Subcommittee on Nursing Shortage. Nursing Shortage Statistics. Members of the Nursing Shortage Subcommittee

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1 Subcommittee on Nursing Shortage Report and Recommendations to the House Health Policy Committee March 12, 2008 Members of the Nursing Shortage Subcommittee Rep. Lisa Wojno Rep. Mary Valentine Rep. Robert Jones Rep. Brenda Clack Rep. Marc Corriveau Rep. Ed Gaffney Rep. Brian Calley Rep. Richard Ball Testimony Supplied by: Dr. Teresa Thompson President of the Michigan Association of Colleges of Nursing. Jeanette Klemczak Chief Nurse Executive, MI Department of Community Health Monika Wierzbicki Wayne State University College of Nursing Tom Bissonnette Executive Director of the Michigan Nurses Association Antionette Dziedzic Associate Director of Academic Affairs, University of Phoenix Detroit Campuses Conway A. Jeffress President, Schoolcraft Community College Mike Hansen President, Michigan Community College Association Charlene McPeack Dean of Health and Human Services at Macomb Community College Gay Landstrom, RN Director of Nursing Practice for Trinity Health Joyce Young, RN, MS Vice-President and Chief Nursing Officer, Henry Ford Wyandotte Hospital Dr. Barbara Scheffer, RN, EdD, School of Nursing Eastern Michigan University Dr. Mary Mundt, PhD, RN Dean and Professor, College of Nursing at Michigan State University Nursing Shortage Statistics Michigan and the country are facing a 30 year shortage of nurses. Michigan s demand for RNs is expected to exceed supply by 7000 nurses in 2010, with a shortage of 18,000 nurses by 2015 according to the Michigan Department of Labor and Economic Growth (2004). Michigan from the University Perspective Severe shortages in faculty, facilities, financial resources and clinical placement opportunities will continue to effect the nursing shortage crisis. Shortage of funding needed to hire nursing faculty in order to expand the nursing program to meet the demand. An aging nursing workforce, an aging pool of current faculty, lack of clinical sites and limited classroom space and budget constraints contribute to the nursing shortage in Michigan. Qualified nursing student applicants are being turned away due to a lack of clinical and classroom faculty. Lack of money to fund the development of state-of-the-art educational technology for nursing programs. Universities and Schools of Nursing do not have the resources necessary to implement new PhD programs without additional funding from the state. The current nursing shortage is accompanied by a severe shortage in nursing faculty. Summary of Solutions/Testimony from Michigan Universities Level Programs. 2. Solutions to support the Preparation of Nursing Faculty/Teachers. 3. Solutions to increase or improve access to Clinical Placements. 4. Solutions to help with the Retention of Nurses in the Workforce. 1

2 1. University Solutions to Increase Enrollment in Entry Level Programs. Student Scholarships Create loan repayment programs for nursing students who receive tuition assistance while committing to work or teach in underserved areas of Michigan. Increase financial assistance to nursing students. Student Support through stipends and health benefits. State funding for clinical simulations (resources, programming and technical support). Increased State funding for Nursing programs. Support to colleges to expand space and capacity (advisors, computers, learning labs, buildings). Offer standardized curriculum of nursing classes throughout Michigan so students can move within the state and continue their education where they left off. Offer more on-line nursing courses in combination with or as an alternative to traditional local classes which would allow nurses to work and attend school at the same time. 2. University Solutions to support the Preparation of Nursing Faculty/Teachers. Full funding for the Michigan Nursing Corp. Scholarships for faculty seeking advanced degrees and/or specific scholarships for nursing students to obtain MSN for teaching. Make faculty positions more financially attractive because new nursing graduates can earn as much or more as their instructors. Internet classes to train more Master-level nurses for faculty positions. State and Federal support for financial assistance and loan forgiveness for individuals who seek graduate education and agree to teach in a school of nursing. Encourage or specially fund enrollment in doctoral programs and develop accelerated programs where possible (ex: BSN to PhD) Education-Practice Partnerships to develop shared faculty. A model where hospitals and other health care facilities support a selection of their nurses to seek graduate education. In partnership with the school or college of nursing they would allow these individuals to teach nursing students in their facility and be a part of the college teaching team. This would improve the practice-education linkage, supply additional faculty to accommodate more students, and create teaching opportunities for individuals who wish to remain in the practice setting. 3. University Solutions to increase or improve access to Clinical Placements. Funding for automation and management of clinical placements (Web based) for Michigan. Funding for a Student Pass Port system to expedite the clinical placement process. 4. University Solutions to help with the Retention of Nurses in the Workforce. Support RN refresher courses for registered nurses wishing to return to the workforce. Retain aging experienced nurses in the workforce as mentors for new nurses. Michigan from the Community College Perspective There is a growing shortage of teachers of nurses (MSN s). There is a high costs for colleges to offer nursing programs which, due to a number of limitations, cannot achieve economies of scale. Lack of availability of qualified nursing program faculty. The lack of availability of appropriate clinical sites for clinical training. Lack of funding to hire additional nursing faculty. There is an insufficient number of nurses graduating from nursing schools to replace the ones that are leaving for retirement or other reasons. Summary of Solutions/Testimony From Michigan Community Colleges Level Classes. 2. Solutions to Increase Faculty 3. Solutions to Clinical Site Availability and Development. 2

3 1. Community College Solutions to Increase Enrollment in Entry Level Classes. Support DLEG s proposal for creating a standardized curriculum for nursing education. Provide funding for nursing education at the community college level. Help to offset the extra costs associated with educating RN s. Amend the Community College Act to permit Michigan s community colleges to award BSN degrees allowing for the seamless progression from LPN to ADN to BSN programs. 2. Community College Solutions to Increase Faculty Develop incentives for hospitals to make joint appointments that release their nurse employees on a part-time basis to serve as college faculty. State Aid Funding to hire Masters prepared nurses. Help the colleges offset the salary difference between hospital and faculty pay. By being able to hire more Masters prepared nurses they would be able to admit for entry level nursing students. Support the Michigan Nursing Corp. with full funding. This would fast-track 300 individuals through accredited MSN programs. Accelerate training of staff nurses prepared as clinical faculty using a statewide curriculum. Recruit displaced workers with a BS to the accelerated nursing program. 3. Community College Solutions to Clinical Site Availability and Development. Encourage cooperative agreements between colleges and hospital and other health care facilities. Develop incentives for hospitals and other clinical sites to accept more students. Provide funding to develop 12 month programs that would utilize clinical sites at off-times such as summer. Implement a web-based software data system to coordinate statewide sharing of clinical sites. Michigan from the Hospital/Hospital System Perspective High nurse vacancy and turnover rates. Lack of initiatives to improve nurse satisfaction. Lack of qualified faculty and inability to meet the educational, social, financial, and clinical-training needs of prospective nursing students. A contributing factor to Michigan s low nursing faculty supply is the inability of colleges and universities to compete with the private sector with regard to salaries and benefits. Summary of Solutions/Testimony from Hospitals and Hospital Systems Level Classes. 2. Solutions to Increase Faculty 3. Solutions to Clinical Site Availability and Development. 4. Solutions to help with Nurse Retention. 1. Hospital Solutions to Increase Enrollment in Entry Level Classes. Support efforts to move to a common nursing curriculum, standardized clinical training requirements, and greater adoption of accelerated advanced nursing degree tracks to streamline and improve the educational process. Increased State funding for colleges and universities that educate nurses. Fund initiatives to attract and train more nurses. 3

4 2. Hospital Solutions to Increase Faculty Fund initiatives to attract and train more nursing faculty. Fully support the Governor s Michigan Nurse Corps. Proposal. Institute job-sharing pilot programs that allow masters and doctorate-level nurses to serve as adjunct faculty, while also keeping their hospital positions. 3. Hospital Solutions to Clinical Site Availability and Development. Support the work of the Michigan Center for Nursing and Alliance for Clinical Education project which brings hospitals, community colleges, and universities together to enable students in healthcare programs to access clinical learning in a more effective manner. Encourage further leveraging of health technology. Continue to fund and support the efforts of the Office of the Michigan Chief Nurse Executive. 4. Hospital Solutions to help with Nurse Retention. Promote and recognize standards and initiatives that empower nurses as decisionmakers; offer incentives for the replication and adoption of national standards. Provide nurses opportunities to expand their skills by investing in ongoing nurse education opportunities. Adopt the recommendations of the Nursing Agenda for Michigan drafted by the Coalition of Michigan Organizations for Nursing. Michigan from the Chief Nurse Executive Perspective, Jeanette Klemczak Lack of funds to increase the number of nursing seats in the educational programs. Shortage of qualified faculty many educators face salary cuts when transitioning between working in the hospital and working as a nursing educator. Little incentive for the universities/colleges to expand the nursing programs because the laboratories and equipment needed for state of the art teaching are cost prohibitive. Michigan must maintain high quality care and increase respect for professional nurses while increasing the nursing workforce. Summary of Solutions/Testimony from the Chief Nurse Executive, Jeanette Klemczak Focus on recruitment and retention in both nursing education and practice. Support Funding for the Michigan Nursing Corp. Adjust nursing faculty salaries who often earn less than the starting salary of the newly trained nurse. Create a state subsidy for nursing education. Utilize staff nurses as clinical instructors for nursing students. This serves as a nurse retention tool for burnt out nurses by providing them with teaching opportunities and wit helps alleviate some of the faculty shortage because staff nurses may find that they like the teaching role and pursue the advance degree in nursing. Revising and updating the Michigan Public Health Code (1976) that prescribes nursing education practice. Invest in technology in nursing education and practice. Create incentives for nurses to work in local public health departments. Generating state and community based data regarding the supply and location of practicing nurses, as well as the demand for nurses in all settings and including vacancy rates and projections. Support the recommendations of the Task Force on Nursing Regulations. Michigan from the Michigan Nurses Association Perspective Michigan finds it difficult to compete with other states for nurses in terms of working climate, economy, and creating legislative solutions. Mandatory overtime requirement by the hospitals and lack of RN-to-patient staffing plans affect nurse retention at the bedside. Michigan s nursing programs turned away as many qualified applicants as there were nursing program graduates in

5 Summary of Solutions/Testimony from the Michigan Nurses Association, Tom Bissonette Executive Director Full funding for the Michigan Nurses Corp. program. Pass Safe Patient Care Legislation: HB 4339 establishes nurse/patient ratios and eliminates mandatory overtime. SB 63 establishes nurse/patient ratios and eliminates mandatory overtime. SB 377 establishes a safe patient handling policy/committee within hospitals. The Nursing Shortage Issue is Two- Pronged. It is like a bottle that is narrow at the top but open at the bottom On the one end of the bottle we can t graduate enough nurses to meet the demand and on the other end we don t have the policies in place to retain the nurses we do have. Legislatively we must simultaneously address both prongs to have an impact on the nursing shortage in Michigan. Legislative Solutions Increase Nursing Graduates in Michigan Funding for scholarships at all educational levels from ADN to BSN to MSN to PhD. Fully fund annually the Michigan Nursing Corp. Require Michigan Colleges and Universities to establish a common curriculum and standardized clinical placements and greater adoption of accelerated advanced nursing degree tracks. State Funds directly allocated to nursing programs for labs, faculty retention and growth, expanding building space and other items that would directly impact the expanding of the number of nurses that they are able to graduate each year. RN Loan programs that incentivise the nursing career in Michigan so that nursing is more attractive and more easily attainable than other careers. Loan programs that would also diversify our nurses. To adequately meet the needs of patients, we need to attract more men into the nursing profession and more minority nurses. Consider establishing a payment share structure between colleges/universities and hospitals that implement cooperation agreements for clinical placement and hospital nurse employees as clinical faculty. Change the pay structure for nursing faculty so that it is more competitive with the private sector. Legislative Solutions Nurse Retention Improve working conditions by passing HB 4339, SB 63, and SB 377 Change state law to allow hospitals to bill separately for documented nursing service/hours. Currently, nursing care is lumped in with the room charge. In order to make nurses valuable within the workplace and contributing to hospitals for work they are performing we need to separate and bill for nursing service. Look at fixing the nursing pay structure. Currently, there is little incentive to obtain advanced degrees. ADN/BSN/MSN nurses that work on the same unit receive the same pay. Thank You to the Members of the Nursing Shortage Subcommittee for your time and effort and interest in this problem. Thank you to the Chairwoman Angerer for the opportunity to address this issue through the subcommittee process, I look forward to working with all the Health Policy committee members and stakeholders to address this crisis. 5

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