This year’s nursing school graduates matriculated before the pandemic took hold, and over the course of their studies, they’ve seen the profession go through an upheaval.
Waves of COVID-19 delayed students’ clinical rotations at patient care facilities. When they were allowed back into hospitals, clinics and long-term care facilities, the work was more intense than many had expected.
“I was shocked,” said Jillian Levesque, one of the University of Connecticut School of Nursing’s five valedictorians from the class of 2022. “I remember thinking, ‘Oh, I’ve got time to get better at my vital signs,’ and then it was the second day and I was giving medication,” she said. “There was no getting better and practicing your vital signs. It was the real world because of the COVID-19 pandemic.”
A prolonged shortage of nurses across the state became more acute during the pandemic. And the graduating class of 2022 — roughly 2,000 in number statewide — won’t be able to fill those yawning gaps in the workforce.
Over the last two years, mid-career and older nurses experienced burnout, left emergency departments and intensive care units for less stressful positions or retired early. Many younger nurses opted for lucrative traveling assignments. Nurses periodically fell ill with COVID and had to stay home, placing further stress on health care facilities.
The health care field accounts for 16% of the state’s total workforce, and nurses and certified nursing assistants are in high demand. In late 2020, the Governor’s Workforce Council estimated the state’s registered nurse (RN) workforce was roughly 50,000, more than half of whom were over the age of 50. There were “significant shortages” in health care workers, the council reported, estimating an annual need of 3,000 new RNs and 2,500 openings for certified nursing assistants.
It’s been nearly two years since that report. At the time, deaths from COVID-19 in the United States had just passed 200,000. Today, that number is over 1 million. Weeks ago, the U.S. Surgeon General issued an advisory about health care worker burnout, warning that “the public’s ability to get routine preventive care, emergency care, and medical procedures” is at risk.
“Dyed-in-the-wool, hardcore, ED, ICU nurses, who’ve been that forever — COVID has just burned them out,” said Beth Beckman, chief nursing officer at Yale New Haven Health. “These nurses who would have never dreamed of leaving their practice, because that’s what they do and who they are, are now moving to ambulatory settings or … areas where they can work 9 to 5 and they can create physical and emotional respite for themselves.”
Those nurses have left vacancies in critical areas.
“We’ve got to do something to increase the pipeline,” Beckman said.
77% of qualified applicants turned away
As it stands, that “pipeline” for Connecticut nurses is too narrow.
Sherri Dayton, a registered nurse and health care division leader within the AFT union, said with experienced nurses choosing traveling gigs, telemedicine or the steady schedule of a doctor’s office or surgery center, acute care facilities have to recruit primarily among recent graduates.
“It’s really just brand new nurse residents coming out of school that are applying,” she said.
And there aren’t enough of them.
That’s not for a lack of interest. Colleges and universities in the state lack the capacity to meet both the industry’s workforce needs and students’ level of interest. Last year, 13,175 applicants qualified to attend RN programs in Connecticut, but there was only room for 2,992. Of those accepted, 2,781 enrolled.
Marcia Proto, executive director of the Connecticut Center for Nursing Workforce, said another shortage is exacerbating the nurse shortage: a lack of instructors.
“Faculty is paramount, because if we don’t have people to teach, it doesn’t matter how many people we have wanting to go to school,” she said.
Earlier this year, CCNW surveyed the state’s nursing schools and found they’d need more than 300 additional faculty and staff statewide in order to expand capacity by 20% within three years. And that was only for undergraduate pre-licensure RN programs.
“The shortage is the worst I have seen in over 19 years that I have been working in health care in Connecticut,” she said.
Still, for nurses who might be interested in the transition to teaching, the decision often doesn’t make sense financially, Dayton said.
“You go to school to get your master’s in nursing education, and then you make pretty much what you’d make as an acute care nurse in the hospital — but now you have $40,000 in debt,” she said. “Who wants to do that?”
Even if Connecticut schools had the faculty and resources to add seats in their RN and Licensed Practical Nurse (LPN) programs, there would still be hundreds of graduates each year who take jobs in other states.
“Everyone is going so many different places,” UConn graduate Levesque said, listing California, Florida and North Carolina among her classmates’ destinations.
Levesque grew up in Massachusetts and she said she’s hoping to work in Boston.
“I’ve always felt sort of this desire to go back there, because that’s where my family is, and that’s where most of my life has been,” she said.
Stabilizing the workforce
State lawmakers took various steps to shore up the state’s health care workforce during this year’s legislative session. The annual budget bill included funding for tuition repayment and housing for health care workers, as well as bonus “premium pay” for those who worked through the height of the pandemic. New legislation expanding mental health services is expected to create more opportunities for nurses in those fields. The mental health bills also expanded loan repayment for those workers.
And Senate Bill 251, signed into law May 22, calls for the Office of Workforce Strategy to expand health care academic programs, develop distance learning, on-the-job and other health care education opportunities for people looking to change careers, and to recruit and retain people within underserved populations for health care careers. A plan for that program is due Jan. 1, 2024.
“A lot of what we tried to accomplish was to try to deal with a need that is immediate and urgent but also recognizing that some of these things can’t be fixed overnight,” said Rep. Jonathan Steinberg, D-Westport, co-chair of the Public Health Committee.
Steinberg said the work isn’t done.
“We didn’t get everything we asked for,” he said, “and we also want to prove out some programs — pilots or experiments that have been successful on a local level. … Those are the kinds of things we hope to revisit in the coming years.”
Some of the state’s health care systems are funding their own programs to develop the future workforce. Yale New Haven Health plans to spend more than $7 million over the next four years to enhance programs at Fairfield University, Gateway Community College, Quinnipiac University and Southern Connecticut State University, with the goal of educating more than 500 additional new nurses.
Kimberlee Richard, vice president of patient care services at Griffin Health, said Griffin is partnering with high schools in the Naugatuck Valley to offer “dual curriculum” training — in classroom and clinical settings — so students can begin working in various certified assistant roles upon graduating from high school.
Still, as the state’s population ages and more health care workers are expected to retire, they’ll join the ranks of other retirees who need medical care, which could further compound the state’s health care workforce needs.
Recruiting and training the next generation of nurses and health care workers is just one part of the solution, industry leaders say. The other part is preventing burnout among established people in the field.
Stephanie McGuire, who leads government relations for the Connecticut Nurses Association, said much of the organization’s focus during this year’s legislative session was on “stabilizing the workforce.” That means making sure nurses find the career rewarding and valuable, especially after what they’ve been through the last two years, she said.
“It’s a lot of rebuilding,” McGuire said. Just as the pandemic has driven other professions to envision new models for work, nursing professionals are “trying to recreate the new norm,” she said. CNA has held forums and online hearings to try to connect with newer nurses and gather ideas to avoid burnout. “I think it’s incumbent upon us to maintain what we’ve learned over this time,” McGuire said.
The pipeline, a lifeline
This past year, UConn rising junior Zaheer Turtem served as a “floor mentor” in UConn’s Nursing Learning Community, helping incoming freshmen make friends, settle in and get comfortable with the rigorous academic experience.
That camaraderie is important. Often asked by non-nursing students why they’d pursue such a stressful — often messy — profession, Turtem and his classmates have ready responses.
“It’s about helping people,” Turtem said. “It’s about understanding your privilege as a guide for patients throughout their health care journey.”
Turtem started out pre-med at UConn but switched to nursing. The urgency of the pandemic made him eager to help.
“The way I saw it, nursing school was a way to fast-track getting into the field, instead of waiting on medical school to happen,” he said.
Many young people in Connecticut have felt a similar calling over the last two years. This fall, UConn’s nursing school is set to welcome its largest-ever incoming class. Since the start of the pandemic, undergraduate applications to UConn are up 25%.
Connecticut State Universities has expanded from 61 graduates of its nursing bachelor’s programs in 2010-11 to nearly 340 last year. Connecticut State Community Colleges train roughly 1,600 more students in nursing and patient care-related fields each year.
And Sacred Heart University in Fairfield just awarded degrees to its first cohort of graduates from an accelerated 15-month nursing bachelor’s program, available to students who already have a bachelor’s degree in another discipline.
Joan Palladino, nursing professor and interim dean of the School of Professional Studies at Western Connecticut State University, said the pandemic’s effects on the profession aren’t all negative. Observing students in patient-care settings, “the level of enthusiasm was tremendous,” she said.
“We see all the challenges with nursing over the last few years, and I’m sure in some ways it turned some people away,” Palladino said. “I think it brought some other people in.”