As a critical care nurse on Portland’s cardiovascular unit, Jazzy Walker has experienced COVID burnout that is driving nurses out of the profession and exacerbating the nursing shortages that are prevalent in Oregon’s health care system.
Watching some of her most experienced colleagues crumble under the pressure of a growing patient load, she sensed a shift in team dynamics as the hospital needed short-term traveling nurses to fill staffing vacancies.
When the stress got on Walker, triggering panic attacks and sleepless nights, she decided to move from the bedside to academia and focus on developing the nursing workforce of the future.
After four months as a nurse administrator at Clackamas Community College, Walker faced a chicken-and-egg situation that prevented Oregon’s higher education institutions from meeting the needs of the healthcare industry.
Nurses don’t make as much money teaching as they do helping patients, making nurse educators hard to recruit. Faculty shortages limit the number of students that nursing programs can enroll, preventing Oregon colleges from graduating enough nurses to meet the state’s workforce needs. Staffing shortages in both settings mean fewer nurse educators are available to train students in practice clinical settings, further limiting the number and experience of nursing graduates.
“It’s a really ugly cycle,” Walker said.
Nursing programs in Oregon ranked third last in graduates per capita in 2020, according to the Oregon Longitudinal Data Collaboration, which analyzes data on Oregon’s education and workforce landscape.
“Most of our schools have programs. It’s a capacity issue,” said Tracy Thompson, a nursing education policy analyst for the Oregon Council of Nursing. “There are no teachers supporting additional students.”
The collaborative report, expected to be released in February, will recommend that the state convene a task force to address nursing faculty compensation and create a centralized clinical placement system. Nurse educators are also seeking policy changes from lawmakers to address problems in the critical state industry workforce pipeline.
“If we could provide incentives for clinical partners, and if there was a way for states to fund nursing educator salaries and program administrators, that would really help solve two of our problems,” Walker said.
Ali Oakley, a second-year nursing student at Clackamas, discusses a case study with his peers. Clackamas administrators want to expand the nursing program to help address industry staffing shortages, but are constrained by a shortage of nursing educators.
limited capacity
Oregon offers 17 associate degree programs for students who want to become registered nurses, as well as six public and private baccalaureate degree programs and an additional eight community college programs for licensed nurses who have less than registered nurse.
In 2020, 409 students graduated from the practical nursing program, 606 students graduated from the associate degree nursing program and 929 students earned a bachelor’s degree in nursing, said Ben Tate, director of the Oregon Longitudinal Data Collaborative.
Still, the Data Collaboration estimates that Oregon needs 1,000 more graduates that year to meet workforce needs, according to a draft summary of the forthcoming report.
The school has enough applicants to more than double its capacity. Nursing schools in Oregon received more than 6,000 applications in 2020 but accepted less than a quarter, the draft summary said.
Clackamas Community College sometimes receives more than 300 applicants for an average of 30 openings, Walker said.
“It’s very difficult to turn down so many potential nurses,” she said.
Jennifer Limones, 36, is in her second year of nursing at Clackamas and plans to work in the industry full-time this summer. She spent several years working and taking prerequisite courses before applying to the nursing associate degree program, inspired by the nurses who cared for her 4-year-old son at Randall Children’s Hospital when he needed kidney surgery.
Limones, a medical assistant for 15 years, was accepted into the Clackamas program on his first attempt. She knew it was an unusual feat.
“The fact that so many able and qualified prospective nursing students do not make the cut is not because of a lack of qualifications or ability. These are not incompetent or incompetent prospects,” Limones said. “There are only so many seats, it’s really frustrating.”
Walker wants to expand the vacant seat at Clackamas. In a perfect world, she’d offer 36 spots next fall and work to open 40, and maybe 60 in the long run.
But this fall, Clackamas doesn’t even have enough faculty to meet its normal enrollment needs. Walker said the school reduced the usual 30 places to 18.
“Trying to advertise and have bedside nurses come and teach with our students is like pulling teeth,” Walker said. “They can’t financially afford to take a pay cut, so they won’t be working full time.”
Daniel Bulek, a nursing instructor and simulation coordinator at Clackamas Community College, works with second-year nurses during the Jan. 9 session. Oregon’s public colleges and universities have difficulty finding enough qualified instructors to teach aspiring nurses, limiting the number of graduates Oregon can prepare for the workforce. Sami Edge/The Oregonian.Sammy Edge
Nurse educators earn less
Walker nearly turned down her position at Clackamas when the school’s first offer was $30,000 less than her full-time nursing salary.
Without overtime, Walker could make $90,000. With extra shifts, she earned more than $100,000. By comparison, full-time teachers at the school earn between $60,000 and $80,000, Walker said.
Nursing program administrators across the state are overwhelmed by this challenge. Janie Griffin, director of nursing at Columbia Gorge Community College, reminds prospective teachers that they can take summer break and most weekends off and juggle nursing shifts.
“When you see an ad and I’m going to make $20,000 less, (the nurse says) ‘I’m not even going to apply,'” Griffin said. “I don’t know, how do we grab them, hook them, and bring them in and say ‘Try it out, I think you’ll like it?'”
Oregon Health & Science University is working to advance the workforce of nurse educators through its Oregon College of Nursing Education. The academy aims to train 63 new faculty members and 92 new supervising clinicians through a $4 million federal grant. Nurses admitted to the Academy will receive a scholarship covering most of their tuition fees.
Several lawmakers introduced bills in the 2023 session that would expand the income tax credit for rural health care providers to nurse educators. A similar effort fizzled in committee in 2019.
Linfield Nursing students practice using medical mannequins in a simulated emergency room setting in the school’s Experiential Learning Centre. High-tech manikins can simulate bleeding, neurological symptoms and even childbirth. Courtesy Timothy Sofranko, Linfield University.Timothy D. Sofranko/Linfield University
few clinical sites
Nursing students need hands-on experience to complete their studies, but a lack of faculty and on-the-job nurses means there are too few mentors to guide students in a clinical setting. The shortage of clinical placements has become acute during the COVID-19 pandemic, when many healthcare facilities are closed to visitors.
Deb Henry, a nursing education and practice specialist at Legacy Health, said the hospital system offered 2,607 clinical sites for nursing undergraduates in fiscal 2020 and only 468 in 2021. Clinical sites rebound to 1,110 in 2022, but still not back to previous levels. Pandemic levels due to staff shortages.
Hospital units with multiple nurse vacancies cannot accommodate as many students, so hiring new legacy staff or travel nurses will be prioritized ahead of training students, Henry said.
“We try, I try, to place these students, but there are so many variables involved, it’s difficult,” Henry said.
The Oregon Board of Nursing allows schools to substitute simulated nursing scenarios — such as working with high-tech mannequins, case studies or actors — for up to 49 percent of students’ clinical hours, Thompson said. Some schools are already leaning towards this option.
Linfield School of Nursing has expanded its simulation center during the pandemic to help meet student demand for clinical experiences. Julie Fitzwater, associate dean for the School of Nursing, said spending time working with professional nurses in real health care settings helps prepare students for face-to-face work with patients, but time may not predict. Simulations allow instructors to design exactly the experiences they want their students to experience, such as caring for a mannequin who has given birth and is suffering postpartum hemorrhage, or interacting with an actor simulating a patient in a mental health crisis.
“Having both experiences is very important in building their clinical reasoning and clinical judgment,” Fitzwater said.
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Sami Edge is responsible for higher education at The Oregonian.you can contact her sedge@oregonian.com or (503) 260-3430.
