California is already low on nurses, but the way things are going, it may get much worse. A nursing shortage has been predicted for decades, and some parts are being affected more than others. The needs and the severity of the problem depend on what part of the state you look at, and boils down to a variety of factors, some which may seem strangely conflicting. But southern and central California in particular seem to be hit the worst. Let’s look at the hard data before outlining the trends that could cause a major nursing shortage in that part of the state.
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The Hard Numbers
There are currently around 400,000 nurses in California. Assuming the current level of healthcare is steady, population growth plus the projected needs of an older population will mean that seven states will have a shortage of registered nurses by 2030. Four states will have a shortage of 10,000 or more full time nurses. California will be the worst off with a shortage of an estimated 44,500 nurses. Texas came in second with a projected shortage of roughly 16,000 nurses. New Jersey and California came in at just over 10,000 nurses short. Another study projected a deficit of around 140,000 nurses, and that, too, would be the nation’s largest shortfall.
Sacramento Seems to be Doing Well, However
The trend is not the same across the whole central valley. As a matter of fact, some places may actually be experiencing surpluses. One industry study suggests that there may be a surplus of nurses in Sacramento and Los Angeles by 2030, but there will be deficits in San Francisco, the Central Valley and Central Coast regions.
The Certain Growth in Demand
Whether the state rolls out universal healthcare or simply expands existing healthcare programs, the end result will be an increase in demand for medical services. That in turn will increase demand for nurses, though supply isn’t increasing in line with need.
Another factor is the aging population. One government study predicted a 28 percent greater demand for nurses by 2030 due to the greater needs of an aging population. Many states are on track to meet that demand, but California is not among them. In the Central Coast, the older workforce means the area will suffer a nurse deficit as Baby Boomers retire in large numbers.
Population growth in some parts of the state is much faster than the rate at which new nurses can be trained. In Central Valley, for example, population growth is far faster than the capacity of local nursing schools.
Not only that, but certain areas are in more dire need of specialists than others. And the areas with the most demand aren’t necessarily the ones that are attracting new nurses. For instance, there will be increased demand for nurses that can provide assisted living, but this is not always the first choice for nurses. More are trying to encourage nurses to move away from bedside positions and consider other options, such as senior housing among others.
The Impact of Legislation
California has made matters worse for itself by moving to require all nurses earn a bachelor of science in nursing or BSN degree. This shuts out those with just a 2-year associate’s degree in nursing, though the associate’s degree will make you an RN. If they mandate a higher credential for the job, they will limit the supply of nurses because of the time and cost required to earn the BSN. Nurses with an associate’s degree who want to continue working can get ahead of the curve by completing a BSN now.
The Bottlenecks in the Training Pipeline
There are state leaders working on identifying and implementing local solutions to the overall shortage of RNs. For example, in some areas, there are more newly graduated registered nurses than employers can onboard. This slows the entry of new nurses into the wards. Another factor is the shortage of clinical training sites for nurse education programs. Opening up the educational pipeline would help alleviate the projected nursing shortage as the rapidly expanding RN programs in LA and Sacramento demonstrate.
The Nursing Education Bottleneck
Another factor contributing to the nursing shortage is the lack of nursing school slots. Thousands of Californians want to train to be nurses but can’t get into California nursing programs. The Board of Registered Nursing estimates that 20,000 students are turned away due to enrollment caps.
Some attend out of state schools, though this may result in them never returning to work. On the flipside, some choose to return as traveling nurses, a high paying position. This is understandable given that California is the biggest employer of travel nurses. Others are attending online nursing programs. Attending an online neonatal nursing college,for instance, could allow more career flexibility while guaranteeing their future in the profession. This allows many to become degreed nurses before the accredited programs find ways to accommodate every nursing student.
The worst part is that there is also a shortage of teachers to teach this new crop of nurses who want to enter the profession. This is especially true for certain specializations such as psychiatric nursing for instance. And California is not the only state with faculty vacancy issues. As a matter of fact, the rate across the nation was at 7% in 2018.
Another issue is that trying to get nurses to leave their positions to become educatorsisn’t easy, considering that many can stand to make much more in their current jobs. And increasing class sizes wouldn’t be viable for a variety of reasons. For one, it could end up overcrowding clinical settings, and overstretching teachers that won’t be able to perform as they should. This would do a huge disservice to these new nurses, and the patients they’ll have to serve.
What are the Solutions?
California is far from being the only state with nursing shortages, and legislators would be wise to look at some of the efforts that were made in other parts of the country to deal with the issue. Many faculties have also decided to partner up with private support channels to curb the trend.
For instance, the University of Minnesota partnered with a veteran’s health care organization to provide incentives to nurses who want to enter the teaching profession. Through the initiative, the organization will fund the nurses who decide to turn to teaching in the state after they finished their studies.
Private companies are also doing a lot to promote the nursing profession at all levels. Johnson and Johnson, for instance, has a program dedicated solely to promoting nursing and encouraging more people to become nurses.
The AACN is also working hard on the issue and came up with their own initiatives. One of them is the creation of a central location for all nursing school applications. What this does is make sure that every spot in faculties around the country is filled. The initiative, named NursingCAS, was able to fill up over 50,000 vacant spots in faculties across the country in 2018 alone.
Another initiative that is worthy of mention is the narrative that was published by the Robert Wood Johnson Foundation. The narrative was published in 2010 and featured a few of the major initiatives and partnerships that have been made to address the staffing and educator shortage. The narrative also stressed the importance of higher education and observers suggested that all nurses should pursue at least a bachelor’s degree within the first 10 years of practice. This would fill the pipeline with nurses with a graduate or undergraduate nursing degree.
Facilities Have to Do Their Part Too
However, the sole responsibility shouldn’t rest in the hands of private companies and faculties. Healthcare facilities will also need to do a better job at painting a better image of the profession, and it all starts by improving conditions. No to mention that shortages are not only a question of not enough fresh blood coming in, but failure to retain talent. More facilities are trying to find ways to increase their retention rates, some being more successful than others.
What Can be Done to Improve Retention Rates?
Many things could be done to make sure that more nurses stay, and stay longer. Everything starts at the recruitment stage; employers have to do a better job at onboarding new nurses and make sure that they’re comfortable from the start. Driving excitement will also be important for new hires, and many facilities have started implementing simple things like job preview presentations to get new hires prepared.
More also has to be done to make the work environment better for nurses. This means genuinely focusing on wellness in the workplace, and giving them readily accessible resources. Many facilities have also started looking at alternative schedules to give nurses more scheduling flexibility.
Overtime continues to be a major issue in the healthcare industry, and is one of the main reasons for nurses burning out. As a matter of fact, one study by PhD Amy Witkoski Stimpfel stated that nurses who work twelve-hour shifts or more were nearly 1 ½ times more likely to leave their position within a year. She mentioned that the industry will need a massive change in culture, and overtime should no longer be looked at as the norm, but the exception.
Facilities will also have to do more to encourage further education and development. Not only will this lead to greater engagement, but it will also allow them to address internal shortages. A direct link has been made between professional development and engagement, and the industry could end up killing two birds with one stone by investing more heavily in their nurses’ education. Some facilities, for instance, are already offering tuition reimbursement for nurses who decide to go back to school. A 2010 report by the Institute of Medicine stated that the US would need 80% more bachelor prepared nurses by the year 2020.
Longevity and Excellence Will Have to be Recognized
Longevity and excellence will have to be rewarded as well if facilities want to improve their retention rates. One facility in St Louis, for instance, created a program that offered a variety of incentives for loyal nurses and those who outperformed their duties. As the result of these initiatives, they were able to reduce their voluntary resignation rates to one percent. One of the rewards was that nurses receive a direct cash bonus equivalent to up to 5 days of work when the facility was able to reach their objectives.
Nurses could also earn up to two thousand dollars for special assignments like speaking at a conference, going through a fellowship program, or even getting thank you notes from the patients they worked with. In addition to that, those who had 15 years or more at the facility received an additional 5 days of vacation instantly.
Technology to the Rescue
Let’s not overlook the importance of technology in the process of alleviating the workload, not only at the care level, but for faculties as well. Distance education is already achieving this, but additional on the job training solutions could also help certain nurses take on more responsibilities. Telehealth also allows more patients to stay at home and receive distant care. Combined with tools like wearables and the IoT, this could help reduce the load significantly, and allow more self-monitoring to be done.
Robotics could also be helpful to many nurses. AI and robotics are already being used in clinical settings in countries like Japan, and are used to help nurses lift patients among other things. Some are also equipped with sensors to inform staff when a patient is about to fall off their beds, for instance.
Voice assistance technology could also be used to quickly assess important information about patients. For instance, they could help keep track of a patient’s records, or give important reminders. This alone could have a significant impact on the number of accidents, and streamline the work of nurses.
Nurses are the foundation of the healthcare system. They work in hospitals, schools, rehab facilities and nursing homes. We need to work towards ensuring that there are enough of these critical healthcare professionals to maintain the proper level of care everyone deserves.