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Nursing numbers growing, but shortage remains a complex labor issue

Instructor Mei Sather (left) and registered nursing student Heather Nelson go through the symptoms of the "sick" manikin at Northland Community and Technical College in East Grand Forks. (Joshua Komer / Grand Forks Herald)1 / 8
Mercedes Efta tends to a "patient" in the nursing department at Northland Community and Technical College in East Grand Forks on Monday. (Joshua Komer / Grand Forks Herald)2 / 8
Registered nursing student Heather Nelson checks the heartbeat of a manikin that has symptoms she is attempting to identify and treat at Northland Community and Technical College in East Grand Forks. (Joshua Komer / Grand Forks Herald)3 / 8
Nursing tools stand at the ready at Northland Community and Technical College in East Grand Forks. (Joshua Komer / Grand Forks Herald)4 / 8
Nursing instructor Mei Sather uses a remote control to prompt symptoms in a manikin that students work to treat at Northland Community and Technical College in East Grand Forks. (Joshua Komer / Grand Forks Herald)5 / 8
Instructor Mei Sather gives instruction to registered nursing student Heather Nelson as Nelson diagnoses a manikin during a training exercise at Northland Community and Technical College in East Grand Forks on Monday. (Joshua Komer / Grand Forks Herald)6 / 8
Registered nursing students Mercedes Efta (left) and Heather Nelson work to even a manikin's breathing during a simulation at Northland Community and Technical College in East Grand Forks. (Joshua Komer / Grand Forks Herald)7 / 8
Registered nursing student Mercedes Efta checks the breathing of a mannequin, simulating part of her regular learning at Northland Community College in East Grand Forks, MN on Monday, November 21, 2016. (Joshua Komer / Grand Forks Herald)8 / 8

The nursing lab on the East Grand Forks campus of Northland Community and Technical College looks more like a hospital room than a classroom.

Throughout the day, nursing students attend to the various medical needs of lifelike manikins who take residence in hospital beds lining the walls of the practice ward. The mock patients are highly detailed. The one under the care of Heather Nelson, 22, during a Monday afternoon exercise is actually groaning on its own accord, its face molded into a contorted expression of discomfort.

As Nelson attends to the male manikin's symptoms, instructor Mei Sather—who acts as the voice of the patient, answering Nelson's various questions on his behalf—informs her he's vomiting, a complication the registered nursing student takes in stride. Later in the exercise, fellow registered nursing student Mercedes Efta, 21, steps in to help resuscitate the manikin with a bag valve mask.

The scene would be tense if the patient were not made of plastic, but the two students eventually stabilize their charge to the satisfaction of their instructor.

Both young women are intending to graduate from Northland's RN program in May, though they're already working under a more basic certification as licensed practical nurses.

In the school lab, Nelson said she found inspiration in actually working in her industry while completing the next step of her education.

"You learn something new each day in class that you can apply to your job, which is really cool," she said.

Nelson is employed on the Altru Health System oncology/renal floor in Grand Forks; Efta works at a RiverView Health facility in Crookston.

Both want to stay on with their employers after graduation. For the most part—provided they pass their board exam to earn their RN licenses—they'll be entering the field at a good time in nursing history.

The national economy could create 1.6 million job openings for nurses through 2020, according to a 2015 report released by the Georgetown University Center for Education and the Workforce. An increase in demand for nurses, coupled with an aging U.S. population and subsequent retirement of many current nurses, could yield a nursing shortfall of some 193,000 professionals.

At the present time, there are more than 127,700 total nurses with current Minnesota licensure. In North Dakota, there are now more than 19,600 licensed nurses.

Year over year, that picture will change; the Center for Education and the Workforce projected through 2020 about 4,400 new openings in North Dakota and more than 36,000 in Minnesota.

Efta said her job at RiverView's inpatient unit is already lined up for her once she passes the board exam. She was excited to be trained in the facility's labor and delivery practices and said she was interested in someday working in a neonatal intensive care or obstetrics unit. Overall, Efta was confident about the general prospects open to the nursing profession.

"You can just tell by looking at a newspaper ad—there's always a job there," she said. "I feel I can move anywhere and do anything. With nursing, you can work with babies, work in a hospice with dying patients or something else you wouldn't think of at first."

Nursing numbers growing, but still short

Along with much of the country, North Dakota is already in the midst of a nursing shortage, a status which can place new graduates in a strong position for job hunting. According to an annual workforce development report compiled by the North Dakota Center for Nursing, the state's supply of nurses at various certification levels might not meet demand for the next several years.

However, the nursing deficit isn't expected to be the same across the board. The center has projected the supply of certified RNs and their counterparts, advanced practice registered nurses, will stay close to equal with the total workforce demanded by the North Dakota population.

Over the past five years, the report states, the number of these kinds of nurses has undergone a substantial increase. If the current rate of RNs and APRNs added to the workforce in that time holds steady into the future, workforce supply could catch up to and surpass a high level of demand within the next five years.

The supply of LPNs is a different story. Though the number of more basically certified nurses has grown at a steady pace over several years, the center projects a "striking statewide shortage" to persist through 2023, with workforce supply gaining little ground on an increasing demand.

As new nurses move into the state or are sent into the workforce by educational institutions, there remains a substantial number of unemployed nurses in the state. The NDCN report estimates 10 percent of North Dakota's RNs and as many as 17 percent of LPNs were unemployed last year.

More than a third of those unemployed nurses indicated they were caring for home and family instead of working. A large percentage of each classification also stated pursuit of some kind of education as their cause of unemployment.

The unemployment numbers also could belie some of the reality of nursing—the job can be difficult, physically strenuous and subject to odd hours that take away from personal pursuits.

Scarcity not just a matter of supply

Matthew Keller, a regulatory and policy nursing specialist with the Minnesota Nurses Association union group, compares high licensing numbers from the Minnesota Board of Nursing with lower job growth data from the state Department of Labor when he says he doesn't believe shortfalls in RNs exist simply as a matter of inadequate supply in his state.

"I think it's not a question of a nurses shortage, but rather, are we getting nurses where they need to be and are facilities working to get nurses in," Keller said.

Keller said some employers, especially in Minnesota's metropolitan areas, may overlook RNs with associate's degrees in favor of those with four-year degrees, creating artificial scarcity in their applicant pools. He also pointed to pay disparities between urban and rural nurses as a potential obstacle to bringing necessary workers to smaller, lower-paying facilities.

Keller suggested a lack of focus on employee retention is an often overlooked side of the nursing shortage discussion. Facilities that implement measures aimed at preventing nurses from getting burned out could see a reduction in turnover as well as an advantage in hiring, he said.

"You have a lot of people leaving units, leaving facilities, and hospitals need to find new nurses to fill those roles," Keller said. "We need to talk about how to maintain current staff, and that's what a lot of people are trying to do. Trying to have a good culture, a culture of safety, having good staffing ratios and treating nurses right is a simple thing you can do to maintain your current work staff."

Providing care while short-staffed

Back in North Dakota, Altru talent strategy director Marlene Miller says the health system's leadership is focusing efforts on building a friendlier environment for nurses, both in terms of attracting new hires and in decreasing turnover.

"I don't think any one thing is magical, but we need to set ourselves apart, and I do think our culture sets us apart," Miller said. "We really have to look at our flexibility, what works for our people, whether it's students or some other life situations where people are looking for different hours. We're looking at different shifts, opportunities to grow, to move around in the organization."

Kristine Stoltman, an Altru nurse recruiter, said the health care company currently has about 1,200 nurses on-staff across its various facilities. When it comes to new recruits, Stoltman said Altru tries to hold on to the nursing students who come through the system on clinical rotations or, like Nelson, are employed in an Altru facility while completing a more advanced certification. Current staff also take part in a referral program in which they pass along the names of promising nursing students for a prospective hire.

At the same time, Stoltman said filling rosters can be challenging when health care facilities across the country are jockeying to do the same.

Miller said the recruitment side has made gains over the past year, partially due to an "all hands on deck" approach. Altru still has several openings for RNs and LPNs, she said, but it has filled half of what it needed from a year ago.

As far as retention goes, Miller says Altru is currently below the national benchmark for turnover among nurses. Operating with internal shortages has pushed the company to re-examine some of its staffing strategy to adapt care delivery while avoiding undue burden on Altru nurses.

"We want to engage the nurses we have and give them the opportunity to work at the top of their scope, so we surround them with more nurse aides and tech-type positions," she said. "We know we may not find all the nurses we need, but at the same time, we're committed to providing care so you need to think of processes that meet those challenges."

Andrew Haffner

Andrew Haffner covers higher education and general assignment stories for the Grand Forks Herald. He attended the University of Wisconsin in Madison, where he studied journalism, political science and international studies. He previously worked at the Dickinson Press.

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