The Boise State University nursing program is producing about 80 registered nurses per semester, twice a year.
That’s up from 60 per semester just a couple of years ago, but it’s still not nearly enough to meet a growing demand for nurses in Idaho.
“Even if it was a perfect world where someone could dump the money in so that we could do the programs and have the people come in, have clinical rotations in place, expand our simulation labs, do all that, it just takes time to educate someone,” Tim Dunnagan, professor and dean of the College of Health Sciences at Boise State University, said in an interview at his office. “You can’t just pop them in a toaster and have them come out as nurses.”
Meanwhile, the clock is ticking.
As of June, Idaho had 9,000 health care jobs it could not fill, according to a recent report by Idaho Business for Education. Number one on that list was a shortage of registered nurses — some 1,600 openings.
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One of Idaho’s largest health care systems had 2,000 openings, according to the report. One of the state’s largest standalone hospitals had 700 openings – 400 of them were for nurses. Idaho hospitals are relying on “traveling” nurses who contract with the hospital to fill staffing gaps. This can cost hospitals millions of dollars a year to hire these come-and-go nurses, according to the report.
“Unfortunately, we have a health care worker crisis in Idaho,” Rod Gramer, CEO of Idaho Business for Education, wrote in a preface to the study. “We simply do not have enough health care workers to take care of us and the situation could get worse if we do not act.”
Nationwide shortage
It’s not just Idaho. The U.S. Bureau of Labor Statistics projects nearly 203,000 new job openings a year for registered nurses through 2031.
With 16,000 employees, St. Luke’s is Idaho’s largest health care employer, according to Erin Simms, senior vice president and chief talent and people officer for St. Luke’s Health System, in an emailed statement to me for this story.
“We continue to have a significant number of openings for our experienced nursing positions,” she wrote. “In some areas of care St. Luke’s continues to rely on contracted traveling nurses to help support our employed staff and ensure we can safely care for the patients who need our care.”
The nursing shortage is part of a larger, nationwide labor shortage in all sectors that I’ve been writing about this year. Most recently, I wrote about the labor shortage in construction, which is estimated to need an additional 650,000 workers in 2022.
The general labor shortage is caused by a combination of continued strong job growth, Baby Boomers retiring, younger workers not replacing them, declining labor participation, many women not returning to the workforce, declining immigration and lower birth rates. The United States has nearly 11 million job openings and only about 6 million available workers, according to the U.S. Chamber of Commerce.
Health care may be one of the more serious fields to have a labor shortage.
“Without a robust health care system, no need to build those roads,” according to Brian Whitlock, president of the Idaho Hospital Association, in the IBE report. “Not investing in health care will kill our economy faster than anything else. Let’s have a historic investment in health care infrastructure.”
'Wicked business problem'
While Boise State receives as many as 200 nursing student applications per semester, the program can accept only about 80 nursing students.
One of the main limiting factors is clinical hours — hundreds of hours a graduate is required to spend in a real-life clinical setting, such as a hospital, working on real patients.
In order to get that clinical time in a real-life setting, nursing students need to be paired up with another nurse in that hospital.
“It takes a nurse to educate a nurse,” Shelle Poole, divisional dean of the School of Nursing at Boise State, told me in an interview. “So when we have a nursing shortage in the health care system, those clinical placements, if there’s not enough nurses to meet their daily demands, but we also want to do education in the health care systems, we have a what I call a wicked business problem.”
So it’s a Catch-22: Hospitals need more nurses, but a nursing shortage limits how many nursing students they can help train. We could produce more nurses if only we had more nurses to help train nursing students.
“Clinical roles have proven the most challenging to fill,” Simms, of St. Luke’s, wrote in an email. “Nursing across all units and provider positions, particularly those in the medical subspecialties, continues to be our greatest area of supply and demand challenges.”
Simms said St. Luke’s has hired more recent graduates in the last year than ever.
Retiring workforce
Part of the health care labor shortage problem is that nursing is not immune to workers choosing to retire.
Of the 18,650 registered nurses in Idaho, 3,400 are over the age of 55 and 1,700 are over the age of 65, according to the Idaho Business for Education report.
But retirees also offer a possible solution.
Why not bring those retired nurses back to work as clinical training nurses, part time, for the sole purpose of training nursing students in a clinical setting?
In a lesser-publicized piece of legislation passed by the Idaho Legislature in an extraordinary session in September, legislators earmarked money for career-technical education.
In the bill, “$80 million will go toward training for in-demand careers and prepare our institutions for the likely increase in workforce development training that occurs during times of economic uncertainty,” according to Idaho Gov. Brad Little’s plan approved by legislators.
Legislators will determine how best to spend that money when they reconvene in January.
Idaho should invest some of that money with Boise State, Lewis Clark State College and Idaho State University nursing programs to hire nurses to come back to the workforce as training nurses in real-life clinical settings.
Utah recognizes that they’ll need to compete for nurses. The University of Utah announced this year that its College of Nursing would increase its annual enrollment by 25%, from 144 to 180, by spending $400,000 to add a summer semester, hire more full-time and adjunct faculty, a student adviser, a clinical placement coordinator and patient simulation specialists.
Meanwhile, back in Idaho, a bill in the Idaho Legislature that would have created a state-funded student loan repayment program for nurses who work in Idaho’s rural towns, failed this session in the Senate by a 14-17 vote, according to the Idaho Capital Sun.
The labor shortage isn’t going away any time soon. Businesses, industries and states are going to be competing for workers.
And that competition for workers will become more pitched as the shortage becomes more acute.
Idaho needs to get out ahead of this. If we don’t, other states will pass us by.