Closing gaps in the health care workforce

Nationwide labor shortages that were exacerbated by the COVID-19 pandemic are not over. The health care industry was hit especially hard. The impacts strained hospitals, taxed caregiver well-being and resulted in many departures from health care jobs, according to the American Hospital Association.

North Dakota alone had 4,300 job openings in the field of health care at the end of 2022, Dustin Hillebrand, the director of Grand Forks’ workforce center, told the Grand Forks Herald in late December. His office coordinates workforce development programs in North Dakota’s fourth region, which includes Grand Forks, Walsh, Nelson and Pembina counties. Within that region, there were 932 health care-related job openings at the time.

Health care systems are challenged with finding creative solutions in regard to workflows, workplaces and teams, all while continuing to maintain a high-level of care for patients. Health care organizations may turn to non-traditional partnerships and use advanced technological supports to continue the innovation process.

Altru Health System, which serves more than 230,000 residents in northeast North Dakota and northwest Minnesota, is one of the health care providers working to close the labor shortage gap. Todd Forkel, CEO of Altru, said the issue is multi-faceted.

“First and foremost, it’s a demographic issue. As baby boomers retire and subsequent generations are just not having as many kids, it’s a math problem,” he said. “There are three nearby institutions that have nursing programs, which helps. What is scary, is several of them have talked about not filling all their slots. We’re going to need to work hard to get young people excited about getting into health care.”

What might help, Forkel said, is a project underway in Grand Forks that community leaders hope will ease the worker shortage in northeast North Dakota. The Career Impact Academy is expecting to break ground later this year; it came to fruition after a number of businesses and individuals donated $10 million in less than three months. The project then qualified for a matching $10 million in state funds.

The Career Impact Academy will be a collaborative partnership that includes K-12 school districts in the Grand Forks region, post-secondary education institutions, private sector Grand Forks region employers and the Grand Forks region community.

Altru is working hard to improve the culture and be a welcoming place for employees, Forkel said, and innovation will play a role.

“We’re going to have to start to innovate and use technology where some of these workforce gaps exist. I don’t have a crystal ball to identify every one of those – this gets back to the demographic issue. I just think there are not enough people,” Forkel said. “If we’re going to do this, we need to utilize technology.”

Dr. Joshua Deere, Altru president, agreed that innovation is key.

“We’re going to all have to work differently going forward in health care, to deliver the same or better quality care. That’s our goal, to build the best quality care and to continue to make that better and more safe,” he said.

No matter the position – lab tech, nurse, physician – there are gaps that need to be filled.

“We’re all going to be competing and we have to be the best place to work,” Deere said.

The paramount factor health care systems are grappling with is creating ways to do the work differently, more efficiently and yet continue to provide the same or better quality of care.

“That’s going to be the future of medicine, no doubt,” Forkel said.

Another regional health care system, Essentia Health – which serves North Dakota, Minnesota and Wisconsin – has created a workforce development department to recruit and retain professionals in the industry as a way to close the gap.

The organization has a “Critical Eight” list, compiled of the most integral patient-facing openings across the system, according to Michelle Ufford, workforce strategy director with Essentia Health. Those positions include acute nursing, clinical assistant, surgical technician, lab technician and technologist, LPNs, certified nursing assistant, radiology technicians and respiratory therapists. The supporting positions are also required to keep the entire system running.

Like other health care systems, Essentia Health partners with area colleges and universities to support and inspire the future workforce and build enrollments in secondary programs.

“Nursing is a really great example of that. We have developed a number of academic practice partnerships as part of our magnate nursing journey which are really deliberate, and intentional strategic partnerships with colleges, nursing programs specifically, that create more of a partnership on how Essentia can support curriculum development, and has opportunities for students to gain experience while they’re still in school. That’s a relatively new initiative and is really in development but is a really great example of how we formally partner with schools,” Ufford said.

Matthew Naugle, workforce development director at Essentia, said part of his department’s focus is on career awareness for students and creating authentic, real-world experiences for them.

“We try to connect our public schools in the area with institutions of higher learning with opportunities to engage with mutual programming. For example, offering dual credit or concurrent classes that combine that high school experience with earning early credentials or credit at the college level as well. In doing so I think we also create and highlight the pathway to what’s available to our students regionally for their next steps,” Naugle said.

Educational supports offered by Essentia Health include Education to Employment, a program that allows students to get a leg up financially as they pursue their goals. The program is also available for employees who qualify. Participation in lunch-and-learn events at colleges, as well as career fairs and hiring events, are additional ways Essentia is educating students on the variety of careers available in the health care field.

Essentia Health’s Michelle Stenbeck, chief nursing officer, said the company’s transition coaches are used to help ease the change from being a student to becoming a professional, including providing emotional support as well as professional support.

“Our transition coaches are different than somebody who precepts you right on the nursing floor or in a clinical space,” Stenbeck said. “They get that group together with a frequency to make sure that they are supporting them (students) and mentoring them when they’re not front facing for patient care. They can get into these deep and meaningful conversations. Transition coaches are really key people who are turning out to be an absolute asset to us.”

In addition to recruiting people into the health care sector, retention of staff is a priority for all health care organizations.

Sanford Health, headquartered in Sioux Falls, South Dakota, serves more than one million patients and 220,000 health care members. Sanford uses a three-pronged approach to employee retention: a Sanford leader model program; addressing diversity, equity and inclusion; and creating programs to support and sustain a large and diverse workforce.

DJ Campbell, executive director of human resources at Sanford, said the company has two main strategies when it comes to workforce development. First is growing the talent organically in North Dakota as much as possible. But also, knowing there just aren’t enough people in the state to fill all the needs, Sanford Health is bringing in 700 to 800 internationally trained nurses to fill the shortages across the system.

“There’s a high demand within the marketplace and it’s a challenging time. We’re trying to compete to keep those individuals and recruit the best talent, but there’s just not enough supply to meet the demand,” Campbell said.

At Essentia Health, nurse retentionists partner with on-site leaders to make sure they are allowing growth and development to nurses in a way that keeps them satisfied in their roles.

“The role of the nurse retentionist is evolving,” Stenbeck said. “We have somebody that’s in the space, that's learning and evolving as she gets to know our new hires more intimately. We’re very fortunate to have those two roles.”

Challenges aren’t limited to providers. Health care educators are tasked with recruiting and training enough students to help fill the shortfalls.

Dr. Joshua Wynne, dean of UND’s School of Medicine & Health Sciences, spoke about the university’s health care workforce initiative that was created over a decade ago. It identified specific steps to reduce disease burden and increase the provider workforce through programs designed to increase provider retention for practice within the state, as well as expand the provider network through class size enlargement. The plan works to improve the health of the population, retain more providers, train more providers and expand class sizes and improve efficiencies, according to the university.

Over the last decade, the program has been successful with health care’s professional roles – physicians, physician assistants, registered nurses and occupational/physical therapists, for example. The university leadership knows that one of the best indicators to get more doctors to practice in North Dakota is to recruit them from within the state, Wynne explained.

“By increasing the number we retain in the state, we’ve increased the class sizes by almost 25 percent,” Wynne said. “We start getting students, pre-college, interested in medicine and health sciences through Scrubs camps and academies. The colleges have programs to get them interested in a career. To come to medical school, we give extra credit if you’re from North Dakota and rural North Dakota. About 85% of our class is either North Dakota people or those who have ties to North Dakota.”

All of the program’s students are required to take a rural rotation during medical school training. Those in the rural medical program who agree to practice in North Dakota have their tuition paid by the state.

“It’s helping, but there’s more we need to do. It’s been exacerbated by the pandemic, provider burnout, a population that may have high regard to a provider in general but the public discourse has been divisive and providers are caught in the middle. They’re trying to do the best for their patient, but it’s not being appreciated,” he said.

Travel nurses were used more frequently during the pandemic as well, but their higher wages became a strain on health care systems.

“The good news in North Dakota is we have a plan that’s helping the problem,” Wynne said.

UND works with the state’s health department and the major health care providers in the state to coordinate routinely on how to address the labor shortage. The university could expand the number of students it accepts into the medical program – the university has enough quality applicants, has the physical space and enough faculty – but clinical training sites are now saturated and can’t add any more students.

“Our clinical partners don’t have room for them,” Wynne said, explaining that UND has intentionally not increased class sizes because it can’t ensure the students would have the type of education the university expects.

While solving the worker shortage problem is complicated, one thing is certain – health care systems will need to be agile and innovative to respond to the future of patient care.