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When nurses are needed most, nursing programs aren’t keeping up with demand

LONG BEACH, Calif. — At a time when the Covid-19 pandemic has exposed a growing shortage of nurses, it should have been good news that there were more than 1,200 applicants to enter the associate degree program in nursing at Long Beach City College.

But the community college took only 32 of them.

The entrance to the Long Beach City College nursing program. Nursing programs are falling behind demand for nurses as health protocols limit in-person instruction, instructors quit and hospitals are stretched too thin to provide required hands-on clinical training. Credit: James Bernal for The Hechinger Report

North of here, California State University, East Bay isn’t enrolling any nursing students at all until at least next fall.

Higher education was struggling to keep up with the skyrocketing demand for nurses even before the Covid crisis. Now it’s falling further behind.

Health protocols are limiting in-person instruction. Nursing teachers are quitting in large numbers, while others are nearing retirement. Hospitals are stretched too thin to provide required hands-on clinical training. And budgets are so constrained that student nurses are forced to buy their own personal protection equipment, or PPE.

“What worries people, if Covid continues on and takes its toll, is will people still enroll in nursing programs?” asked Peter Buerhaus, a nurse, economist and professor at Montana State University who studies the nursing workforce.

All of this is only amplifying the existing demand for nurses.

Estimates of the problem vary dramatically, from a projected shortage of 510,394 registered nurses nationwide by 2030, based on a formula used by scholars at the Cleveland Clinic Lerner College of Medicine and elsewhere, to a predicted shortfall in some states by then but a surplus in others, according to federal forecasts.

Experts agree, however, that shortages will be worst in the West and South. California alone needs to turn out more than 65,000 new nurses a year, according to Futuro Health, a nonprofit created jointly by the health care company Kaiser Permanente and a principal union representing health care workers in the state.

And those estimates were all made before the pandemic, which is only likely to make things worse, Buerhaus and others said.

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Nursing programs were already failing to enroll enough students to meet this need, pre-Covid, according to the American Association of Colleges of Nursing.

U.S. universities and colleges last year rejected 80,407 qualified applicants for bachelor’s and graduate degrees in nursing, blaming a lack of faculty, classroom space and clinical opportunities in hospitals. That doesn’t include the number turned away by community colleges, which educate a large number of beginning nurses.

One of the biggest bottlenecks is that overburdened hospitals are closing their doors to clinical training for nursing students who would ordinarily shadow nurses and doctors and learn by treating patients.

U.S. universities and colleges last year turned away 80,407 qualified applicants for bachelor’s and graduate degrees in nursing.

“When Covid hit, clinical sites all just shut like a trapdoor, bam,” said Lindsay McCrea, the chair of the East Bay program.

“It’s very shortsighted of them,” said Sigrid Sexton, McCrea’s counterpart at Long Beach City College. “We’re very supportive of the hospitals’ needs to protect patients, but we’d like to see them be more supportive of students.”

Nursing student Eliana Lopez only barely managed to cobble together enough clinical hours to graduate this month from East Bay.

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nursing education
Student nurse Gail Powers outside the College Medical Center in Long Beach, California. Despite a shortage of nurses, training programs have not kept up with demand, and the Covid-19 pandemic is only making matters worse. Credit: James Bernal for The Hechinger Report

Hospitals left and right were shutting out students from clinical rotations, said Lopez, 34. She and her professors called health care facilities across the San Francisco Bay area trying to find opportunities. Over and over again they were told that the besieged hospitals — the same ones that will eventually need more nurses — couldn’t afford to spend valuable time and equipment on students.

“It was really upsetting,” said Lopez, 34, who has felt unwelcome at hospitals that she says could use students’ help. “We can be a team member as well, but they looked at us as wasting PPE.”

Without students to help out, overworked experienced nurses may not stick around for long.

The average age of an RN is 50, the Health Resources and Services Administration says, with more than a million projected to retire by 2030, deepening the shortfall. And that estimate is from before the pandemic prompted some nurses to quit because of Covid-19 health risks.

“You’re hearing nurses say, ‘I don’t know how much more of this I can take,’ ” said Joanne Spetz, a University of California, San Francisco professor who directs that school’s Philip R. Lee Institute for Health Policy Studies.

That means new nurses will be even more urgently needed, said Gail Powers, 55, who is pursuing an associate degree in nursing at Long Beach.

“It’s very important for us to get through this because there are a lot of older people stepping out of the profession,” she said.

Powers’ classmate, Sergey Bystrov, 40, has been working in the emergency room at a Long Beach hospital and will graduate from Long Beach City College this month. He said hospitals should let students step in not only so they can get important training, but to help keep full-time nurses from becoming overwhelmed.

“When the nurse has a student next to her, it takes some of the pressure off. It’s an extra set of hands,” he said.

Sergey Bystrov, a student nurse, outside the College Medical Center in Long Beach, California. The nursing program in which Bystrov is enrolled, at Long Beach City College, had 1,200 applicants this fall and accepted only 32 of them. Credit: James Bernal for The Hechinger Report

Nursing instructors are also leaving in droves. Nearly one-third of California nursing schools surveyed have lost faculty members since March, said Sharon Goldfarb, dean of health sciences at California’s College of Marin and a regional president of the California Organization of Associate Degree Nursing. The average age of the remaining instructors is 63, she said.

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At community colleges, instructors’ salaries are notoriously low, especially compared to practicing nurses’ pay, so open faculty positions sometimes remain unfilled for a year or more.

The nursing program at Rio Hondo College, a community college in Whittier, California, has been unable to fill two open faculty slots for the past year, said Catherine Page, dean of health science and nursing. Candidates have turned down the jobs because of the salaries, she said. Pay for Rio Hondo instructors starts at $60,000 a year, while the average California registered nurse makes $113,000.

Rio Hondo had an increase in the number of nursing school applicants this year but had to limit new admissions because of the faculty vacancies and a lack of clinical opportunities.

The challenges are keeping colleges from helping solve the nursing shortage, Page said. “We’re not going to produce those new nurses.”

“What worries people, if Covid continues on and takes its toll, is will people still enroll in nursing programs?”

Peter Buerhaus, nurse, economist and professor, Montana State University

Experts worry that the next year or two could devastate nursing — and nursing quality. Scores of nursing programs are replacing on-site clinical work with computer simulations, mannequins or patient care by video, which some educators concede may not sufficiently prepare new graduates for work. Several said they aren’t convinced that students will pass their licensing exams.

“It would be naive to say, ‘Oh, no, this won’t affect them at all,’ ” said Renae Schumann, dean of the Houston Baptist University nursing school in Texas. “Yes, we all worry about it.”

Even if new nurses do arrive completely prepared, lower staffing levels in hospitals may mean higher numbers of medication errors and deaths, according to the American Nurses Association.

Older, experienced nurses are the ones who keep things running smoothly, Buerhaus, the Montana State professor, said. “Some of these nurses are exactly who you need right now, and they’re leaving. I hope many of them hang in there.”

Hospitals could have major problems soon: Acute-care hospitals employ more than 60 percent of nurses, Buerhaus said.

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Yet some hospitals have said they will only accept nursing students who bring their own protective gear and pay for their own Covid tests, neither of which many nursing students can afford.

“When you start putting extra costs on the students and the programs, that becomes a barrier,” said John Cordova, a nurse who directs California’s Health Workforce Initiative, a statewide program that seeks to smooth the transition from community colleges to the labor market.

Lopez, the Cal State East Bay student, worked her way through school as a nurse’s aide. She is preparing to take her licensing exam and find a job, even if it’s out of state.

In the end, she said, her hard-fought clinical rotations this year have turned out to be the most rewarding part of her education.

“What a time to learn, during the pandemic,” she said. “What a once-in-a-lifetime experience.”

This story about the nursing shortage was produced by The Hechinger Report, a nonprofit, independent news organization focused on inequality and innovation in education. Additional reporting by Jon Marcus. Sign up for our higher education newsletter.

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