Students across the region are answering the call to serve in nursing

When Collette Christoffers first became a nursing assistant years ago, it didn’t take her long to fall in love with the work. She enjoyed visiting with her senior patients, hearing their stories, and helping care for them.

“It was a passion,” she said. “It was like, ‘Yep, this is what I'm supposed to do.’ I enjoy taking care of others, but also helping them reach their goals.”

Christoffers today works as interim division chair and associate professor of nursing at Mayville State University, and said the position allows her the best of both worlds: nursing and teaching. She is especially happy to help train a new generation of nurses, especially during the continuing crunch of a nursing shortage. It’s a shortage that likely will not end anytime soon.

“Without decisive action, nurses will practice under increased stress,” according to the American Nurses Association . That means the likelihood of more nurses leaving the profession. “As the health care system is strained by an aging population and broadened access to public health care, it will be nurses that feel the weight of patient responsibility on their shoulders.”

The report also said it is expected this year that more than 500,000 seasoned nurses will retire and more registered nurse jobs will be available in the U.S. than any other profession. Referencing the U.S.Bureau of Labor Statistics, it said the field will need about 1.1 million new nurses “for expansion and replacement of retirees.”

Mayville State is one of a number of schools in the region that is helping to meet workforce demands amid the worry and wonder of the future of the nursing profession.

Some challenges

The nursing shortage is nothing new, nor is it the cause of any one problem. It stems from a variety of causes, including the obvious: senior nurses retiring and not enough qualified newbies to take their place. But it also comes from nurses feeling burned out and who decide to leave the field for less stressful jobs, a situation exacerbated by the pandemic.

Christoffers said she has witnessed the challenge firsthand.

“There's a definite impact that the COVID-19 pandemic has had on the nursing profession,” she said. “Nursing is a caring profession. A lot of nurses wear their heart on their sleeve; they want the best for their patient and to treat the patient holistically, as a whole person.”

Because of the respiratory virus, patients were isolated, families couldn’t visit, and that alone put an emotional strain on nurses, she said – not to mention the burnout that many have felt by pulling extra shifts because of the increased number of hospitalized patients.

“There are so many different situations that can happen in the hospital and COVID just made things more complicated,” she said. “That stress fell to all of the health care disciplines, but nurses are the ones with patients most frequently, out of all the disciplines. Nurses are at the bedside 24/7.”

Carla Gross, associate dean of North Dakota State University School of Nursing, echoed similar sentiments. The profession is “losing some nurses in practice because they're simply exhausted with the workload and the stress and everything,” she said. “And I think that vaccine hesitancy has been difficult.”

Another challenge is the increasing number of traveling nurses, who often are paid more than staff positions and make it difficult for hospitals to compete.

Images: Courtesy of NDSU

Gross said while traveling nurses have their place, there are some issues that facilities should consider. For instance, TNs usually are not as invested as staffed nurses.

“It creates a very big challenge because health care facilities then lose the nurses that are there full time, who are committed to policy, to quality care and those kinds of things, the everyday work that hospitals or long-term care agencies need to do,” Gross said. “It creates a really difficult time on the units.”

She said the number of traveling nurses has risen considerably during the past two years and “wages have gone up astronomically to the point that it is unsustainable.”

Altru uses traveling nurses, but mostly to fill slots that staff is unable to, said Janice Hamscher, Altru’s chief nursing officer.

“We've actually just brought that number down a little from what we have been dependent on, largely because we're seeing fewer hospitalized patients with COVID and that reduces the demand for travel nurses,” she said. “We've also created a number of incentives for our existing staff to contribute additional hours, and we try to create a balance there, because we don't want to burn out the team that we have. Recognizing they can't fill all of the needs, we fill the remaining (slots) with travel nurses.”

During the course of her career, Hamscher said she’s worked through many nursing shortages. But this one beats them all.

The sources Prairie Business spoke with said there is not any one area of health care that needs nurses more than others. Rather, it is a need in all nursing disciplines, including behavioral and mental health.

“I will say that prior to the pandemic, we actually were sitting in a pretty good spot,” she said, noting that Altru had been successful at hiring and onboarding nurses. And then the pandemic hit, and similar to other industries, “we've had turnover for a variety of reasons – people deciding to retire, folks relocating,” she said. “Travel nursing became very popular because of the high rates of pay, and so many staff nurses desired to go do that. Here we are now in the midst of a national shortage, more so than we have been in for a long time.”

Schooling future nurses

Schools in the region are doing what they can to help with the nursing shortage, attracting students and trying to place them in health care facilities across the region.

Nursing students at the University of North Dakota, for instance, currently rotate at facilities in rural areas, according to Stephanie Christian, chair and clinical associate professor of nursing at UND. She said the school is trying to expand some of those partnerships to get students into more critical access hospitals across the state.

UND’s College of Nursing & Professional Disciplines admits about 64 students per semester, but Christian said it is a “very competitive” admission process.

The number was down during the height of the pandemic, a temporary trend that she said was noticed in schools across the state. The last admission cycle saw numbers back up, not only due to a better social environment because COVID numbers have decreased but because workforce demands and salaries have increased.

She said staff at the school have been creative at attracting nursing students while maintaining quality and making sure students have good clinical experiences.

Christian said UND continues to make adjustments to ensure its nursing curriculum meets current and future needs of health care.

“It always seems like there are the comments, ‘oh, you’ve got lots of applicants, just let them in. We wish we could, but we also know they need to be able to have places, like hospitals and other care settings, that we can get them into and have them supervised.”

About 370 students are enrolled in nursing at Rasmussen University’s two campuses in Fargo, North Dakota, and Moorhead, Minnesota, according to Amy Gibson, campus director.

Rasmussen has a number of campuses across the country, offering associate and bachelor’s degrees. Gibson said Rasmussen now also offers a doctoral program in nursing, and it has good relationships with a number of health care companies in the region, including Essentia Health and Sanford Health.

Audrey Charchenko, associate dean of nursing at Rasmussen, said some nursing students also get their clinical hours at Altru.

“We also partner with many of the nursing homes in the area,” she said.

A couple of things that attract students to Rasmussen, Gibson said, is its accelerated program of six quarters and that her school does not have a cap on enrollment.

NDSU, also in Fargo, attracts nursing students from near and far.

It offers bachelor of science, LPN to BSN and RN to BSN tracks, among others. Its pre-licensure BSN program in Fargo accepts about 64 students each semester, or about 128 a year. It also has a nursing program in Bismarck, where it works closely with Sanford Health, and which accepts about 96 students a year.

“We really acquired Bismarck as part of our land-grant mission to meet the workforce needs across the state,” Gross said. “That was a great opportunity to try to help meet workforce nursing needs in western North Dakota.”

In 2020, the NDSU moved its nursing lab into the adjacent Aldevron building, where there’s a state-of-the-art simulation center.

Image: Courtesy of NDSU

Simulators, basically high-fidelity manikins connected to a computer, portray a live person and help give nursing students a more direct approach to what it’s like working with a real patient. The manikins can talk, breathe, emanate lung and heart sounds. Some manikins even simulate the breathing process, and they can react to medications.

“They respond in a way physiologically that a human being would respond to a specific drug,” Gross said.

But only so much education can take place in the labs.

“You really want to get them taking care of real-life patients and families,” she said. “There has to be a nice balance or your outcomes are not going to be what you want.”

Gross said pre-nursing numbers at the school remain strong, and that students in the program are excited to get out into the health care facilities and make a difference.

“I can tell you that our students are excited to practice,” she said.

A call to serve

Christoffers, of Mayville State, said the RN to BSN program started at her school in 2014 and is completely online. There’s benefit to that, she said, especially for those in rural communities.

“That's one of our biggest draws to the program,” she said.

Also, students can earn their bachelor's degree in as little as 12 months.

Mayville offers scholarships for nurses from Altru, Essentia or Sanford and has contracts with multiple counties across North Dakota for students who need clinical placements.

That’s where the pavement hits the road – nurses being placed in clinics and hospitals, where they can answer the call to serve.

Christoffers, who fell in love with nursing years ago, said the profession to her has always been an admirable one and she is just as excited today to see others answer the call as she was when she answered it. It’s a call with returning benefits.

“I think nursing is something that everybody is going to come in contact with sooner or later,” she said. “They know that nurses are there to help them. That is what we're called to do. That is what we're trained to do. We have that purpose. I don't want to get too philosophical, but for me, I feel like it's a calling. I feel like it is something that I was meant to do. That's when I feel like I am filling my cup. I guess it's like this: I help others because I can, and it helps me because I feel like I'm making a difference.”