK HealthCare is in a "rapid growth" phase and has hired around 600 new nurses a year for several years.

"I think most of the folks in Lexington who are trying to hire registered nurses would share a similar perspective," said Colleen Swartz, the chief nurse executive at UK HealthCare. "For example, as recently as three years ago, which would put us in th3at 2013-14 time-frame, we would post a registered nurse position and get 20 applications for it, but right now we have positions that we have posted and re-posted and had no applicants."

Kentucky has about 45,500 full-time employed RNs, whose average annual salary is about $60,000, according to the federal Bureau of Labor Statistics. The Kentucky Board of Nursing website reports 69,337 active RN licenses in the state.

The latest Kentucky Occupational Outlook to 2024 report says the state will need an additional 16,047 full-time registered nurses between 2014 and 2024, mostly because of an aging population.

Peter Buerhaus, a health-care workforce expert at Montana State University, said a retiring workforce, health reform and the primary-care shortage will also drive the need for more nurses.

UK College of Nursing students practice (photo provided)
Research on the nursing shortage is mixed. Buerhaus's research found that Kentucky is expected to have "substantial growth" in the future, which is supported by another report that says the nation and Kentucky will have a future surplus of nurses; but another report projects a future national shortage.

Whatever forecast is correct, that doesn't affect today's nursing shortage in Kentucky, which is searching for innovative ways to fill those vacancies.

Staffing solutions and challenges

Both Highlands and UK HealthCare have returned to using agency nurses, who typically sign on for three months at a time.

Ellis, at Highlands, said it had been five to seven years since they had last used agency nurses, noting they can cost twice as much. UK's Swartz said it had been "more than a decade" since they had used them, but they now do, mostly in specialty areas.

Highlands Regional Medical Center (website photo)
Highlands also offers a sign-on bonus, has a nurse-intern program and has an incentive program for employee's who successfully refer an RN. It also plans to hire four internationally trained nurses, but Ellis said they too are expensive as the hospital pays their recruiting cost, which can be upward of $15,000 per RN.

Appalachian Regional Healthcare, an 11-hospital system that serves Eastern Kentucky and West Virginia, is reported to have severe nursing shortages, with around 177 RN job openings listed on its website, as well as many for licensed practical nurses. ARH offers a $5,000 signing bonus and a $2,000 employee referral incentive. ARH Hazard has also partnered with Galen College of Nursing to bring more RNs into the region. ARH opted to not answer questions on the subject.

More challenges

Nursing schools in Kentucky and the nation often turn qualified applicants away, and are struggling to expand because of aging faculty, who must be doctoral-prepared, and non-competitive pay, not to mention limited clinical access for training and student/faculty ratios that are mandated by the state.

Another challenge is that many nurses come out of nursing school with their sights set on the next job, such as nurse-midwife or nurse practitioner.

There is also a push for nurses with associate degrees, who make up 60 percent of Kentucky's registered nurses, to get baccalaureate degrees.

UK College of Nursing graduates (photo provided)
Pat Burkhart, professor and associate dean of undergraduate faculty affairs at UK's nursing college, said faculty are working on innovative ways to further develop the nursing workforce, with a focus on second-degree students and second-career military medics.

UK Nursing Dean Janie Heath stresses the importance of helping nurses become more resilient and the need for better work environments.

"Science is there," Heath said, "that if we are not taking good care of ourselves, we can't take good care of our patients, our families, our communities."

Burkhart added that students are looking for work-life balance, noting the industry isn't adjusting "fast enough" to this changing attitude.

This article was produced as part of the Health Care Workforce Media Fellowship of the Center for Health, Media & Policy, New York, N.Y.  The fellowship is supported by a grant from the Johnson & Johnson Foundation. Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

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