South Carolina’s nursing shortage began long before the global pandemic stretched health care resources to the limit.
Like the rest of the nation, the state grappled with a shortage of registered nurses for a number of years. As early as 2005, studies conducted by various health care organizations have sounded the alarm.
The U.S. Bureau of Labor Statistics reports registered nursing has been projected to be one of the top areas for job growth between 2019 and 2029, with some 175,000 new openings being created each year.
However, the average age of a registered nurse in the U.S. is around 50 years old. That means over the next 10 or so years, the industry was already expecting to see a spike in the number of individuals leaving the profession, either via retirement or for other reasons.
Another reason for the shortage of bedside nurses is a lack of nursing instructors, making it even more difficult to replenish a shrinking talent pool. Add the COVID-19 pandemic to the mix, and the entire situation takes on a whole new spectrum of challenges and an increased sense of urgency.
Health care organizations across the state are working to come up with immediate and long-term solutions. South Carolina health care providers have worked to rise to the challenges that have been presented to them, both for immediate needs and for long-term solutions.
Patti Hart, chief nursing officer for the Medical University of South Carolina in Charleston, noted that prior to the pandemic, MUSC, while performing above the national average, was experiencing many challenges described nationwide.
Hiring travel nurses, increasing salaries and bonus packages, attracting nurses who had previously left the patient care arena, either for other jobs or for retirement, are all options MUSC have undertaken. Revisiting the day-to-day routine is another.
“We’ve had to get creative,” Hart noted. “We are looking at all the things that RNs do that don’t require an RN to do and making adjustments so that the RNs can do the job they need to do.”
MUSC has hired more health care technician positions across the organization. Offering more flexible hours to support the units and creating roles that support those at the bedside has been an important area of focus. MUSC has also attracted some retired nurses and nurses who left patient care for other opportunities to handle admission work, freeing clinical nurses to concentrate on bedside care.
Most important, MUSC has worked to help nursing staff maintain mental well-being, Hart said.
“We are truly trying to give them the tools to help them take care of themselves and their leaders to take care of their teams,” Hart said.
Christina Oh, the new CEO of Trident Medical Center, a HCA hospital system based in North Charleston, said that, like everyone in the health care industry, Trident has turned to traveling nurses to help alleviate staffing shortages.
“Unfortunately, none of us are in this alone — we are all facing growing challenges industry wide,” Oh said. “But thinking beyond the immediate situation is very important to us. We had a very good running start. We took that bolus approach to our critical staffing needs — and the traveling nurses are heroes — leaving their families and coming here to help us. But we also really tried to make sure we have recognized and taken care of the staff who have been with us, make sure they know they are appreciated and valued. We want to have the financial incentive for them as well. We don’t want to make a traveling contract more attractive.”
The lure of travel nursing is strong. A traveling nurse can often make significantly more money working a short-term contract than they would make as a regular staff nurse. Oh said she wants Trident to not only be a place traveling nurses want to work, she wants Trident to be a place that attracts them permanently.
“The culture of an organization trumps everything,” she said. “You can pay competitively, you can offer all the benefits, but if you don’t have a culture that values people above everything else, you’re going to have very difficult time getting over the wall. So, my number one focus is to show employees and prospective employees, by example, that our culture is the one to choose because we value them.”
Carolyn Swinton, senior vice president and chief marketing officer for Prisma Health, agreed. Prisma, like everyone in the industry, is using travel nurses to bolster staff shortages, as well as offering bonus packages for extra shift work and for employees who refer candidates to Prisma. She is a strong believer in developing and nurturing positive workplace culture.
“The attraction for travel is strong,” Swinton said. “So Prisma works very hard to let our people know how much they are needed, and appreciated. We work hard to take care of our people. We try to market this area — it’s a wonderful place to live, work and play. We try hard to provide a good work/life balance.”
The other important area being addressed is the challenge to replenish the talent pool. According to a report by the American Association of Colleges of Nursing, 2019-2020 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing, U.S. nursing schools turned away 80,407 qualified applications from baccalaureate and graduate nursing programs in 2019 because of an insufficient number of faculty, clinical sites, classroom space, clinical preceptors and budget constraints. Most nursing schools responding to the survey pointed to faculty shortages as a top reason for not accepting all qualified applicants into their programs.
The pandemic has added fear and uncertainty to the mix. Hart said a survey first conducted by the American Organization of Nurse Leadership in 2007 found that 63% of people surveyed in the U.S. would recommend a career in nursing. But when the survey was conducted again in 2021, only 27% said they would recommend a career in nursing.
In South Carolina, efforts have been made to lobby for such benefits as student loan forgiveness for nurses and nursing students, as well as salary increases for nursing faculty.
MUSC and others have been working statewide to identify and establish satellite campuses and bolster programs at the secondary school level, Hart said. MUSC is working with one school district on a pilot program that will start freshmen on a path to graduate from high school at nearly LPN level.
Swinton said Prisma Health partners with school districts, technical colleges, and colleges and universities — and even has a K-12 program — to expose younger students to the possibilities and career opportunities across the entire health care industry, including nursing.
But all agree that it will be some time before results will be seen.
“It’s about course correction,” Hart said. “We’re behind the times, so we need to position ourselves now to change that course to meet those needs.”
Correction: The printed edition of this story previously stated that licensed practical nurses were handling functions such as passing medications. While this hasn’t happened yet, this is something MUSC is looking into.