Virginia needs more nurses. The whole world needs more nurses.
This is not news (there is some news in this column, but this isn’t it, this is just the wind-up). Cardinal’s Megan Schnabel wrote about the nursing shortage – and why it’s so difficult to train enough new ones – in a story last year. In the amendments to the state budget that Gov. Glenn Youngkin has proposed, he wants to increase the amount of money the state spends on training nurses. He wants to double the state’s scholarship and loan repayment program for nurses and nursing faculty to $2 million, he wants to increase incentive payments for nurses who do clinical education rotations from $1,000 to $5,000 and, in the big one, he proposes $30 million to establish a Nursing Education Acceleration program to increase the number of nurses. The rival state budgets moving through the General Assembly contain other items designed to increase the number of nurses. For instance, the House budget includes $2.5 million for GO Virginia Region 1 (Wythe County and west) to increase both the number of nurses and the number of truck drivers. The Senate budget includes $5.75 million in additional funding for nursing programs at George Mason, James Madison, Longwood, Mary Washington, Norfolk State, Radford, the University of Virginia, the University of Virginia’s College at Wise, Virginia Commonwealth, Virginia State and the community college system.
Just in case there’s any doubt about the need for new nurses, a report from Old Dominion University should clear that up. The annual State of the Commonwealth Report issued by ODU’s Dragas Center for Economic Analysis and Policy devotes an entire chapter to the nursing shortage.
The bad news (and, unfortunately, there’s lots of bad news here, sorry): The number of nurses nationwide declined in 2021, the most recent year for which data is available. That’s right, with a pandemic raging, a time when we needed nurses most, their numbers declined by 3.2% nationwide.
What we have here is a mismatch between supply and demand – demand is going up but supply is not.
ODU reports that: “In 2019, the gap between job openings and hires averaged about 560,000 a month. In 2020, this gap declined to approximately 410,000 as attempts to contain the pandemic led to reductions (if not outright stoppages) in elective medical procedures. However, in 2021, the average gap between job openings and hires widened to 947,000 a month and jumped again to approximately 1.2 million in 2022.”
Furthermore, ODU looks at the actuarial tables: “Within the next 10 years, it is anticipated that 23% of the current nursing workforce in the Commonwealth will retire. The five-year periods with the most anticipated retirements are 2020-25 and 2025-30. Among RNs who are age 50 and over, 30% expect to retire by the age of 65.”
Clearly, nursing is one of those high-demand fields. ODU rightly zeroes in on Virginia and comes to this unhappy conclusion: “Virginia faces an average shortfall of 412 nurses a year over the coming decade.” Actually, that doesn’t sound so bad, right? Surely a state our size should be able to produce 412 more new nurses a year, right?
This report isn’t so sure. Right now, one of the bottlenecks in training more nurses is lack of enough nursing faculty. ODU reports that only about half the qualified applicants to nursing programs in Virginia get in because there aren’t enough spaces for them. And that might get worse, ODU warns:
“Should a large portion of baby boomer faculty RNs exit the workforce earlier than expected, the supply would decrease more precipitously and disrupt this niche of the labor market.”
Right now, 812 qualified applicants were wait-listed in the 2020-21 academic year because there wasn’t space for them. Sure, we could train 412 more nurses a year – heck, we could train 812 more a year – but first we need people and places to train them. Youngkin’s $30 million may go a long way toward fixing that problem but then there are others that he may not be able to fix. For instance: “As nursing shortages increase across the state and nation, the competition for existing nurses and new graduates will only intensify,” ODU says. “The Commonwealth of Virginia is likely to see the rise of ‘nurse deserts’ where some rural areas across the state may not have immediate access to a registered nurse. Without sufficient access to health care, the urban-rural divide will only increase, further exacerbating health care inequalities in Virginia.”
There’s also no guarantee that those new nurses we train would wind up in urban Virginia, either. Given the nationwide demand, they might well wind up out of state.
In December, I wrote a column about a new database compiled by the State Council of Higher Education for Virginia that tracks where the state’s college graduates wind up. For that column, I looked at several high-demand majors – nursing being one of them – and ran a spot check at several schools. At each one, most of the graduates were out of state within five years.
ODU conveniently compiles a list of the eight largest nursing programs in Virginia, so I went back to that SCHEV database to run the figures on all of them. SCHEV doesn’t have data for ECPI, a for-profit school, but does for the other seven: George Mason, James Madison, Liberty, Old Dominion, Radford, the University of Virginia and Virginia Commonwealth.
The most recent years for which SCHEV has five-years-after data are 2010-2012, so that’s the data I worked with.
For all seven schools, most of their nursing grads were out of state within five years. And by most, I don’t mean most by a little bit, I mean most by a lot – by figures that, if these were an election, they’d be called a landslide.
Here’s the percentage of nursing grads from that cohort who could be tracked down and were still in Virginia five years after graduation:
Virginia Commonwealth 27.2%
Old Dominion 24.7%
George Mason 23.1%
James Madison 20.1%
University of Virginia 19.7%
Liberty’s in-state figure is so low because it has a lower percentage of in-state students in its overall student body as compared to the state-supported schools.
As I pointed out in my previous column, this big loss of grads out of state isn’t the fault of the schools – they have zero control over that. In fact, you could argue that it’s a sign of respect for how good those schools are – their graduates are in demand all over. Still, it seems a demographic fact: Virginia is, by and large, educating somebody else’s nursing workforce. The state has other nursing programs coming online, with relatively new programs at Emory & Henry College and Ferrum College. Perhaps their percentages will be different once their graduates are out in the marketplace for five years. Or maybe they won’t be.
Regardless, the fact remains: We need more nurses. Obviously so does everybody else.