(upbeat music) - Welcome to At Issue, I'm H. Wayne Wilson.

Thank you so much for joining us.

There are approximately 3.9 million nurses in America today, but 25% of those are at least 50 years old.

And the American Association of Colleges of Nursing is predicting that about 1 million of them may retire by the year 2030.

That if corrective steps aren't taken may cause even more of a shortage in a shortage that already exists for nurses across the country and in central Illinois.

I'm pleased to have the chief nursing officers of the two medical centers located in Peoria here to discuss the shortage and what steps may be taken to correct that.

Let me first introduce to you Jennifer Croland.

Jennifer is the chief nursing officer for OSF Healthcare Saint Francis Medical Center.

Thank you for being on the program.

- Thank you for having me.

- And also here new in the position about three months?

- Three months.

- [Wayne] Three months from Reno, Nevada, and originally from Chicago.

She's Midwesterner, Dr. Debra Adornetto-Garcia, the chief nursing officer for UnityPoint Health, Central Illinois.

Thank you for being with us.

- Thanks for having me.

- And let's start with just a real quick, if we can define how short is the nursing shortage?

- Well, I think over the last 15 to 20 years, we've always had vacancies, but today those vacancies are probably three to four times what they normally are, for many reasons, but largely because of the impact of the pandemic, either directly or indirectly.

- I wanna talk about the impacts in just a moment, but let me turn to Debra and ask.

You've been in Texas, Reno, and now here.

Is the nursing shortage similar in all those states?

- It has been similar.

And I think the problem has been growing over the last few years and like what was said, the pandemic has really thrown kind of a wrench in nursing.

And so I think the biggest impact is the retirees that are the baby boomers in nursing, which is the largest workforce in nursing that have made decisions probably earlier than they would've, through the pandemic.

Deciding to retire a lot sooner than we had predicted.

- Let me turn back to Jen, because you talked about that, too.

A lot of people saying "I'm burned out and that the pandemic has made a decision for me."

- Yeah, I mean, I think, at the start of the pandemic, we didn't know how long it was going to be.

So initially you think it's a sprint and then it becomes a marathon.

And now we're in the ultra marathon wave and COVID's likely never gonna go away.

We're reaching really not a pandemic, but more of an endemic, and how do we live with COVID?

And at the beginning phases of the pandemic, the fear, not knowing what the disease was, not knowing if the isolation precautions that we were gonna have impacted our staff.

That took a severe emotional strain on them.

In addition to all of us coming to work in healthcare when other people were staying home during that first shelter in place and waiting for the first patients to arrive with COVID in our community.

- And is part of the problem that, I wanna be careful how I phrase this, but there's more patients and I don't necessarily mean that because we've had a population growth, but you're keeping more people alive?

- Well, I think over the last 20, 30 years, we've made a lot of advances in medicine.

Patients who used to present with sepsis may not have survived the first 12 to 24 hours of their care.

Patients who had complex cardiac procedures, we've advanced that technology and surgical procedures a lot.

And they're surviving their events.

So we know more today, and as a result of that, those patients are now occupying beds in our hospital that they never occupied before.

So the impact of volume has grown within our hospitals over time, as has the acuity of the patients.

- And we also have more chronic conditions of millennials that are showing chronic conditions sooner than we may have seen in past years.

- Yeah, I think that's true and I think the comorbidities for our population of people now are causing the complexity and the acuity that we're referring to and a lot of complex care that needs to be taken care of.

And acute care has tried to move to ambulatory care, but with the pandemic, it's brought a lot of patients more inhouse that have conflicting diseases along with COVID.

- We talked a little bit about the retirements.

I wanna talk about the pipeline for new nurses and with your perspective, working recently in Reno and then Texas, is this something that you've seen in all those areas where maybe we aren't getting as many nurses as we had thought we might be getting?

- Yeah, I think that we've always been talking probably in the last decade, getting prepared for this, getting prepared for the baby boomers retiring.

Which impacts our faculty and the schools of nursing, that we don't have enough faculty to teach the new students.

So I'm not quite certain that it's the lack of people that wanna go into nursing, but nursing schools can only take so many students in with the amount of faculty.

So we've always been concerned over the last decade.

Do we have enough faculty to sustain the nursing students that need to come in?

Because I know in my experience, many students get turned away because there's not enough positions there.

The pipeline's really important.

And so starting really early in middle school or high schools talking about nursing and making a presence in career days is really important to entice students who go into nursing.

Number one profession, number one most trusted profession that we were speaking about and that's the pipeline.

I also think the pipeline is other healthcare professionals, certified nursing assistants that help the nurse and partner with the nurse at the bedside.

Licensed practice nurses, LPNs that can go to school, come out into the healthcare field, work side by side with registered nurses, be supported with tuition and go back to nursing school.

And that's a real focus, I think, for everyone across the country is to entice those other positions to move on into a nursing position.

- I wanna talk about nursing as a second career, but mentioning the additional, the support staff, so to speak, for nurses.

Jen, is there a shortage of those positions, which is causing that?

I mean, that's exacerbating what the nurse has to do.

- Most definitely.

I think every industry is suffering.

You see it, whether it's with sales staff or restaurant workers, but we've seen a decline in the number or an increase in the number of vacancies with positions like our certified nursing assistants, respiratory therapy, phlebotomy, dietary aides, the list goes on and on.

There really hasn't been a corner of our healthcare industry that hasn't been impacted in the recent years with shortages.

And that places a lot of burden, if it's a direct care role, back on the nurse.

So if I don't have a phlebotomist, the nurse may be drawing the blood.

If I don't have a dietary aide, the nurse may be bringing the tray into the room, taking the tray out of the room.

And it's not that that one task is adding to the workload exponentially, but it's when there's all shortages from all different angles, that increased burden is impacting the nurse's ability to take care of her patients.

- So is there a quick fix for the nursing shortage?

And we talked about nursing as a second career, if you're an LPN, you might be able to become a nurse more quickly, but what is the, don't talk about long term yet, the quick fix for the nursing shortage?

- Well, I think for making sure that we have the right staff at the bedside and in the offices today to take care of the patients who are presenting.

The short term strategies are hiring travelers, which comes at an increased cost because they often make three to five times more than a regular bedside nurse makes because it's a shorter contract assignment.

It's over time and over time with added incentives on top of that, to ensure that we can entice people to work those extra shifts when they're tired and burned out and know that they may be working with not a full compliment of their team available that night.

And then looking at other strategies as well, like recruiting international nurses.

So programs in the Philippines and in the United Kingdom mirror very closely what the United States requirements are.

And we found success with bringing nurses over and sponsoring them on a work visa and having them work a contract with us for several years.

- I want to talk about long term now.

Before we talk long term, Jen mentioned the traveling nurse and the pay is much higher, it is short term contract.

But that's difficult on the budget of the medical center when you have three to five times as much money.

And let's say you have a Medicare patient, you're only getting reimbursed so much money.

A stress on, and I know you're not the chief financial officer, you're the chief nursing officer, but that's a consideration.

You just can't go out and say, "Well, I'm just gonna hire some travelers."

And you may be losing nurses on staff to become travelers.

- Correct.

So our primary concern is the safety of the patient and the safety of the staff.

So we control that with our nurse leaders.

In a discussion about how many travelers, how many bedside nurses do we need.

And we're careful about that.

And through COVID, the traveling companies really drove their costs up.

So we were all in that situation.

If you wanted an ICU traveler, if you wanted an acute care nurse, you paid the cost.

And sometimes it was really hard to get a nurse, even if you put in a request.

So if you put in a rapid request that you needed them immediately, then the price went up.

Now the price is going down.

We see it coming swiftly down.

And we have a nurse manager that talks to the traveling companies and debates and talks about driving that cost down.

Travelers are really important.

They stand side by side with our nursing staff, but it also causes some emotional conflicts of working side by side with another nurse who you believe is making more than you.

And the enticement of traveling and seeing the country is something that the millennials like.

And they like to see the country, they like to travel.

They increase their skills.

So we have lost some people to traveling.

They've come back.

I think in this time in nursing, it's not like it was before.

So it's something that nurses want to do, and you have to fit it into your workforce.

The budget is tricky.

And so we're always looking at the cost, making sure that we're compensating our bedside nurses appropriately as compared to the travelers and giving them other incentives and benefits and opportunity to grow and develop.

- Jen, you were in agreement on this.

- Absolutely, yeah.

We're seeing our traveler rates drop dramatically, very quickly.

I think that they will continue to decline as I look at what my need is going to be.

As I have new graduates who are starting and coming out of orientation, we're not gonna have as much need for travelers.

And the rate of pay is very much based on supply and demand and when there's not the need across the nation, and I have to believe that everybody will be in a similar boat with not having the need for as many travelers because the hiring season is upon us now for new graduates coming out.

And the rate of pay for travelers is declining.

And so those people who had left to travel are, as Debra said, coming back.

- Long term solutions.

You mentioned earlier that we might not have enough, we're turning away applicants at nursing schools.

Are there other long term solutions?

Because if we lose 25% of the current nurses in America by 2030, you'd really have a shortage.

- Right, so years we've been talking about faculty.

So we talk a lot about adjunct faculty and encouraging our bedside nurses to explore that opportunity to teach and give back and leave a legacy for the new nurses coming out.

It's the faculty that I think is most worrisome.

And we've been talking about this for many years, to replace faculty, to bring on more nursing students and create more programs.

But I think what's important, I think for chief nurses across the country is talking about our care models.

How do we deliver care and how are we gonna do that into the future?

And we can't do it the same way we always have done it.

The nurses need people who surround them and help them.

And that's the entire team, that maybe LPNs, certified nursing assistants, certified medical assistants, physical therapy aides.

We have to think differently and be open to the idea of how to deliver care.

The nurse is the primary care deliverer.

They own the patient, they own the outcomes of the patient, but they need assistance.

And so looking at different care models, how we can deliver that care into the future of nursing is gonna be vitally important, 'cause we're at a pivotal time for nursing and we do have a shortage, but we have to be creative and innovative to work through that.

- So it's more of a system.

It's not just a simple, you have a doctor, you have a nurse, there's a support staff, many of whom we never see as a patient.

- Correct.

- Absolutely.

It takes an entire team to deliver care.

It's not just the nurse.

And there are so many things that nurses have done over the years that doesn't require a nursing license.

And so it's identifying those pieces of the work and then identifying who else can do it.

And what other roles do we need to bring on board?

- And I wanna delve into the issue of attracting students who are younger to actually pursue a nursing career and you have to sell the image of nursing.

How do you go about doing that?

- Well, I think that the number one reason that I see for people entering the nursing career is because they want to deliver compassionate clinical care.

Nursing is a calling.

You see a lot of people going back to nursing as a second career, you mentioned that earlier.

People who are in their thirties, forties.

My brother-in-law is 50, and he's in nursing school right now.

He'll graduate later this year and it's one of the most rewarding careers because nursing is an opportunity to have just an incredibly meaningful difference.

And the people that you're interacting with, all throughout your shift, you're encountering people who are getting terrible diagnoses.

That are at their end of life.

But you're also with people during some of their most joyous moments.

To learn that a surgery was successful or that they've had their last chemotherapy treatment or the birth of a baby.

And so I think that's what should attract people into the nursing career.

And along with that, all the opportunities that nursing can afford them.

I've long said that one of the reasons for the shortage within nursing is we're a victim of our own success.

Nurses are being looked at to fill informatics roles, to fill roles to care manage people, across the care continuum.

Helping get them well from start to finish and make sure that the ball in their healthcare isn't dropped.

Nurses are tackling the provider shortage, the physician shortage with advanced practice roles really blossoming over the last 20 years.

Nurses are leading healthcare organizations, they're at the helm in CEO roles, where 20 years ago, you didn't see that.

All of those things create a vacancy in the frontline delivery of nursing care, whether it be in the acute care setting, home care, office clinic.

And so as Debra said, that's why we need to innovate and look at how do we deliver care, not in the model of 30 years ago that we've been using, but in today and the future's model.

- I have to ask, your brother-in-law is making nursing a second career?

- Yes.

- Did you have any influence in that?

- I really, I did not.

I mean, I'm a nurse, his mother-in-law is a nurse as well.

And it was just something that has always resonated with him and he's always thought that he wanted to do and he just, he went for it.

- What's the image of nursing, do you think in the public's mind?

- I think it's very positive.

I think that we've held that position as the most trusted profession for over 20 years as Jen and I were talking about.

I think that it's really ours to own.

So when we're talking out in the public and even talking to my own family, I'm the only nurse in my family, in my extended family, and I talk about it a lot.

And there's an image of nursing, I think, just in my close relatives that we're there 24/7 for the patient and we care for the patient and we went into nursing, like Jen said, it was a calling.

That's all I ever wanted to be, was a nurse because I knew I wanted to help people.

I think the public sees us there.

And I think COVID has shown them that when you needed someone, it was a nurse who stood by you.

It was a nurse who helped you through COVID and with patients.

And I just wanna reflect on, that having so many roles that you were talking about, Jen, in nursing was the attractive part of nursing years ago.

That you could go into nursing, but you had so many opportunities to do other things.

And as we move forward, those opportunities have turned to, now away from the bedside.

And it's been made more attractive to go away from the bedside.

So our roles, as chief nursing officers with our leadership teams is to make the bedside attractive and to make it fulfilling and to create healthy work environments with strong cultures that we're listening to the nurses.

That they have a voice in their practice.

They have a say in their practice based on evidence and research and that they wanna stay at the bedside, that it is fulfilling.

I think we've lost some joy at the bedside.

I think we all realize that.

And we're all trying to create that joy back, to bring them back to the bedside and be fulfilled with that.

- She's essentially been talking about retention.

What would you say to somebody of any age, it doesn't have to be the traditional, I'm going to go to nursing school at age 18.

What would you say to a young lady or man, this is what you should consider?

- Well, I think the field of nursing is challenging, right?

I mean, the way patients respond to treatment, it's gonna be different.

It is hard, but at the same point, it is very rewarding and it does afford you so many opportunities within the profession and how you use your license.

As Debra said, we are challenged with keeping people at the bedside, but I think we need to make the bedside frontline nurse role, whether, again, in the office clinic or at ambulatory, more attractive to stay in that.

Looking at, do we have more of a professional development plan from novice nurse to expert experienced nurse that rewards them financially throughout their career, more of a career ladder.

And do we need to look at different pay scales, different financial compensation?

The nursing market pay right now is extremely volatile.

I think it's volatile as a result of the pandemic, but I think that it's probably been something that's been festering for many years.

The pay has not always reflected, I think, the job that nurses do and the impact that they have on health outcomes.

And I think that Pandora's box was opened with the pandemic and it's never going back in.

So I think over the next several years, it's gonna take that long to see market pay level out.

- [Debra] I agree.

- Can you, this might, I shouldn't say require speculation.

To your knowledge.

We have seen so much advancement in technology.

For instance, across the highway from you, the proton beam therapy is being built.

Are people who might become nurses a little bit leery of this is way too technical for me, it's getting too complex.

I wanted to be a nurse where I'm at the patient's bedside, but the technology is something I don't know that I want to handle.

What do you say to someone like that?

- So I'm thinking the opposite as I talk to the younger generation and I was just talking to some new graduates the other day that were coming in about technology and virtual nursing and seeing the progression of medicine.

And I think they're excited about that.

I think some of our best nurses are the younger nurses who are coming in that know technology, that can use technology, that see nursing over and above being at the bedside and being able to be involved in that.

So I think that that's a lure for nursing right now, for our profession, that it is at the bedside, but there's so much that, and I think Jen alluded to this, knowledge and skills that you now can have.

Now on the flip side with the seasoned generation, I think there's a struggle with some technology for some of us and new things are coming out and it's sometimes intimidating, but it's ours to make sure that they're supported.

They have the resources around them.

And we have so many generations of nursing right now, maybe five out there, and they can all compliment each other and help each other and support each other through everything, and all of the advancements that are happening.

- Briefly, Jen, as chief nursing officer, you have a busy schedule, but do you have the opportunity to talk to nursing students and others to encourage them?

- More limited with nursing students.

Although I do have opportunity at the beginning, at the beginning of their semester to meet with them and talk to them about some of the clinical experiences.

But some of the best time that I spend in my schedule is with my professional nursing congress.

So that's a frontline staff, that's a representative from every department across our medical center.

Talking to them about the issues and challenges as I see them and then asking for their feedback on what they're experiencing as issues and challenges.

Because they give me a lot of feedback on things that need to be changed.

- And with that, the half hour has expired.

We thank both of you for being on At Issue.

Jennifer Croland, OSF Healthcare Saint Francis Medical Center, chief nursing officer.

Thank you for being with us.

- Thank you.

- And also to Dr. Debra Adornetto-Garcia, who is also the chief nursing officer at UnityPoint Health, Central Illinois.

Thank you for joining us.

- Thanks for having me.

- And thank you for joining us on At Issue.

Please join us next time as we'll have another topic to discuss right here on WTVP.

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