Brattleboro, Vt.
According to the Sigma Theta Tau International Honor Society of Nursing, in the United States alone, 126,000 nursing positions remain unfilled and by 2020, there will be at least 400,000 fewer nurses available to provide care than will be needed.
There are many reasons for the shortage, but one factor stands out: age — that is, an aging population in need of services and an aging nursing workforce.
Issued in May 2014, the U.S. Census Bureau report on “An Aging Nation: The Older Population in the United States” found that by 2050, the number of U.S. residents age 65 and over is projected to be 83.7 million, almost double its estimated population of 43.1 million in 2012, stated the the American Association of Colleges of Nursing. “With larger numbers of older adults, there will be an increased need for geriatric care, including care for individuals with chronic diseases … Insufficient staffing is raising the stress level of nurses, impacting job satisfaction, and driving many nurses to leave the profession.”
And according to a 2013 survey conducted by the National Council of State Boards of Nursing and The Forum of State Nursing Workforce Centers, 55 percent of the registered nurse workforce is age 50 or older.
“These issues are occurring just as the majority of nurses are retiring and job opportunities within health care are expanding,” noted Sigma Theta Tau, an international honor society for nursing. “The result: Hospitals and other institutions need more nurses, especially those who deliver specialized care.”
Health care organizations in Windham County, though not in such a dire situation as indicated by Sigma Theta Tau and AACN, also are struggling to hire and retain registered nurses.
“As people retire, we have to be able to keep up,” said Jodi B. Stack, chief nursing officer at Brattleboro Memorial Hospital. “We probably have 10 to 15 open positions at any given time.”
Across Brattleboro Memorial Hospital and its clinics, the organization employs between 140 and 150 nurses.
While the shortage BMH is facing doesn’t impair its mission as at other hospitals around the nation, Stack said, it does affect the budget and means that many nurses are working overtime shifts, which can lead to occupational burnout. To fill in the gaps, BMH relies on an outside contractor to provide temporary nurses.
“It is certainly challenging,” Stack said, “and our relationships with local schools is important as we look to the future.”
BMH and Grace Cottage Hospital in Townshend are working with Greenfield (Mass.) Community College, and Vermont Technical College — which has a campus in Randolph — to develop a pipeline for nursing students. As part of their curriculum, student nurses spend one to two semesters at the hospital, participating in patient care in collaboration with BMH nurses and under the supervision of their instructor.
“We have quite a few nursing students that end up taking positions here,” Stack said. “They tell us they like the small-community feel of BMH.”
Brattleboro Memorial Hospital also is working with Windham Southeast Supervisory Union and Windham Regional Career Center. As part of the health sciences track, students will now be able to become licensed nursing assistants during their senior year. BMH plans to host its first clinical rotation for this program in the spring.
“The licensed nursing assistant position is a key part of Nursing Services at BMH,” Stack said. “Under supervision of the registered nurses, the LNAs assist with different aspects of patient care. The LNAs are a valued member of the nursing team, and I am looking forward to this new collaboration with the high school.”
Along with the traditional demands placed upon nurses, Stack said, more and more each day these nurses are being called upon to step outside their traditional roles and respond to issues such as substance misuse, mental health, homelessness and food insecurity. BMH is working with other community organizations such as HCRS, Groundworks Collaborative, the Women’s Freedom Center,the Brattleboro Retreat and Turning Point to insure those on the front line have the resources and support they need to help their patients.
“The needs of our patients and our community change over time,” Stack said, “and I am proud of our nurses for everything they do to meet these needs and deliver quality care with compassion and respect.”
A Smaller Staff
At Grace Cottage Hospital, Chief Nursing Officer Lisa Eaton has a much smaller nursing staff than BMH, but has the same concerns about finding qualified nurses to fill positions.
“We’ve been pretty lucky,” said Eaton. Her staff of slightly more than 40 nurses has not needed to be supplemented by contract nurses, she said, though they do have per diem nurses who fill in when needed, such as covering for vacations or sick days.
“That per diem pool helps us absorb some of the slack due to changes, such as someone leaving the job,” Eaton said.
As at BMH, she said, Grace Cottage’s partnership with Greenfield Community College and Vermont Technical College helps to funnel nurses into the hospital’s halls and rooms.
“We have hired a number of employees who performed onsite work here as students,” Eaton said.
To assist in the emergency department, Grace Cottage has hired EMTs and paramedics, many of whom have shown an interest in continuing their education and eventually becoming nurses. Grace Cottage offers reimbursements for educational expenses to those who earn certification and take jobs there.
“We’ve been voted the best place to work in Windham County,” said Eaton, adding that the hospital’s status that helps in recruitment and retention.
“People enjoy working in this team environment,” she said. “And we have a great leadership team here that encourages initiatives designed to take care of our patients and keep our staff engaged. Our job is to support the people in our community, and that includes our employees.”
Eaton said she also believes nursing can be an incredibly rewarding career.
“There are so many things you can do with a nursing degree,” said said. “You can work in a community hospital, a doctor’s office or a community clinic. There are many avenues to choose from.”
Specialized Care
With more than 140 nurses on staff, the Brattleboro Retreat, a specialty psychiatric and addiction treatment hospital, faces the same challenges with a slightly different skill set, said Meghan Baston, chief nursing officer and senior vice president of Patient Care Services.
“The challenge for a specialty hospital like ours comes from the inherent need of the training specific to our specialty,” she said. “All of our nurses are trained in psychology.”
While registered nurses trained in a typical hospital setting might consider a career at a facility such as the Retreat, Baston said, they need to be trained to respond to patients with mental health issues.
“It’s nice when we get psychiatrically trained nurses, but they are very difficult to find,” she said.
To make up for that lack of training, Baston said, “we have a quite robust clinical education department providing didactic training.”
And recognizing that the Retreat needs to do more outreach in encouraging qualified nurses to come to or stay in Brattleboro, the Retreat recently hired a recruitment and retention specialist specific to registered nurses.
Baston said that person will be responsible for getting out into the community, promoting the culture of nursing at the Brattleboro Retreat and with creating a residency program.
The Retreat also works with nursing colleges.
“We are a robust clinical site for psychiatric nursing in this part of Vermont,” Baston said. “We have upward of 10 nursing colleges who send students to our site.”
Many of those students end up coming to work at the Retreat, not only because they find its mission rewarding, but also because it provides support to nurses who are interested in their own professional development, she said.
“We work very diligently to insure our staffers have the tools they need to be successful and do their jobs safely and appropriately,” Baston said. “It’s about knowledge and being empowered to think critically and make patient care and clinical decisions.”