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May 15, 2017
Focus: Education / Training

Colleges respond to Maine's need for nurses

Photo / David Clough
Photo / David Clough
Lisa Harvey McPherson, Eastern Maine Healthcare System's vice president for government relations, says Maine has hundreds of nursing vacancies and too few people to fill them.

Breakdown of Maine's nurse workforce by title

Registered Nurse: 85.3%

Advanced Practice Registered Nurse: 7.4%

Licensed Practical Nurse: 7.3%

Source: Center for Health Affairs, nurse registration data for 2015, current RN (FTE) workforce

Breakdown of Maine's nurse workforce by age

Under 35: 18.3% (3,721)

35–44: 20.0% (4,043)

45–54: 25.7% (5,200)

55–64: 28.5% (5,784)

65 or older: 7.5% (1,524)

Source: Center for Health Affairs, nurse registration data for 2015, current RN (FTE) workforce

Maine is facing a growing shortage of nurses, a situation that affects every person in a state where health care goes hand-in-hand with an aging population.

Help is on the way. Colleges and universities are investing in new programs to train nurses. The state's health care, academic and government communities hope to address the issue with plans for an upcoming nursing summit. Their deliberations will likely be of interest to the business community as it plans for the future of its health and wellness programs.

"We have hundreds of nursing vacancies across state," says Lisa Harvey McPherson, Eastern Maine Healthcare Systems' vice president for government relations and co-chair of the Maine Nursing Action Coalition. "Hospitals, nursing homes, home care providers, we all need nurses right now."

Facing the nursing 'cliff'

By 2025, there could be a shortage of 3,200 nurses, according to a forecast commissioned by the Maine Nursing Action Coalition. The situation creates a puzzle of many pieces.

The shortage is largely a problem of age — but Maine gets hit from three directions.

  • Maine's nurses are aging: 30% of full-time equivalent nurses are ages 55 to 64, without enough young nurses or nursing education capacity to replace them upon retirement through 2025. Some 12,000 nurses are age 45 or over, compared to 7,764 nurses age 44 and under.
  • Maine's nursing faculty is aging: 32% of Maine's full-time nursing faculty is over the age of 60.
  • Maine's overall population is aging: The senior population is projected to grow by 37% by 2025. Age has a significant impact on inpatient demand for services in most health care settings.

The forecast projects Maine will need to increase the number of newly licensed nurses by approximately 20% each year to solve the projected shortage and avoid impacts on care levels.

The situation isn't new. Maine currently has 18,000 to 19,000 full-time RNs. But that's not enough: The state already has a nursing shortage.

A crisis years in the making

McPherson Maine Nursing Action Coalition says health systems in Maine became concerned about the nursing workforce before the recession, precisely because of the aging nurse population.

As it happened, she says, the recession made the problem worse because health care providers didn't have the finances to hire as many new nurse graduates as before.

"We were all financially challenged," says McPherson. "So these older nurses stayed in the workforce longer than they otherwise would have, and they stayed full-time and many were the primary wage-earners and sole source of health insurance for their families. Now that we're out of recession that makes our 'retirement cliff' issue far more severe than other parts of the country because they were already older."

Health care consumerism will continue to grow as the baby boomer population ages, says Pat Cirillo, vice president of initiatives and analytics for the Center for Health Affairs.

"If you asked all health care employers in Maine how many nurses they could hire tomorrow, it would probably be 1,000 to 1,500," says Cirillo.

The ability to fill that gap is affected by a shortage of nursing program educators, themselves aging, with 32% of full-time educators over age 60. According to a report by the University of Southern Maine:

  • Vacant full-time faculty positions statewide nearly doubled (10 to 19) from 2013 to 2015.
  • Full-time nursing faculty fell from 169 positions to 130 from 2013 to 2015.

Maine now graduates about 900 nurses a year with a range of degrees, from two-year associate through bachelor of nursing science and onward to master and doctoral degrees, says Terry Colby, professor of nursing at the University of Maine in Augusta. Colby, who co-chairs a committee across the University of Maine System nursing programs, says one priority is to assess how nursing education can impact the nursing shortage.

But there's limited capacity for expanding graduate numbers.

"We don't have enough nursing faculty currently to fill positions and expand programs," Colby says. "In the next five years, with the average age of nursing faculty now 60, there is the potential they will retire and/or not work as much and move on to other things in life. So we need to not only make sure we're attracting people who want to practice nursing but who also want to be nurse educators."

Four campuses in the University of Maine System have pre-licensure entry-level bachelor degree programs for nursing, says Colby. All of the state's community colleges have associate degree nursing program. Several private colleges also have bachelor programs. And Colby says university programs are full to capacity.

"We have the nursing programs in the state," says Colby. "But if we're not graduating enough students now, the question to answer is how many more nurses do we need to graduate each year to be able to fill that workforce gap for nurses in Maine?" That's to be determined, she says.

Faculty numbers are compounded by other problems. That includes:

  • A shortage of clinical settings for skills training. The state has an eight-to-one student/faculty ratio in the clinical setting; some institutions set it lower.
  • A salary gap that often makes it more profitable to practice than teach.
  • Flight of young adults to out-of-state urban centers.

On the first point, Colby says, "Students have to have access to practice settings, and practice settings can accommodate only so many students at one time. In many parts of the state, specialty areas are limited: Not every hospital has a pediatric unit, for example. We need to look at effective, creative ways" for students to get clinical experience.

Regarding misaligned salaries, "We need to look at salary adjustments and incentives for people coming into the profession."

The problem is particularly acute in rural Maine, says state Rep. Anne Perry, D-Calais, a nurse practitioner.

"We have a small critical access hospital, and the hospital and Washington County Community College are working together to create an associate degree nursing program, to educate people locally," Perry says. "We want to keep our people and give them the opportunity to work."

Funding that will be on Perry's agenda at the summit, she says.

Maine is facing shortages of other types of health care practitioners, too, Perry notes. In Calais, "We've spent years to recruit physicians to come in. It's a struggle. In many ways, nurse practitioners have filled some of those gaps."

The university system is exploring solutions, Colby says.

Possible solutions could include:

  • Increased collaboration among campuses to offer advanced practice education at the master and doctoral levels that are easily accessible and affordable to students throughout the state. That might include online options for working students
  • New ways to mitigate differences in salaries
  • Expanded simulation labs to enhance clinical training
  • Reestablished programs in Rockland, Ellsworth and Machias/Calais to reach more students
  • Additional accelerated programs for people who want to change careers
  • Reexamination of the state statute that says students must perform clinical practice within the semester they studied the content.

Higher ed steps up

Other initiatives underway:

  • Saint Joseph's College in Standish earlier this year received a $1.5 million challenge grant from the Harold Alfond Foundation toward the creation of a new Center for Nursing Excellence, with expanded programs, labs and scholarship opportunities.
  • In 2016, the University of New England, where enrollment in nursing programs has tripled in the last five years, established of an online graduate degree program in health IT. Expected to relaunch in fall 2017 is UNE's BSN program at a 50% discount.
  • The University of Maine campuses at Fort Kent and Presque Isle, working with Northern Maine Community College, are launching a Northern Maine Nursing Education Partnership that will make a BSN degree available to students in Presque Isle, with an expected launch this fall.

Other options

Another option deployed by health care employers is to hire traveling nurses through a "Nurse Licensure Compact," a National Council of State Boards of Nursing program that allows nurses licensed in 25 states, including Maine, to practice in any state that's part of the compact. McPherson says the nursing coalition supports legislation sponsored by state Sen. Amy Volk, R-District 30, to roll Maine into the National Council's latest "enhanced" compact.

Traveling nurses are "a critically important short-term solution," says McPherson. But if Maine's education capacity doesn't increase, the state would need to recruit and retain approximately 600 nurses a year.

Innovations and partnerships are essential for bringing new capacity online. The University of Maine System and the LePage administration plan to convene a nursing summit of providers, elected officials, policy makers, philanthropic organizations and higher education leaders in the near future.

From the state's perspective, says Department of Health and Human Services Commissioner Mary Mayhew, the solutions are not about spending more money on educational programs, but about making sure resources are prioritized to meet needs effectively. Resource prioritization will be a topic at the summit, she says.

"It's a recruiting challenge," Mayhew says. "Maine is competing with higher wages that are being paid throughout the country, and we are competing with other states that have lower tax rates."

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