Columbus has a nursing shortage. Here's how hospitals, colleges are trying to solve it

Nov. 22--The state of Georgia and Columbus are dealing with a nursing shortage that experts predict could get worse in the coming years.

Georgia is among seven states projected to have a shortage of registered nurses by 2030, according to a July 2017 report from the U.S. Health Resources and Services Administration, which is the most recent federal data available.

Meanwhile, the Georgia Department of Public Health, in a report updated on Nov. 19, declared, "The nursing shortage has reached a crisis level in Georgia's public health."

"I wouldn't describe it as a crisis (in Columbus), but it's one that I have to stay vigilant about all the time," said Cary Burcham, the chief nursing officer at Piedmont Columbus Regional.

However, officials at local hospitals say they are making strides to reverse the trend as they identify the various causes of the shortage from aging nurse and general populations to burnout. Then they use what they learn to devise a range of solutions.

For instance, Sharnette Grubbs, who is in the nurse residency program at PCR, credits recent changes to the program with helping her cope with challenges that could lead to burnout if not handled properly.

"My preceptor (an experienced nurse mentor) that I work with makes sure I understand what's going on," Grubbs said. "If it gets overwhelming, she's like, 'OK, hold on. Let's stop and take a breath.'"

Problems and causes

Officials at PCR report that they have 900 nursing positions with a vacancy rate of 7.5% at their three Columbus locations: the Midtown and Northside hospitals and the John B. Amos Cancer Center. They say their annual turnover rate is 14%.

St. Francis Hospital officials say it has 600 nursing positions with a 13.3% vacancy rate and a 25% annual turnover rate.

The national vacancy rate is 8%, according to a January 2019 survey by Nursing Solutions Inc., a registered nurse placement company. While the national annual turnover rate is 17.2%, according to the survey.

Some of the top causes for the nursing shortage based on interviews with local officials and a January 2019 report by the National Center for Biotechnology Information include:

-- Turnover

-- Burnout

-- Aging nurse/patient populations

-- Career and family challenges

Turnover and burnout

The national average for annual nursing turnover rates vary greatly, depending on location and specialty, according to the report, but the reasons are similar.

"Some nurses graduate and start working and then determine the profession is not what they thought it would be," the report says. "Others may work a while and experience burnout and leave the profession."

Turnover doesn't necessarily mean the nurses who depart are dissatisfied with their profession, said former St. Francis chief nursing officer Patricia Hannon, who left her position this month. She said they could leave to pursue more education or another work environment or because their spouse got another job.

"It's just life situations that may move them to other opportunities," she said.

But as much as mobility contributes to nursing turnover, it also is "a drawing card of the profession," Hannon said, because nurses can find jobs after moving to another community faster than many other career fields.

"There are so many opportunities," she said, noting that insurance agencies, pharmaceutical companies and law firms sometimes hire nurses for their medical expertise.

Burcham, the PCR chief nurse, agrees.

"It takes a good probably two years to mature a nursing graduate into a competent nurse that can handle a myriad of scenarios, and just about that time is where we start to see the greatest losses," he said. "I don't think we're unique in that. I think that's a challenge at all the hospitals."

Compassion fatigue also can be a powerful challenge for nurses to overcome.

"They get burned out," Hannon said. "If you're watching ill patients, if you're taking care of patients that are dying frequently, or you're seeing patients come back multiple times with healthcare issues, over a period of time, it takes a toll on healthcare providers."

Research indicates that a nurse "must remember over 200 things for each patient they're taking care of," Hannon said. "... Nursing isn't only about providing care, but you also want to prevent. You want to stay ahead to prevent things from occurring."

That's why, Hannon said, she has seen the typical load of patients for a nurse decrease "because of the number of things you have to know and manage and coordinate to take care of patients."

At St. Francis, she said, the patient load for nurses usually ranges from two in the intensive care unit to as many as five or six elsewhere.

PCR wouldn't disclose its actual patients-to-nurse ratio, but Burcham said the budgeted ratio is 5:1 and is "slightly better than in recent years."

Aging populations

The aging population factors into the nursing shortage on both ends of the healthcare industry: increasing the number and acuity of patients, and decreasing the number of nurses.

The U.S. already has the highest number of Americans older than 65 in its history, and that number is projected to increase from 41 million in 2001 to 71 million in 2029, according to the NCBI report.

"The population is surviving longer, as a whole, causing increased use of health services as well," the report says. "Many disease processes that were once terminal are now survivable for the long-term. Treating these long-term illnesses can strain the workforce."

Hannon and Burcham have seen acuity rise among patients at their hospitals.

"It is just more challenging to take care of the patients that are hospitalized today," Burcham said. "That's at any hospital."

"They're requiring more healthcare needs, so the demand has increased," Hannon said. "... They're coming into the hospital with many (ailments). They may be diabetic, they may have high blood pressure, they may have cancer. Now, when people come in, they don't just have one disease. They have multiple diseases you have to try to manage at the same time. That puts a lot of responsibility and accountability on the whole team."

Meanwhile, an estimated one-third of registered nurses could retire in the next 10-15 years, including those who teach future nurses, according to the NCBI report.

"Decreased and limited amount of faculty can cause not only fewer students but the overall quality of the program and classes can decline as well," the report says.

The status of the economy often affects retirement decisions among nurses, Burcham said.

"When the economy was down, there were a lot of nurses that became the primary income earner in their family or their income was significant enough for other reasons that they decided to defer their retirement plans," he said. "So you do have a lot of Baby Boomer era nurses, the economy has been better now for a number of years, and they're able to execute on their retirement plan."

Burcham wants PCR's staff to have no more than 40% of its nurses with less than two years of experience. The rate ranges between 45-55% now.

"You need to have mentors that can mentor those nurses and get them to the point of where they need to be competent clinicians at the end of two years," he said. "... With the acuity that you see in major medical centers today, you ideally would love to have a skill mix of no greater than 30% of nurses with less than two years."

Career and family

Despite increases in the number of male nurses, the profession still is majority female, according to the NCBI report.

"Often during childbearing years, nurses will cut back or leave the profession altogether," the report says. "Some may eventually return, but others may move to a new job."

The NCBI report cited research that indicates "nursing shortages lead to errors, higher morbidity and mortality rates."

Hannon, however, insisted, "With the nursing shortage, the care should not be different, because we focus on providing safe, efficient, high-quality, effective, timely care. ... The challenge is for healthcare organizations bringing in and educating the nurses to provide the high-level performance."

Local solutions

In 2017, PCR upgraded its nurse residency program by becoming one of the more than 500 U.S. hospitals and health systems offering nursing school graduates the Vizient/American Association of Colleges of Nursing Residency Program.

Vizient is a Texas-based healthcare performance improvement company.

The year long nurse residency program at PCR gives new nurses more attention than the 8-14 weeks of orientation all registered nurses receive.

Cohort sizes vary from 15-70. The program is on track to have more than 260 graduates by the end of this year, contributing to a better retention rate for first-year nurses, said PCR senior communications specialist, Jessica Word Roberts.

Burcham credits the upgraded residency program for adding "a degree of rigor and formality to the program that we simply didn't have before."

As a result, he said, the first-year turnover rate for PCR nurses has been cut in half, to 6%, the past two years.

"Our instructors received training on Vizient," he said, "and we use all of our tenured clinical staff as guest faculty to give lectures and work on projects."

Vizient's accredited program provides a framework to teach some of the soft skills nurses need, such as time management, organizational development and communication, to succeed in a fast-paced healthcare environment, Burcham said.

Grubbs, who graduated in May with a bachelor's degree in nursing from Columbus State University, works in the PCR Midtown neonatal intensive care unit.

"Instead of new grads graduating and here's two or three weeks orientation and throw you on the floor, they kind of coddle you and help you and make sure that you're comfortable taking care of your patients," Grubbs said.

For example, Grubbs said, when she feels her patient load gets too much, "I might pull my hair out if I was by myself. But having my preceptor, she's helping me to find ways of doing things that's going to flow for me."

St. Francis started its nurse residency program in 2009, revamped it in 2015 and has 46 participants this year, according to hospital officials. The hospital also has a critical care fellowship for nurses to move to a higher acuity area, Hannon said.

"We're bridging that gap between school and the workforce," she said. "... It's been successful with retention as a well as job satisfaction."

PCR and St. Francis have nursing students doing clinical rotations in their hospital. Hannon praised the collaboration the Columbus hospitals have with local nursing schools.

"We have nurses that are adjunct faculty at the schools, so you're bridging that gap between what is being taught at school and what's actually occurring in the facility, in the hospital," she said. "... On the other end, we have faculty that work in the hospital on weekends and holidays so they stay abreast about what is really needed in the workforce."

And then there's the pay.

The average annual salary for registered nurses in Georgia is $66,750, in Alabama it's $57,890, and nationally it's $73,550, according to NurseSalaryGuide.net, which compiles figures from the U.S. Bureau of Labor Statistics.

Starting salaries for newly graduated registered nurses are around $50,000 at PCR, increasing to an average of $60,000-$65,000 for those with more experience, Roberts said.

"Most of my departures are not for pay," Burcham said. "We have been able to remain very competitive with pay. We have a very strong benefits package. Most of the departures are, if I had to put them into bucket, most of the departures are when you look at first- and second-year turnover, it's nurses wanting to seek new and different experiences."

St. Francis human resources director Jerry Kersey declined to share salary figures. The hospital does have incentive programs, such as sign-on, referral and clinical ladder bonuses, as well as compensation for differences in shifts and being a preceptor, Kersey said.

Other solutions to retain nurses could include making work schedules more flexible or more fixed, depending on preferences, Burcham said, as well as promoting the dynamics of the job.

"I don't know a profession where you can have the opportunity multiple times in the course of your career to change your specialty and to keep it fresh, keep it interesting, keep it challenging," he said.

Nursing schools' role

Local nursing schools "seem to be turning out ever-increasing numbers of students," Burcham said, "but there are a lot of opportunities for nurses to do things other than hospital-based or bedside nursing care."

The Ledger-Enquirer checked with local nursing schools at Columbus State University, Columbus Technical College and Chattahoochee Valley Community College.

Overall, they reported an increase in nursing graduates.

Columbus State

Columbus State University offers bachelor's and master's degrees in nursing.

The number of graduates from the bachelor of science in nursing program at Columbus State increased in the past year by 34% to 91 in 2019, according to CSU School of Nursing director Janet Alexander.

Alexander said 96% of them are employed a year after graduation, including 70% by hospitals in the region.

"The shortage is real," Alexander said. "... After a year's experience, an RN can do travel nursing almost anywhere in the U.S. and make a lucrative salary, have benefits and housing provided."

Which is one of the reasons Alexander encourages students to choose the profession.

"Nursing is a viable and rewarding job -- mentally and financially -- anywhere in the country and in many parts of the world, with fantastic job and life opportunities," she said. "I would recommend it to anyone interested in working with people and who cares about improving the health and lives of others."

Columbus Tech

Columbus Technical College offers an associate's degree in nursing, which is the minimum amount of schooling to become a registered nurse and can be completed in five semesters at CTC.

The college also offers a practical nursing degree, which can be completed in four semesters at CTC and qualifies graduates to become a licensed practical nurse. LPNs have more responsibility than RNs.

The number of nursing graduates fluctuates at CTC, "depending on the number of staff and clinical space availability," said Matt Dennis, the college's dean of academic affairs in health sciences and nursing.

The college had 58 ADN graduates and 26 PN graduates in 2018-2019, he said.

Dennis sees evidence of the local nursing shortage in the employment rate of the program's graduates.

"One hundred percent of our ADN and PN graduates are placed in the field," he said. "So that demonstrates that there is a need in our area."

CVCC

Chattahoochee Valley Community College has nearly tripled its total number of graduates in three nursing programs during the past 10 years, according to statistics from CVCC health sciences coordinator Heather Lameda:

--

Practical nurse certificate graduates increased from five in 2009 to 35 in 2019.

--

Associate of applied science in nursing for direct-entry graduates (not licensed in Alabama) increased from eight in 2009 to 32 in 2019.

--

Associate of applied science in nursing for mobility graduates (licensed in Alabama) has remained around the same number and was 12 in 2019.

"We have a 100% job placement rate in all three programs," Lameda said.

Starting in summer 2020, CVCC will offer a stand-alone practical nurse certificate program "due to the local shortage of LPNs, as well as the Alabama Nursing Home Association and the system's office push to produce more PNs," said Bridgett Jackson, the college's health sciences director.

CVCC's certificate program currently is embedded in the associate degree program for student to become an RN, which is five semesters. This addition will allow students to become an LPN in three semesters.

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