North Carolina could be among the top five states for nursing shortages by 2026 if current trends continue. By 2033, the state could have a shortage of nearly 17,500 nurses, according to N.C. Nursecast data presented to the State Board of Community Colleges during a luncheon at its April meeting. That statistic reflects an estimated shortage of nearly 12,500 registered nurses (RNs) by 2033 and slightly more than 5,000 licensed practical nurses (LPNs).
More robust education pipelines can help address this anticipated shortage, state nurses and educators told the Board.
“There almost always seems to be a shortage of nurses,” said Cheryl Jones, director of the Hillman Scholars Program in Nursing Innovation and a research fellow at the Cecil G. Sheps Center for Health Services Research at UNC-Chapel Hill.
Jones helped lead N.C. Nursecast, a recent study evaluating the state of nursing in North Carolina. The study was led by the Sheps Center, N.C. Board of Nursing, and Strategic Modeling Analysis and Planning.
“Leaders across the state told us they had a shortage of nursing personnel and particularly RNs, LPNs, and nursing assistants,” Jones said. “Now there are continuing shortages, and you will see that we’re projecting that future shortages are likely.
“COVID-19, we all know, has changed the landscape. How can we address this shortage?” she asked. “It’s going to come down to all of these things: attracting, educating, getting students through the pipeline, onboarding them.”
‘A really tough scenario’
A large contributor to nursing shortages is the declining number of educators to train nursing students. The vacancy rate nationwide for faculty positions increased from 6.5% in 2020 to 8% in 2021, according to a survey released in September 2021 by the American Association of Colleges of Nursing. U.S. nursing schools turned away more than 80,000 qualified applicants for baccalaureate and graduate nursing programs in 2019, the association reported, mostly due to faculty shortages.
The North Carolina Board of Nursing sets a faculty-student ratio of 1-10 for clinical experiences.
“Schools are turning away hundreds of qualified students from East Carolina to Wilmington to your other major programs,” Linda O’Boyle, a professor of nursing at Barton College, told North Carolina Health News last October. “They meet the criteria to get in, but we are limited in pre-licensure education by our regulations of how many students we can take to clinicals. It is a safety issue. We have to protect the public.”
Low faculty pay is another issue. Across the North Carolina Community College System (NCCCS), faculty with a bachelor’s degree in nursing make $14,923 less on average than they could make in a hospital setting, according to data from the North Carolina Nurses Association. Faculty with a master’s degree in nursing make $17,618 less.
The new state budget allocated $1.31 billion to the NCCCS for 2021-22 and $1.34 billion for 2022-23. That budget didn’t specifically address nursing programs, but it did include a 5% salary increase over two years for community college personnel. It also included a one-time bonus, minimum wage increases, and, for the first time, over $20 million to recruit and retain faculty in high-need areas.
In addition to faculty shortages, Jones told the Board that younger nurses are also leaving the profession sooner than usual.
The pandemic has exacerbated an already critical problem, presenters told the Board. A recent national survey by Incredible Health found 34% of nurses say it’s very likely that they’ll quit by the end of 2022. In addition, 44% cited burnout and a high-stress environment as the reason for their desire to leave. Nurses cited benefits and pay as the second leading reason (27%) for quitting their jobs.
“We’re getting set up for a really tough scenario,” Jones said.
‘An ongoing situation’
In January 2021, a proposed rule change concerned people at small and rural nursing education programs.
The North Carolina Board of Nursing oversees nurse licensing and approval of nurse education programs. Many of those programs are at the state’s 58 community colleges. A rule increasing education requirements for nursing faculty took effect on Jan. 1, 2021. After hearing concerns, the Board of Nursing issued a waiver for the duration of 2021, EdNC previously reported.
The rule previously required 50% of a nursing program’s faculty to hold a Master in Nursing. The changed rule required 80% of full-time and 50% of part-time nursing faculty to hold a master’s degree.
For smaller or rural programs, administrators told EdNC the change would make finding nurse educators even more difficult.
“This has been an ongoing — I don’t want to say problem — but an ongoing situation with North Carolina community colleges’ nursing programs of getting adequate faculty,” said Robin Harris, dean of health sciences at College of the Albemarle.
David Shockley, president of Surry Community College, said North Carolina’s community college system produces over half of the nurses in the state. He said the rule change had the potential to exacerbate the current nurse shortage.
“Of course we’re proponents for education. I think everybody should be a lifelong learner, that’s not it,” Shockley said at the time. “But when you put this restriction on, you are hurting communities where it’s already tough to find nurses.”
‘Significant shortages ahead’
Speakers at the State Board luncheon stressed the need for accessible pathways and student supports in addition to continued funding.
Tywana Lawson, chair of the nursing department at Nash Community College (NCC), spoke about success coaching.
NCC is one of six N.C. community colleges that received grants from the North Carolina GlaxoSmithKline (GSK) Foundation to help increase retention, graduation, and the passage of nursing exams. The grants also went to Southwestern, Halifax, Isothermal, McDowell, and Vance-Granville community colleges. North Carolina GSK Foundation granted $2 million to the North Carolina Community Colleges Foundation for nursing program support in 2021 and $150,000 to the NCCCS for health care programs at rural colleges in 2020.
Fern Aspen, a success coach at Southwestern Community College, told the Board there are many different needs represented among community college nursing students.
“We have such a variety in North Carolina,” Aspen said. “From the 17-year-old that’s been taking some pre-college classes while she’s admitted in high school, to someone who’s on their second or third career, that has their bachelor’s or perhaps even their master’s degree.”
New pathways can also help produce more nurses. An option at Roanoke-Chowan Community College, announced earlier this month, will allow Martin Community College students to complete all the general education requirements for the associate degree in nursing program. This is in addition to the requisite Nurse Aide I class at Martin Community College.
State Board Chair Burr Sullivan attended the signing ceremony. Sullivan told The Enterprise he looked forward to sharing the collaboration between the two colleges with the entire Board.
“The need for nurses is expected to worsen with the ongoing retirement of baby boomers,” he said.
If nurses exit the workforce two years early, the prediction by N.C. Nursecast increases to 16,700 RNs by 2033 and 5,500 LPNs. If nurses exit five years early, the shortage is more than 21,000 RNs and 6,000 LPNs.
“So you can see that, boy — significant shortages ahead,” Jones told the Board.
Jill Forcina, associate director of nursing for the N.C. Area Health Education Centers Program Office, said the Nursecast data is based on 2018 trends. In other words, the study doesn’t show pandemic impacts.
Nursing leaders emphasized a need to prepare for such shortages by investing in programs and solutions now.
“So everything that you see is really probably the best case scenario,” Forcina said. “When you look at the early exit, which (Jones) demonstrated, that’s probably closer to what we’re seeing now in the pandemic.”