COVID-19 fueled nursing shortage but also inspired new generation of nurses
The skills lab at the University of Rochester School of Nursing looks just like a hospital unit.
Hospital beds are separated by curtains. Students break off into small groups as instructors walk them through specific parts of their training.
On a Friday in late October, Andrew Pierle and Christian Tarantola were learning how to place a patient in restraints.
Their instructor, Rachel Ngo-Oum, explains that this may be required if a patient is deemed to be a danger to themselves or others.
Pierle and Tarantola are both in their first semester of an accelerated program for people who are switching to nursing from a different career.
Tarantola used to work in supply chain management at Xerox, but decided to go back to school to become a nurse because of what he noticed during the COVID-19 pandemic.
"When I saw what nurses do for people, especially during a pandemic, this is a potentially a once-in-a-lifetime opportunity to deal with this kind of disease,” he said.
Pierle worked as a lab technician at the University of Rochester Medical Center but he was also looking for a change.
"Sitting at a desk and doing, like, bench work, can be kind of grating,” he explained. “And so I wanted to have some face-to-face contact."
Pierle and Tarantola are keenly aware that grueling, long shifts and other job-related stresses caused some burned-out health care professionals to quit during the pandemic.
"It's definitely daunting to hear about,” Pierle said, “but I want to try to welcome it as an opportunity and a challenge."
If the latest enrollment trends at the UR School of Nursing are any indication, there are plenty of others who aren’t scared off by concerns about COVID-19.
From 2018 to 2021, applications increased by 30% and enrollment jumped 47%.
Enrollment this fall was 799 students, believed to be an all-time high for the school.
That's an encouraging sign when you consider that nursing staff levels are down 25% at hospitals throughout the University of Rochester Medical Center network due to people quitting or transitioning to new roles.
The number of open positions is even higher (up to 30%) among nurse specialists in areas like critical care, emergency, and medical surgery.
Before the COVID-19 pandemic, overall vacancy and turnover rates for nurses in the health system were between 12% and 15%.
Nursing shortages affect everything from the number of patients who can be admitted to hospitals to wait times in the emergency department.
"It really has been magnified more specifically over the last couple of months,” said Kathy Rideout, dean of the UR School of Nursing. “And I think that we all have an obligation to try to increase the nursing workforce but we're really limited, for a lot of reasons, in how quickly we can do that."
The school is trying to accommodate more students. Construction on three new floors is expected to be completed by next month.
The additional classroom space, scheduled to open in May 2022, includes virtual technology which will allow students to work on a scenario remotely or even through an app.
This is needed because not as many nurses can train in clinical settings as they once did. COVID-19 safety concerns are part of the reason for that. Another factor is the level of care that patients require.
For instance, Rideout explained that groups of eight students used to be able to train in psychiatry units. The groups are now limited to three or four students because of the level of care required for patients.
“The complexity of having more people on a unit can be much more distracting to the care that's being provided to the patients that are on those units,” she added.
It's not just space that’s needed for training. In some nursing schools, a shortage of teaching staff is an ongoing problem.
According to Rideout, this is not the case at the University of Rochester because it’s part of an academic health center with nursing professionals who can combine clinical work with teaching, or transition from one to the other.
"We have not had a situation where we could not admit students because we don't have faculty,” she said. “That has never been an issue for us."
But this is a problem in other local institutions.
SUNY Brockport, for instance, currently has four openings for nursing instructors; two at the undergraduate level and two at the graduate level.
Kathleen Peterson, dean of the school’s department of nursing, said there aren’t many qualified applicants. She thinks it’s because of the salary.
There’s a big drop in pay for a nurse moving from clinical work to teaching.
"If I were a full-time pediatric nurse practitioner right now, my guess is I'd be making close to $130,000 or more,” Peterson said. “But to move to academia, I might be making $80,000."
Nurse educators also need to have a Master’s degree or a PhD, which not everyone can afford.
Other local nursing schools have seen enrollment drop in the last several years.
Roberts Wesleyan College links a recent decline in enrollment in its undergraduate nursing program to pandemic-related restrictions that limited the school’s ability to host in-person campus visits and tours.
In the fall of 2021, enrollment was 166 compared to 180 in 2020.
Rochester Regional Health is attempting to fuel the pipeline of future nurses by expanding its Isabella Graham Hart School of Practical Nursing to Ontario, Genesee, and St. Lawrence counties.
The health system expects the additional locations to boost enrollment by 60 students per year.
The new sites, which offer training for certified nursing assistants, licensed practical nurses, and registered nurses, are scheduled to open in January 2022.
While adding more students into nursing programs can help, Karen Keady, chief nursing executive at the University of Rochester Medical Center, believes a team approach will be needed to make a real dent in the nursing shortage.
"I think the path out is going to be not necessarily more nurses, more nurses, but developing a different care model and give them other support people around them,” she said. “That's going to be the long-term solution."
That might mean expanding the roles of nursing assistants and patient care technicians and creating new positions, such as behavioral health technicians, to allow psychiatric nurses to care for more patients, and spend more time with patients who need complex care.
Despite the many challenges, most of the administrators and students who talked to WXXI News are optimistic about the future of the profession.
Peterson has seen nursing undergo a lot of changes since she started her career in the 1970s.
"I think nursing is seen very different now than it was 20 years ago,” she said. “I think 20 years ago, many people thought it was a handmaid job."
At the same time, Pierle, the University of Rochester student, is worried that current attitudes are eroding people's trust in health professionals.
That’s his biggest concern about becoming a nurse.
"We've seen a lot of medical disinformation being spread, specifically because of COVID and because of the vaccines,” he said.
“I think there's a lot of fear and hesitation these patients are experiencing and I'm just worried that we as nurses aren't going to be as trusted to give the sort of quality health care that I think patients deserve."
But Pierle doesn’t seem intimidated by this. Once he starts working as a nurse, he said he hopes to use his experience in clinical research to put people’s fears to rest.