Fewer nurses are working longer hours and caring for more patients — thanks to a combination of tight hospital budgets and an aging workforce. And in Colorado, the problem is nearly twice as acute as in the rest of the nation. Colorado health care experts say there is currently an 11 percent nursing shortage statewide, a figure expected to rise to 31 percent in the state by 2020.
In Colorado Springs, UCCS, Memorial Hospital and Penrose-St. Francis Health Services have all come up with ways to address the nursing shortage – with more training, different platforms and a commitment to cooperation.
For hospitals, adding nurses actually saves money. Figures from the American Nurses Association show that increasing the number of registered nurses can save $3 billion — avoiding 4 million extra days of hospital stays for patient problems like infection. And adding more nurses has been shown to eliminate one-fifth of all hospital deaths, simply because nurses can help avoid medical errors.
But the move to educate more nurses is facing an uphill battle. There are plenty of people interested in nursing education, but not enough nurses with advanced degrees to teach them. Rural areas face even more serious shortages, and budget cuts have led nurses — many of them in their first year on the job — to flee the profession completely. Added to the education problem: There are mandates that 80 percent of nurses must have bachelor’s degrees by 2020. How do nurses with associate degrees continue to work while obtaining bachelor’s degrees?
Local hospital solutions
Hospitals and universities work together to educate nurses, but in Colorado Springs, local hospitals have taken that training a step further.
At Memorial Hospital, the system started a year-long training program for first-time nurses, those with fewer than 18 months of experience. They spend their first week learning at the simulation center, training on specific scenarios with experienced nurses.
“We’ll have them do things like deal with a mother and child,” said Teresa Taylor, director of professional development resources at Memorial. “Or we’ll put them in a situation where they have to be comfortable confronting a doctor — the medication is wrong or the patient’s status is changing. Things they’ll face on the floor.”
After the first week, new nurses spend one day a month in the simulation center, receiving real-world training on high-tech mannequins and machines that mimic actual patient problems.
The reason for implementing the simulation center in 2009 was that most nurses quit in their first 18 months, Taylor said. The additional training after graduation is crucial to keep them interested and involved in the field.
“And it’s working,” she said. “We started our 25th class this week, and our retention rate since 2009 is 97 percent for first-year nurses. That’s excellent for a hospital.”
There are other ways to bring nurses to Colorado Springs. Deb Nussdorfer, Magnet coordinator at Penrose-St. Francis Health Services, says the hospital can showcase its working environment while student nurses are doing clinical rotations.
“It’s a chance to get them to see what working here would be like,” she said. “And it’s a great recruiting tool.”
Penrose also has launched a five-year effort that has been proven to attract and retain nurses. Called the Magnet certification, Penrose is hoping to be the first hospital in southern Colorado — and one of only seven in the state — to achieve the certification, proving that the system is a good place for nurses.
“It’s creating a system of nursing excellence,” she said. “Showing accountability, strong clinical outcomes, quality care, a great working environment where employees are recognized and appreciated. We have to prove satisfaction across the board — with patients and with the nursing staff.”
The hospital sent in the credentialing packet earlier this year, and believes the accrediting agency will be visiting on-site this fall.
“It’s very exciting for us,” Nussdorfer said. “Because having this certification is proven to increase recruitment and retention.”
Currently, Penrose’s turnover rate for registered nurses is 17.8 percent. Nationally, the level is 28.3.
The program started in the 1980s as a response to the retention problem in nursing. Since then, only 400 hospitals nationwide have earned the status.
“It makes recruitment easy,” she said. “It shows the hospital environment is one of the best places to work.”
But both hospitals admit that while getting and keeping nurses in some areas is easy, in others, it requires on-the-job training programs.
“Recruiting nurses in the operating room or in the emergency room is difficult,” Taylor said. “The same for ICU. So we’ve developed specific, special training for nurses who already work here to fill those slots.”
The training is specific to needs in each of the high-stress areas.
“One of our issues is to teach critical thinking skills,” Taylor said. “We develop situations that could be typical in the emergency department – acute care, critical care. That way, nurses are better trained to respond.”
And training nurses before putting them into the situation saves turnover costs, both hospitals say.
“New nurses are the most vulnerable,” Nussdorfer said. “And so you have to prepare them as much as you can.”
But the nursing shortage isn’t felt solely on hospital floors, in emergency departments and surgical suites. It’s felt at the area’s universities as well. There are not enough nurses with advanced degrees to teach classes at the schools, creating fewer opportunities for new graduates to enter the workforce.
According to the American Association of Colleges of Nursing, nursing schools turned away 75,587 qualified applicants in 2009 because there just aren’t enough teachers, clinical sites, classrooms or clinical preceptors. Almost two-thirds of the nursing schools reported that faculty shortages were the biggest reason for not accepting qualified applicants into the programs.
Nationwide, there are a total of 1,181 faculty vacancies at 662 nursing schools. And schools said there was a need for 103 additional positions to accommodate student demand.
Beth-El College of Nursing and Health Sciences at UCCS is no exception. But the school has created inventive ways to reach more students with its limited faculty.
The school has entered into agreements with rural community colleges in places like La Junta, Lamar and Otero County. Nursing students there can go to classes via high-tech tele-teaching via video monitors. The classes are taught at UCCS, but students don’t have to leave home to take them.
“It helps because they’re more likely to stay there and work there,” said Nancy Smith, dean of the college of of nursing. “And rural shortages are much worse than those in Colorado Springs.”
But that’s not all. The four-year university works with the two-year college to create dual-status programs for nursing students. Recently, a student graduated from community college in Lamar with an associate degree in nursing, and three months later, graduated from UCCS with a bachelor’s degree in nursing. The programs allow students to take enough courses to earn a bachelor’s degree in less than three years.
“It’s not for everyone,” Smith cautioned. “If you have a full-time job or kids at home, this program isn’t for you. It’s intensive, and it’s fast-paced.”
But even these programs might not be enough to stem the flood of retiring nurses, she said.
“We just don’t have enough nurses with graduate degrees,” she said. “And that’s the real problem. We’re just limited by faculty, by clinical sites. We need more solutions.”