(bright music) Welcome to "At Issue".

I'm H. Wayne Wilson.

Thank you for joining us for the conversation on the shortage of nurses.

It's no secret, we all know there is a shortage of nurses nationwide and here in central Illinois.

We're going to be discussing solutions, some of them short term, some of them long term, on how we might fill the gap in the nursing shortage and have that conversation.

I've invited Theresa Adelman-Mullally to join us.

She is with Illinois State University Mennonite College of Nursing, where she's an assistant professor.

Thank you for joining us.

- Thank you - [Wayne] Also with us, Kim Blakey.

Kim is OSF Healthcare Vice President of Clinical Business Strategic Operations and thank you for joining us.

- Thank you.

- I opened by saying there's a shortage of nurses.

I don't wanna get bogged down in numbers, but how severe is the shortage?

- So pre-pandemic, we started with a fair amount of nursing openings that we've had shortened long-term strategies to address.

With the pandemic, we've seen that at probably its worst, near double, and we're beginning to make strides to correct that.

But there's a continued shortage and need to work on strategies to improve.

- And turning to nurse educators, which is your specific field, although you were an RN to start with.

But the pipeline, I mean OSF healthcare, Unity Point, et cetera, et cetera, all need nurses.

How well are you doing in increasing the number of nursing candidates for these facilities?

- Well specifically at our institution, we end up turning away about 100 students.

So we have just entered a collaborative project with Memorial in Springfield and we're gonna be opening an additional site where we're gonna now be able to have 48 additional students in the fall.

So that will help because that'll increase our enrollment, which will then increase the number of nurses that enter the pipeline.

- And that agreement does what?

I mean it adds students, but is that for clinical purposes?

- And as well as theory.

So that will be those students, that will be their site for their education, both theory as well as clinical.

- OSF Healthcare has Colleges of Nursing, one in Rockford, one in Peoria.

Do you have similar arrangements in order to try to...

I mean you've got your own College of Nursing, maybe we can get those people to go to OSF.

- Yeah, we have strategies to increase enrollment at both Colleges of Nursing.

In addition to partnering with all community resources for education on increasing the amount of clinical time that we're able to extend to those programs.

We have partnered with our healthcare advanced analytics to help create a program that really manages that time so that we can offer more hours, times of day, nursing types of units, for those programs to increase enrollment broadly.

- Theresa, what's the definition of clinical time?

- Well it's actually, I think the clinical time she's talking about is that nursing student with patient with an instructor present.

But there's other ways to do clinical time.

One of them is simulation.

So we are allowed to have up to 25% of our hours to be in simulation with the other 75% being in that to face with a patient.

- Simulation would mean mannequin?

- It could be, it could be what's called a low fidelity mannequin where the mannequin is a shell, right?

And you could do all sorts of very low risk, but high frequency items such as learning to turn or make the bed with somebody in the bed.

You also have higher fidelity mannequins which have a lot of bells and whistles, technology.

You can have that mannequin actually have their heart stop and have the team respond in a CPR.

The third option is having what's called a standardized patient, which is essentially a very well prepared actor.

- [Wayne] Oh, a human being?

- Yes, and they get into the role of the patient.

And that is especially important with learning about how to communicate because while you can speak to a mannequin, and we can have you script to a mannequin, it's not the same as speaking to a person.

And that makes it far more authentic, especially with issues like mental health.

- Kim, as the nurses come out of nursing school, they graduate with an RN or a Bachelor's.

And I assume ISU would be a Bachelor's degree?

- Well we actually have a multiple number of degrees.

So we have the Bachelor's degree, we have a Master's degree, and we have the Doctorate nursing practice and we have a PhD.

So multitude of tracks.

- Before I get to Kim, just is RN, I mean do people graduate with RNs from ISU?

- So the RN is the test or the exam that anybody who has graduated with a qualifying degree is then qualified to sit for that exam to meet that standard that then says "yes I know enough, I'm a safe practitioner, I can now take care of folk".

So that's what the RN is, it's the licensure, the education is the degree.

- So as we get more of these nursing students who have now graduated and said "I'm gonna come to OSF Healthcare and work", they're new, they know the medical issues, but they have to acclimate to the OSF Healthcare environment.

And does that cause any issues in terms of are there enough seasoned nurses to give them guidance?

- That's something that we always have to balance.

And so we have very structured transition to practice or onboarding programs where we partner nurses with preceptors that have more experience.

And so we have to, as our workforce changes, and we have more newer nurses than we have seasoned with retirements and other things that are trending, we have to be a little more creative with how we manage that.

And so we're looking at support by having dedicated onboarding units, having virtual support for precepting, and innovative ideas like that to meet the need so that we can support new nurses in providing high quality care at all times.

- So the issue of the lack of nurses, and this was true before the pandemic, but it was even worse during the pandemic.

There were retirements, maybe a little bit earlier than they had anticipated.

That's one issue.

But what else led to this significant shortage?

- I would say that the work has changed a little bit and become a little more intense in our acute care settings.

COVID illness was prevalent for a long time, increasing the acuity on some of our nursing areas, or the workload is probably a better word as far as acuity.

And so the job became a little bit harder to do, wearing full PPE while you're giving care, and things like that.

And so we saw nurses leave the workforce earlier than planned for retirement.

And we saw some leave the profession altogether, going into other types of work.

And so we've really had to think about how that has changed the needs of our workforce and really adapt our programs and our practices in order to meet the changes.

So we have things like we're working on hiring differently.

We used to really look at the organizational needs and interview a broad array of candidates and then make selections on who we hire.

And we really had to pivot to compete with not only other healthcare organizations, but other industries.

And so we really adapted to have a more candidate centric hiring process from the application point on.

And so we really connect with nurses specifically as soon as they apply and start to talk to them about their needs and their interests and what their career goals are, and then match them to the right initial position and put them on a pathway or trajectory that meets their needs.

And so that's really a big change in the industry.

- In a similar vein, the seasoned nurse, if I may use that term, they may have burnout.

Do you accommodate them, not only with counseling, but in terms of maybe accommodating their interest and work schedule, things of that nature?

- Yes, we really have a lot of initiatives, short and long term, on work-life balance.

And so really meeting nurses where they are in their career, whether they're a new nurse and has specific needs for scheduling or a seasoned nurse who may want a lesser amount at the bedside for physical reasons.

And so we've really, rather than having set or fixed positions, really try and meet individuals where they are.

Whether they wanna work 40 hours a week or 32 hours a week as far as the amount of total hours.

And then we've also taken work-life balance in another aspect and really looked at how many weekends and holiday commitments mission partners have, we call our employees mission partners, so that we can meet their needs.

For example, we have many long-term nurses that are very experienced that say "really at this point in my career, I love what I do but I really just wanna be home on the weekends with my family at this point" or "I want to know that I have the holiday off".

And so we're really looking at years of experience based-programs.

We're looking at offering a different weekend compensation level to draw in people that want to have that additional income and are willing to work the weekends to alleviate those that don't want to from having to do so.

And that allows us to be more competitive across the care continuum and with other industries that maybe don't have to work weekends.

We have to cover our patient care needs 24 hours a day, seven days a week.

And so we've really worked hard on being a little more creative.

- So that work life balance is important today.

- It's very important.

- Let me turn back to the pipeline.

Getting more nurses to hospitals, et cetera.

What role does the state legislature play?

And I know there's multifaceted solutions, but the state legislature can have an impact.

- There is one particular bill that is probably gonna be so important, and that's, essentially, it's about the compact.

Meaning there's a bill on the floor that I am an a nurse, I am licensed in Illinois, and if we were a compact state then I could practice maybe through telehealth or something like that with a state that's also in that same compact.

So I can cross state lines, whether physically or through technology, and that would help add more access to quality care for the people we serve.

So that's an important piece of legislation.

- So currently, if someone was licensed in Missouri, let's say, they could not practice telehealth or in person in Illinois?

- Not without an additional license, their Illinois license.

So this would mean you could hold one licensed practice in multiple states and that has a huge impact when it comes to education as well.

That if you're gonna teach in a course or a program that brings in students from all these, and you're doing virtual work, many times you have to have these other licensures.

So it would really release a lot of burden.

- There's a couple of bills dealing with money, Senate Bill 1315 and 1316, that has to do with helping educators financially?

- I know one of them is, it's almost a repayment.

So I get paid for my education and then I give back some time in service.

Is that one that you're referring to?

- And we need to point out these are bills.

These are not laws yet.

- They're not that far yet.

- Let me turn back to you, Kim.

There's a problem.

It was kind of a solution but it also created a problem and that is what we call traveling nurses.

Used to be called visiting nurse association, what have you.

But traveling nurses, explain the solution that they presented and then present the problem that grew out of that.

- Sure.

So we've always used what we would call an external agency nurse or travel nursing program in healthcare.

And the initial intent was to really meet hard to fill needs or short-term shortages in a workforce.

Let's say we had a rise in census that we didn't think would sustain, you would pull in an agency nurse rather than filling a full-time position.

So there's been a place for that long-term.

Those nurses, pre-pandemic, made around two to three times the core nurse and paid for that flexibility and agility to go travel and be away from home.

When the pandemic started, we saw a rapid rise in the rate of pay for travel agency nurses, and at the same time, a rapid rise in the need to have more nurses work at the bedside.

And so those two things really drove the cost up about triple the baseline rate in some areas and in some specialties.

- So a travel nurse, to be clear, a travel nurse could make three times as much money as a then coworker who is employed by the hospital?

- No, that's not the comparison I'm talking about.

I'm talking about the baseline rate for the agency nurse in some cases almost tripled the hourly rate, which then created even a wider separation from the frontline nurse that was a core mission partner working next to them.

And so that increased, and so we had many nurses leaving their local, across the nation, not just in our community.

We had many nurses leaving their bedside roles, working for a specific entity and going out to earn that higher rate of pay.

- So when you attracted a traveling nurse, you probably lost nurses to travel elsewhere?

- Correct.

- Is that difference starting to come closer together?

- Yes, we are seeing nationally the labor rate or the rate of pay for agency nurses coming back down to pre-pandemic levels.

And so that's really helping bring some of the nurses back to their home communities, and throughout the pandemic we adjusted that rate of pay for the local nurses to stay and work at the one entity to a level that was a little more competitive with the agency rate.

- Do you offer bonuses at all for certain situations in terms of retention of nurses?

- Yeah, we have retention programs at times, we've offered incentives to stay in their frontline nursing role, and then we also have incentives on a daily basis at times to help fill some of the greater needs.

- Let's stay on the topic of money with you, Theresa.

And that is, a nursing student at ISU Mennonite College of Nursing might want to go to OSF or Unity Point or St. Anthony's in Rockford, what have you, urban areas.

But while we know that the significant shortages is in rural areas, is there a program in place to help attract nurses to the smaller facilities?

- There are a number of programs where if I'm the student, I find out about this program, I apply, they pay my education, and in turn, I agree to work in that rural facility or area that they have the need that they've already identified.

So I get my education and I have a job.

It's pretty win-win.

- I would add to that that we're looking at programs really for educational assistance that are really broad and innovative, increasing not only the amount that we cover, but the types of programs.

And as a healthcare system, that's not limited to just nursing, we're looking at supporting pathways and career development for all of the roles that we need in healthcare.

- Yep, because nursing does not operate in a silo.

It's a team.

- We talked about telehealth earlier.

Does that help in terms of... You have a certain number of patients, they need help, you only have a limited number of nurses.

Does that help in terms of, I'll use the term lightening the workload so to speak, that the patient may not be in the facility, they're not in the hospital, but they need guidance on some issuing.

- Yes, we had pre-pandemic telehealth roles that really help support the care team as far as like intensive care.

We have an EICU program that really helps do some overwatch and support the frontline from physician and nursing standpoint.

Now with the shortage in the workforce for nursing, we are looking very in-depth at lots of different ways to supplement that care, looking at our patient care delivery models.

And so we are looking at team nursing would be one example where you partner a nurse with a nursing assistant type role and have them deliver care a little bit differently.

Really focusing in on training the nurses, how to delegate and empower the team in the right area so that we can deliver the same level of quality and safety at the bedside.

So we're looking at that.

And then we're also looking at solutions like you mentioned with telehealth.

So adding support virtually for some of the things that can be done remotely like admission questionnaires, planning for discharge, and even supporting our frontline nurses with mentoring and precepting in some cases where we have a newer experience mix really offering a different level of support.

- I want to talk about another bill that's in the hopper right now down in Springfield, that's Senate Bill 199 where it's going to amend the Nurse Practice Act so that a nurse can administer schedule two drugs without getting the doctor to say yes, you can do that.

Is that helpful?

- Yes, I think that is helpful.

So that will allow us to utilize our resources to the highest and best use of their education and training and skill mix.

For example, we may use that in a rural health setting, having an advanced practice nurse be able to be the onsite in-person caregiver or provider and then support them with telehealth.

That's another connection when we think about care delivery models where we would have a physician available to answer questions there.

And that makes that a little more feasible or easier to do.

- And I think an important piece in that particular bill is that there are enough safeguards in there too, that nurse practitioner has to have, I can't remember, is it 4,000 hours of practice, which equates to about two years of practice.

So it's not that new nurse practitioner graduates are being launched to have their own prescriptive authority without a collaborative agreement.

It's after having developed some expertise that they now are ready.

So that's what that bill is helpful with.

- I wanna talk a little bit about the Mennonite lab.

The Mennonite College of Nursing has a new building that will open next year, 2024.

How might that help in terms of practical experience for your nurse students and maybe even increase the number of students that you can handle?

- Right now we are probably operating at max capacity, so adding that space is gonna be so important to be able to add more simulation, to be able to increase the number of students we have because they have to have a certain amount of clinical experiences in order to be eligible to sit for that registered nurse exam that we were speaking of earlier.

And the simulation plays such an important role, right now, I mean we're on top of each other, so that's gonna open up space, give a little bit more breathing room, and there are certain kinds of simulations that require a bit more space, and so that will also help as well.

- People hear a lot about the Jump Trading Simulation Center and know very little about it, and there's a lot of experimental work that's going on there, a lot of research.

But does that relate to nursing in some capacity?

- Yeah, it directly relates to nursing and how we deliver education.

You talked about newer nurses coming in.

We also have simulation, whether it's with mannequins or whether it's with standardized patients, yes, there as well.

And so it really allows us to be a little more innovative and creative with the way that we deliver education.

And that's changing as well.

More and more we think about the changing workforce and their needs.

We have often traditionally held education where we would pull people into a meeting or a classroom and do one-on-one or a group setting and deliver material.

And the newer workforce, they learn by watching YouTube.

If they need to do something, they open up the app and they learn how to do it.

And so we're really looking at platforms and innovation that allow us to deliver just in time training, which is what the workforce is asking for.

- And I think that's really important because we have these issues with the nurse, we have to work together.

And so one thing that clinical practice partners have done has, they've really changed their orientation for the new graduate to really extend that.

It is no more just throw you in the deep end and hope you can swim.

So kudos to the practice partners that have done that.

And to that end, we have a higher expectation of what we need to do to prepare that graduate.

So we're really trying to work to meet in the middle.

So we have simulation, they have simulation.

We're really trying to bridge that gap.

- I'd like to spend the last two minutes, maybe a minute each on a hopeful note, starting with you, Theresa.

What do you see in terms of the fix?

How are we doing in filling that gap with the shortage of nurses that currently exists?

- Well one thing I think that's very important is our accreditation standards for AACN have changed.

And like I said, we are being expected to do more in the amount of time that we have with our students to get them ready.

The one piece I'm so excited about, I think we talked about burnout, is that one of the newest elements, of this competency is we have to prepare our students to be able to take care of themselves.

In the culture of nursing, nurses have been great at taking care of other people.

And that's gonna be so important that nurses can do that for themselves.

And the organizations are prepared to have a system that adapts with them.

- Briefly with you, Kim?

Your hope for filling the gap.

- Yeah, I think we have to continue to be innovative and creative and really change as the needs of our workforce and nurses change.

And so we're hopeful and we have the support of our leaders to really be creative and do things like work-life balance and also be creative in when we address burnout, like offer positions that maybe a nurse can be at the bedside and also teach half time.

- And with that, the half hour is expired.

Thank you to Theresa Adelman-Mullally of the ISU Mennonite College of Nursing, and to Kim Blakey, who is with OSF Healthcare.

Thank you both for the conversation.

We hope you continue the conversation at home and then join us again next time when on "At Issue", we'll be talking about child abuse.

April is Child Abuse Prevention Month.

We'll talk about that issue next time.

See you then.

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