Newspaper headlines this fall told the story of a serious challenge facing the nursing profession: staffing shortages. In the largest health care strike in history, a coalition of 11 unions representing 85,000 Kaiser Permanente employees walked out for three days in October. The president of one of those unions, based in Maryland, said staffing levels have put patient care in “crisis” at some facilities.
Part of the reason is that staffing levels that were decimated during the COVID-19 pandemic have been slow to improve. Another is demographics. According to a study by the National Council of State Boards of Nursing, the average age of registered nurses in the U.S. is 46, down from 52 in 2020. Many older, more experienced nurses have retired or left the profession.
Another recent survey, Nurse.org’s 2023 State of Nursing report, also pointed to staffing shortages as a major problem, with nine out of 10 polled saying the shortage is getting worse. Solving that problem, and the associated problem of low staffing ratios, was cited as more important than improving pay.
According to the Bureau of Labor Statistics, the United States will need to fill 190,000 nursing positions in each of the next 10 years to keep up the country’s health care needs. Schools of nursing also will face challenges preparing the nursing workforce for the changing demands on the job.
Telemedicine exploded during the pandemic and remains largely popular (and insurable). And an aging population with increased need for home health care likely will add impetus to that trend. The ascendancy of artificial intelligence in health care is expected to impact not only nursing informatics, but also administration, research, and even clinical care. And improvements in virtual simulation technology may bolster the demand for online nurse education.
Although many schools of nursing around the U.S. report difficulties recruiting students, the University of Maryland School of Nursing (UMSON) is doing just fine.
“I think Jane [Kirschling] left us in a really good place,” said Yolanda Ogbolu, PhD, NNP, FNAP, FAAN, who succeeded Kirschling as the Bill and Joanne Conway dean of UMSON in July. “I’ve been going around all over the country, and schools are reporting low enrollment, but we’re growing here.” Ogbolu, appearing on the online program Virtual Face to Face, explained that the student body isn’t just growing, it’s also becoming more diverse.
“We’re over 50 percent underrepresented minorities in Baltimore, and over 80 percent at [the Universities at] Shady Grove. And that’s a big deal in nursing. Because nursing is not a diversified profession,” Ogbolu said. “Many schools are really fighting to get diverse nurses. We want them to match the American population as they’re providing care in the health system.”
Ogbolu added that 11 percent of students enrolled are now men, two or three times more than were enrolled when she began working at UMSON 13 years ago.
Now in her fifth month as UMSON dean, Ogbolu’s experience includes 25 years of clinical practice caring for critically ill newborns before entering academia in 2010.
“It seems to me, one of the challenges that we have in the professional schools is we don’t have a lot of educators,” said the program’s host, University of Maryland, Baltimore (UMB) President Bruce E. Jarrell, MD, FACS. “We have a lot of people who are nurses or physicians or pharmacists or dentists or whatever, and all of them are trained in their specialty, but not so many are trained in the art of education. Tell what your thinking is on that and how that applies to nursing.”
“We’re really fortunate here in the School of Nursing, because we have the Institute of Educators,” Ogbolu replied. “The Institute of Educators has been around for over 15 years and was really designed to teach nurses how to teach. And so, we’re really excited about the work that they’re doing to support our faculty. But really, they’ve been supporting faculty all over the state, teaching clinical educators how to precept our students in practice. And now, with some new foundation funds that we’ve received, we’re starting our innovation grant that is going to be able to have a fellowship for nurses that will be coming into academia to begin teaching.”
“Part of this is making the connection with clinical arenas, and I know you’ve had a rich relationship with the [University of Maryland] medical center. So, how’s that going?” Jarrell asked. “And what do you foresee in that relationship for the future?”
“We partner with them on several programs to help nurses transition out,” Ogbolu said. “Things like the Nurse Residency Program, the academic clinical education program, and the one that I really love is what we call P-3.”
P-3, the Practicum to Practice Program, is a partnership between UMSON and the University of Maryland Medical System (UMMS). The program creates a path for students in their senior practicum experience — required for all fourth-semester Bachelor of Science in Nursing (BSN) students — to a registered nurse position at an UMMS hospital. Upon accepting a nurse graduate position on a unit at a UMMS hospital, P-3 participants complete their senior practicum on that unit, serving as a nurse graduate following graduation. Once the graduate successfully completes exam and licensure requirements, they transfer to a Clinical Nurse I position. Ogbolu explained that over 200 nurses have already gone through the P-3 program, and UMMS hospitals have retained over 70 percent of them.
“It allows nursing students to identify a practice environment that they want to work in, do their practicum in their last semester, see if they really like it, if it’s a good fit for the medical center, and also if it’s a good fit for the students, and then if they’re successful, they go, they are automatically offered the position there. So that’s really exciting,” Ogbolu said.
“That’s a good bet, and a good investment, too,” Jarrell agreed.
After their discussion, Ogbolu and Jarrell fielded a wave of questions from within the UMSON community, and many from without.
“I was wondering about what we’re doing to get high schoolers interested in nursing,” asked Valli Meeks, DDS, MS, RDH, director of the University of Maryland School of Dentistry’s PLUS Clinic. “Back in the ’60s and ’70s, when I was in high school, many students that were interested in nursing would go to the vocational technical school. Many of the students that wanted a career in nursing would go to the school first and upon graduating went directly into nursing schools associated with hospitals.”
“It was still happening when I was in high school. That Carver Vocational High School, if you finished that high school, you were a licensed practical nurse, when you finish that,” Ogbolu said. “One of the things we’ve learned over time is that as the educational status increases to the BSN level, we have better patient outcomes. We have less errors, and we have safer care.”
Ogbolu added, “So, there should be a trajectory from high school all the way through the community college to coming to places like the University of Maryland to get that bachelor’s degree, and we have a master’s program, a Doctorate of Nursing Practice, and a PhD.”
In response to an audience question regarding steps faculty and school administration can take to prepare to more effectively engage students, Ogbolu offered an interesting insight.
“People have heard me talk about the social determinants of health, but many of the social determinants that impact our community also impact students here,” she said. “A few years ago, I did a conference with students around hunger, and it was a global health conference, and I thought, we’re going to be talking about global hunger. And the students started saying, ‘Well, I’m hungry, too. You know, my food runs out.’ And so, I think it’s really important for us to understand that if a student is hungry, it’s really difficult for them to learn if they’re worried about housing, and so many of our students do have to work because there are families that they have to take care of.”
Ogbolu explained that UMSON has a student emergency fund students can draw upon when they need support to obtain additional resources.
“Again, a lot of times when we think about diversity, we’re thinking about race and ethnicity,” she said. “But are we helping students that are parents? Are we helping students that are military? Are we thinking more broadly about our students and what they might need to really be successful? And then just really making sure that we develop those meaningful relationships with students so that they trust us and they can come to us and they know we want them to be successful.”
Watch the entire Virtual Face to Face program by clicking the video link at the top of the page.