As a critical care nurse at a Portland cardiovascular unit, Jazzy Walker has experienced the COVID burnout that has driven nurses away from the industry and exacerbated the widespread nurse shortage in Oregon’s health care system.
She’s seen some of her more experienced colleagues collapse under the strain of heavy workloads with increasingly sicker patients, and she’s felt that team dynamics change as hospitals brought in short-term travel nurses to fill staffing gaps.
When stress got to Walker, resulting in panic attacks and sleepless nights, she made the decision to move from bedsides to academia and focus on building the future nursing workforce.
Four months into her job as nurse administrator at Clackamas Community College, Walker is faced with the chicken-and-egg situation that is keeping Oregon’s higher education institutions from meeting the needs of the health care industry.
Nurses may not make as much money teaching as they help patients, which makes it difficult to hire nursing educators. That shortage of instructors limits the number of students nursing programs can enroll, preventing Oregon colleges from graduating enough nurses to meet the needs of the state workforce. Understaffing at both facilities means fewer nursing educators are available to train students in practical clinical settings, further limiting the number and experience of nursing graduates.
“It’s a very bad cycle,” Walker said.
Oregon’s nursing programs produced the third-fewest graduates per capita of any state in 2020, according to the Oregon Longitudinal Data Collaborative, which analyzes data across Oregon’s education and workforce landscape.
“Most of our schools have programs. It’s a capability issue,” said Tracy Thompson, a policy analyst for nursing education at the Oregon State Board of Nursing. “There are no faculty to support other students.”
An upcoming report from the collaboration, expected in February, will recommend the state convene a working group to address nursing faculty compensation and establish a centralized clinical placement system. Nursing educators are also seeking policy changes from lawmakers that could resolve kinks in the workforce pipeline for a critical state-owned industry.
“If we can get incentives for clinical partners and if there’s a way for the state to help fund the salaries of nursing educators and program administrators, that would really help with two of our problems,” Walker said.
Oregon has 17 associate degree programs for students who want to become registered nurses, as well as six public and private bachelor’s degree programs and eight other community college programs for licensed practical nurses, which have less education than a registered nurse.
In 2020, 409 students graduated from practical nursing programs, 606 students from associate degree nursing programs, and another 929 students with a nursing degree, said Ben Tate, director of the Oregon Longitudinal Data Collaborative.
However, the data collaboration estimated that Oregon needed more than 1,000 more college graduates to meet workforce needs that year, according to a draft summary of its upcoming report.
Schools have enough applicants to more than double their capacity. Nursing schools in Oregon received more than 6,000 applications in 2020 but accepted fewer than a quarter, the draft summary says.
Clackamas Community College sometimes receives more than 300 applicants for an average of 30 vacancies, Walker said.
“Turning down so many potential nurses is a very difficult thing to do,” she said.
Jennifer Limones, 36, is a sophomore in the Clackamas Nursing Program and plans to enter the profession full-time this summer. She spent several years working and taking introductory courses before applying for an associate’s degree in nursing, inspired by the impact of the nurses who cared for her 4-year-old son when she needed an operation kidney at Randall Children’s Hospital.
Limones, who worked as a physician assistant for 15 years, was accepted into the Clackamas program on her first attempt. You know it’s an unusual undertaking.
“There are so many capable and qualified prospective nursing students who are not making the cut and it’s not for lack of qualifications or skills. These aren’t clueless or incompetent prospects,” Limones said. “There are only so many places and it gets really daunting.”
Walker hopes to expand Clackamas’ open vacancies. In a perfect world, he’d offer 36 vacancies this fall and work to open 40, maybe 60 over the long term.
But this fall, Clackamas didn’t even have enough teachers for its typical enrollment. The school has reduced its usual 30 slots to just 18, Walker said.
“Trying to advertise and get bedside nurses to come teach with our students is like pulling teeth,” Walker said. “They can’t financially afford to take that pay cut, so they’re not coming full-time.”
NURSING EDUCATORS DO LESS
Walker nearly turned down her position at Clackamas when the school’s first offer was $30,000 less than she was making as a full-time nurse.
Without picking up extra shifts, Walker could make $90,000. With extra shifts he earned over $100,000. The school’s full-time faculty earn between $60,000 and $80,000 in comparison, Walker said.
Nursing program administrators across the state are hampered by this challenge. Janie Griffin, director of nursing at Columbia Gorge Community College, reminds prospective teachers that they have the summer and most weekends off and can take nursing shifts on their own.
“When you look at an ad and see I’m going to make $20,000 less, (nurses say) ‘I’m not even going to apply,'” Griffin said. “I don’t know, how do we catch them and hook them and bring them in and say ‘Try it, I think you’ll like it?'”
Oregon Health and Science University is working to raise the ranks of nursing educators through its Oregon Nursing Education Academy. The academy aims to train 63 new faculty members and 92 new supervisory physicians with a $4 million federal grant. Nurses admitted to the Academy will receive scholarships that cover most tuition fees.
Several lawmakers proposed bills in their 2023 session that would extend income tax credits for rural medical providers to nursing educators. A similar effort died in commission in 2019.
FEW CLINICAL POINTS
Nursing students need hands-on practice to finish school, but a lack of working faculty and nurses means there are too few mentors to guide students in clinical settings. The shortage of clinical internships has been exacerbated during the COVID-19 pandemic as many healthcare facilities have closed to visitors.
Deb Henry, a nursing education and practice specialist at Legacy Health, said the hospital system offered 2,607 clinical seats for nursing undergraduates in fiscal 2020, then just 468 in 2021. Clinical seats rebounded to 1,110 in 2022 but did not they are still back to pre pandemic levels due to staff shortages.
Hospital units that have several nurse openings cannot accommodate as many students, Henry said, and will prioritize hiring new Legacy hires or roving nurses ahead of student training.
“We try, I try, to place these students, but there are so many variables involved it’s difficult,” Henry said.
The Oregon State Board of Nursing allows schools to substitute simulated nursing scenarios — such as working with high-tech mannequins, case studies or actors — for up to 49 percent of a student’s clinical hours, Thompson said. Some schools have leaned towards this option.
Linfield School of Nursing has expanded simulation centers during the pandemic to help meet students’ clinical experience needs. Spending time alongside nurse practitioners in real healthcare settings helps prepare students to work one-on-one with patients, but the hours can be unpredictable, said Julie Fitzwater, associate dean of nursing. Simulations allow instructors to create the exact experience they want their students to work on, such as caring for a mannequin that has given birth and is suffering from a postpartum hemorrhage or interacting with an actor simulating a crisis patient mental health.
“Having both experiences is so important for building clinical reasoning and clinical judgment,” Fitzwater said.
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Sami Edge covers higher education for The Oregonian. You can reach him at [email protected] or (503) 260-3430.