National nursing shortage – contraints on producing more domestically

The average RN annual salary in the median state (for nursing salaries) today is $81,000. The median salary (combining all sorts of 3 million nurses) nationwide is $77,600. (Go here and here.)

There is a national nursing shortage….to frame an effective strategy to bring in immigrant nurses, we first have to streamline nursing education and placement.  (The same problem exists with STEM workers: the domestic pipeline needs to be improved.) Here is a quick assessment of the issue in one state, Massachusetts, drawn from an editorial in the Boston Globe:

The Massachusetts Health and Hospital Association estimates that hospitals have 5,100 vacant nursing positions, forcing them to pay temporary staff. Vacancy rates exceed 25 percent in some specialties, as nurses are retiring and leaving the field due to burnout.

While hospitals need to create working conditions that retain qualified nurses, there is also a need to increase the pipeline of trained nurses.  Massachusetts’ nursing training programs — which graduated around 5,000 students in 2020 — cannot easily scale up to meet the demand. While state regulations limit the pace at which schools can grow, and relaxing those rules may be worth considering, the biggest barriers are a lack of faculty and of the clinical placements required for training.

The challenges with attracting faculty are nurses generally enter the profession because they want to do patient care and the salaries for practicing nurses are far higher than salaries for nursing educators, especially at public colleges.

“Each time I earned a degree, my salary went down,” said Judith Pare, director of nursing education at the Massachusetts Nurses Association and a clinical nursing professor at University of Massachusetts Boston.

Teachers are generally required to have a master’s degree or be working toward one — and those are also the nurses able to command the highest clinical salaries.

Another problem is finding hospitals willing to teach nursing students. Unlike the system for physicians, where medical schools partner with academic medical centers and doctors train medical students as part of their job, no such partnership exists for nursing. Instead, nursing schools pay clinical instructors, then partner hospitals let in those instructors with small groups of students.

Hospitals have limitations on how many students they can absorb….They have nursing shortages, nurses are overworked.

Endicott College developed a unique model with Beverly Hospital and Addison Gilbert Hospital where Endicott undergraduates work as nursing assistants at the hospitals, providing labor and a pipeline where students can do clinical placements and often find a post-graduation job.

There are new nursing schools opening. Massachusetts College of Liberal Arts, a public college in North Adams, is opening a nursing school this fall. Several schools have started offering accelerated nursing programs to help certain populations — like students switching careers or majors — complete school more quickly. But without the ability to hire more faculty and find more hospital placements, expanding the number of trained nurses will be nearly impossible.



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