Rapid Response – Nursing Programs Adjust to Changing Landscape, Growing Needs

It wasn’t so long ago — OK, maybe it was 10 or even 12 years ago — when the primary challenge for the area’s college nursing programs was filling seats in the classrooms.
Times have certainly changed, and, for the most part, enrollment is not the issue it once was, as the laws of supply and demand have caught up with this profession, meaning that demand has greatly increased and opportunity-seeking individuals — compassionate, opportunity-seeking individuals — are responding accordingly, creating a greater supply.
But there are new challenges for area programs, and they come in many forms, from finding enough educators to meet that aforementioned demand (talented nurses can generally earn more in the field than they can in the classroom, so most choose that setting) to meeting escalating need for more-educated nurses, meaning those with at least a bachelor’s degree but, increasingly, a master’s or a doctorate, to finding enough clinical hours in area hospitals for their students.
To do all this, area programs are responding — with new degree programs, including many at the graduate level, a broader array of learning options, including hybrid programs that provide the flexibility demanded by today’s students, and other initiatives that reflect a changing landscape in nursing education.
Summing things up, Clare Lamontagne, dean of Health Sciences at Holyoke Community College, said the nursing profession is one that offers pathways — a great many of them — and the challenge for programs today is to serve students regardless of what path they might be on.
“This field is wide open for opportunity depending on your experience and education level,” she said, putting heavy emphasis on that word opportunity.
Indeed, local colleges offer an extensive range of nursing-education options, from practical nurse certificates to master’s and doctorate programs.  At every level, job placement for graduates who meet their licensure requirements are in the 95{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} to 100{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} range. Many, if not most, students have job offers even before they take their licensing exams.
And while there are still ample opportunities for those with an associate degree, increasingly a bachelor’s degree or graduate degree is necessary to earn jobs at the end of some pathways.
In 2010, the Institute of Medicine along with the Robert Wood Johnson Foundation released a report titled “The Future of Nursing.” The landmark study recommended that, by 2020, 80{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of all nurses should have a baccalaureate degree or higher. Latest estimates show between 55-60{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} currently meet that threshold.  
Maeve Howett, assistant dean for Undergraduate Nursing Education at UMass Amherst, said the growing importance of educated nurses is based on years of research data. “Evidence shows that hospitals with more bachelor’s-prepared nurses on their staff report improved patient outcomes and improved patient safety.”
While many employers in Massachusetts prefer to hire nurses with four years of education, in New York state, it’s the law. In 2017, New York passed the “BSN in 10,” mandating that all nurses obtain a baccalaureate degree in nursing within 10 years of receiving their initial RN license. Current New York-licensed RNs and enrolled nursing students have been grandfathered into the legislation, but going forward, “BSN in 10” will be a licensing requirement for all registered nurses.  
Meanwhile, a combination of forces is creating a need for nurses with graduate degrees.
Over the last several years, fewer medical-school graduates are choosing primary care as their specialty, which has created a shortage of physicians. Cheryl Sheils, program director for the Doctor of Nursing Practice at Bay Path University, said this development gives an urgency to training more master’s-and doctorate-level nurses.
“Advanced-practice nurses can help address physician shortages because graduates of these programs are qualified to oversee the health and wellness of so many different populations,” she said, adding that Bay Path has been enrolling students into its inaugural program for the doctorate of nursing practice (DNP), which begins in late February. The first graduating class is scheduled for spring 2022.
The “Future of Nursing” study recommended a doubling of doctorate-level nurses by 2020, suggesting that nurses become full partners with physicians and other healthcare professionals. “Advance-practice nurses work with other specialists to co-manage conditions of their patients and provide case management for long-term illnesses and conditions,” said Sheils. “That’s why our training includes courses on team-based care and leadership skills.” 
Teresa Reske, director of the DNP program at Elms College, agreed. A DNP-trained professional helps patients understand what’s required to remain healthy and how to navigate the complexities of the healthcare system, she said, adding that a DNP nurse brings a unique skill set to a patient’s team of providers.
“We’re educated to be caring and humanistic; combine that with scientific knowledge, and it makes for a wonderful blend.”
For this issue and its focus on health education, HCN talked with area nursing-program administrators about the changing landscape and how schools are adjusting.
Degrees of Progress
There are many reasons people choose a nursing career, said those we spoke with.  Some are drawn to it because of an interest in science and healthcare, while others like the flexibility.
Tina Jacques, chair of the practical nurse certificate program at Holyoke Community College, defines flexibility as everything from the opportunity to work anywhere in the country (once licensed in that state) to choosing day, night, or evening shifts to accommodate family and personal preferences. She said flexibility also applies to career movement.
“I can work as a practical nurse and stop there, or I can be a registered nurse and pursue a bachelor’s degree to advance in the profession,” she noted.
And flexibility also applies to the methods of learning. While many courses of a nursing program can be taught online — and often are — some of the most essential skills require the personal touch.
“We want to see where and how you are touching the patient,” said Reske. “By having clinical faculty observing students in a simulated environment, students are much better prepared when they go into an actual clinical setting.” 
As noted earlier, a bachelor’s degree or a graduate degree is becoming increasingly necessary, and there are several ways to go about earning one, which brings a different form of flexibility.
Indeed, like many area colleges, UMass offers two popular paths to a bachelor’s degree.  At its Amherst campus, students can pursue a traditional bachelor of science with a major in nursing, and at its Springfield campus in Tower Square, the university offers an accelerated nursing program for students with a bachelor’s degree in another subject area who want to pursue a bachelor of science in nursing.
“There’s a huge, unmet need for nurses; there’s kind of a push-pull where employers are trying to address a nursing shortage and at the same time bring in higher quality and more educated nurses,” Howett said. 
That nursing shortage has been persistent, said those we spoke with, and for several reasons, from implementation of the Affordable Care Act (ACA), which has increased overall demand for healthcare services, to the aging of America, which is doing the same, but also impacting the healthcare workforce as well, compounding its influence.
Unlike previous generations, Baby Boomers (currently 54-74 years old) are living longer and will need increasingly more healthcare as they age. On top of that, Baby Boomer nurses are retiring in larger numbers each year, reducing the number of experienced working nurses.  According to the U.S. Bureau of Labor Statistics, 500,000 “seasoned” registered nurses are projected to retire by 2022.  The bureau suggests 1.1 million new RNs will be needed by then to replace the retirees and address the growing demand for nursing services.
And while more nurses are certainly needed, more diversity within the profession is also needed.  
Many of the educators we spoke with noted the importance of encouraging a nursing workforce that better reflects the community it serves. They emphasized the importance of recruiting students and faculty who represent the diversity of the population, especially under-represented minorities.
“Nurses who speak a second language are such a treasure,” said Howett. “When a patient is sick and feeling vulnerable, they are so grateful when their healthcare provider can share their language.” 
A blurring of gender lines is another way to address the nursing shortage. Nationally, the percentage of men in nursing fluctuates between 9{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} and 10{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}. In the UMass accelerated program in Springfield, 25{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of the students are men, many of whom received training as medics in the military.
“Society now recognizes that behaviors are not part of your gender,” said Howett. “Men can be compassionate and caring, and women can be great technical ICU nurses who don’t even speak to their patients because they are under anesthesia. Both qualities make for great nurses.”   
And there are many potential landing spots for such individuals, she went on, noting that, while hospitals are still the largest employers of nurses, the role has expanded into many other areas of healthcare. From doctor’s offices to community clinics to nurses who provide care in the home, many more patients are treated outside the hospital than in the past.
“Years ago, patients would be admitted to a hospital for an asthmatic condition or for a simple IV,” said Howett. “These days, patients never go to the hospital for routine treatments like these; they can be taken care of through an office visit or at home by a nurse.” 
Meanwhile, demands on nurses in hospitals are also different than in the past. With so much care administered outside the hospital, only the sickest patients are admitted. Several educators HCN interviewed noted the increased challenges of workplace hazards such as blood-borne pathogens and exposure to bacteria and viruses.  Another point they mentioned was nurse staffing levels, which received heightened public awareness in this past November’s election when a referendum to establish the number of patients assigned to nurses was defeated.
While the shift away from hospital care is driven by cost, it’s also better for patients.
“If we can keep you healthy at home, it costs far less than care in a hospital or long-term-care facility,” said Lamontagne, adding that the growing population of older Americans puts a huge strain on healthcare facilities, so more services at home helps the whole system. “We know that, whenever possible, people would rather be home where they are on their own schedule, eating their own food, and they’re more comfortable. Nurses who provide home care are a win-win for the patient and the system.”  
Course of Action
As the demand for more educated nurses grows, the profession faces the additional challenges of finding enough qualified faculty and clinical settings in which they can get hands-on experience.
“It’s an interesting time in healthcare because we have to turn away people who would be wonderful nurses,” said Howett. “We just don’t have enough places to train them.” 
Indeed, with fewer hospitals and other healthcare organizations, clinical settings for students in Western Mass. are at their capacity, said Kathleen Scoble, dean of the School of Nursing at Elms College. “We run our accelerated program during the summer so we can get access to clinical sites that are completely booked the rest of the year.”
Meanwhile, Howett said, in addition to training the workforce, another role educators play is to feed the pipeline for future nursing instructors.  “Every time we graduate students, we say, ‘see you in grad school’; we encourage them to come back and teach, especially students who represent diversity.”
Despite all these challenges, nursing educators express great satisfaction about their students and the profession.
“We tend to get students who really care,” said HCC’s Jacques, adding that “we’ll see them with patients, and they spend a little extra time with someone who doesn’t usually get attention.”  
Howett agreed, and said nursing tends to attract people who seek more meaning in their work than just a paycheck. “Nurses witness a lot of life,” she noted, adding that they are grateful for the opportunity to be there for such moments and play an important role.
Providing enough nurses, and enough nurses with the needed skills for the pathway they’ve chosen, is becoming increasingly challenging, but area nursing programs are responding the same way that those in the profession do — with attention to detail and a desire to serve.

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