UMSON counters the nationwide nursing shortage with transformative solutions.
Nursing has routinely been plagued by the specter of a workforce shortage. “I’ve been a nurse for 40 years — it seems like there’s always been a nursing shortage,” says Susan Bindon, DNP ’11, MS ’96, RN, NPD-BC, CNE, CNE-cl, FAAN, associate professor and associate dean for faculty development at the University of Maryland School of Nursing (UMSON).
The last significant warning bells went off in the late aughts, as the United States was grappling with the financial crisis and ensuing Great Recession. At that time, population growth, and the approaching retirement of baby boomers who made up a significant portion of the nursing workforce, fueled the crisis.
This time around, the shortage is being driven by the exodus of workers burned out by the COVID-19 pandemic and by older, more experienced nurses leaving the profession. The Maryland Hospital Association 2022 Health Care Workforce Report notes that one in every four hospital nursing positions is vacant due to high staff turnover, shifting care delivery models, and an insufficient talent pipeline.
Throughout it all, UMSON’s mission to prepare exceptional new nurses has remained consistent, and it continuously seeks innovative solutions to develop experienced nurse leaders who can adapt to the changing demands of the profession.
More Students Require New Opportunities
UMSON enrollment has remained more or less steady, and class numbers for entry students continue to grow year over year. Last fall’s entry Bachelor of Science in Nursing (BSN) class was the largest in UMSON’s history, at nearly 215 students. The school’s current challenges revolve around adequate classroom space, recruiting enough qualified faculty, and ensuring requisite clinical education opportunities.
To accommodate the increase in the number of students enrolled, the school has had to be creative to overcome these barriers, says Katie McElroy, PhD ’16, MS ’10, BSN ’97, RN, CNE, associate professor and associate dean for the baccalaureate program. “We’re so fortunate to be in this region that has a number of outstanding, high-quality facilities that partner with us to educate our students,” McElroy says.
The school has partnered with the University of Maryland Medical System (UMMS) to establish a Practicum to Practice Program (P3), which creates a path for BSN students to move seamlessly from their senior practicum experience to a registered nurse position at a UMMS hospital. P3 participants complete their senior practicum on a specific unit, serving as a nurse graduate following graduation. Once the graduate successfully completes exam and licensure requirements, they transition to a Clinical Nurse I position. More than 200 UMSON students have gone through the P3 program since its introduction in spring 2022, and UMMS hospitals have retained over 70 percent of the graduates.
This opportunity merges a hiring strategy with a high-quality and personalized practicum experience. It incentivizes graduating students to consider employment at a UMMS hospital, and it gives them the autonomy to select their practicum placement while also relieving the stress of job searching.
Hospitals win by getting commitments from students early, and onboarding times for these new hires decrease. “When the student graduates and becomes a staff nurse, that orientation time can be shortened,” McElroy says. “They’ve already been on that unit for months, so they’re familiar with a lot of the policies and the physical layout and the location of things. Those logistics that can take awhile to learn have hopefully already been learned.”
The clinical education experience is essential to preparing new nurses for practice. The hours spent in clinical rotations allow students to integrate their theoretical knowledge with hands-on experiences that enhance critical-thinking, decision-making, and problem-solving abilities.
Lisa Rowen, DNSc, MS ’86, RN, CENP, FAAN, chief nurse executive of UMMS, who created the P3 concept, developed another model that modernizes the traditional clinical education model and aligns with the American Association of Colleges of Nursing (AACN) Essentials, an updated framework for nursing education using a competency-based approach. UMMS and UMSON partnered again on its pilot program, the Academy of Clinical Essentials (ACE), that pairs a small group of up to four entry students with an UMMS-funded clinical instructor for a full shift. “We’re really focused on the experience of the students,” McElroy says. “The students are immersed in that unit, they’re working with a nurse who’s intimately familiar with that setting and who’s functioning as a staff nurse, picking up an extra shift on that particular day.”
ACE elevates nursing education by providing students with an authentic inpatient nursing experience but also addresses staffing issues and the faculty shortages plaguing schools of nursing. “An ACE cohort will create better staffing ratios on units where there may be some nurse vacancies,” Rowen said in a 2022 article. “It also provides experienced UMMS nurses an opportunity to diversify their role by being a clinical instructor for future nurses.” Another perk for instructors is removing the requirement to grade assignments and supervise students during scheduled lab and simulation labs. A clinical liaison takes over those duties.
Recruiting and Preparing More Faculty
In addition to the clinical nurse shortage plaguing hospitals across the country, nursing schools are struggling with a talent pipeline for faculty positions. According to a 2022 AACN report, a survey of 909 nursing schools identified a national nurse faculty vacancy rate of about 9%. Most of the vacancies (85%) were faculty positions requiring or preferring a doctoral degree. The impending increase in faculty retirements will likely create “a significant ‘brain drain’ that will exacerbate the current faculty shortage,” states a 2021 report from the National Advisory Council on Nurse Education and Practice.
UMSON had the foresight to address faculty preparation two decades ago, when it launched the Institute for Educators in 2004, the first of its kind in the country. The institute has two primary initiatives: prepare nurses for teaching roles in Maryland’s academic and practice settings and provide ongoing professional development for faculty and educators in clinical settings. Since the institute’s inception, nearly 800 graduate and post-graduate students have taken academic courses in the institute’s Teaching in Nursing and Health Professions Certificate. This 12-credit, graduate certificate prepares nurses and other health professionals for teaching roles.
Increasing the number of prepared nurse educators is critical to expanding the nursing workforce. “So many faculty have great expertise in their clinical specialty but are not prepared as teachers,” says Bindon, who also serves as director of the institute and of the teaching certificate. “Just having a doctorate or master’s degree in nursing doesn’t guarantee teaching skills. That was a really important gap to address.”
Bindon is passionate about preparing educators who can attract great students to become nurses that make a positive impact on health care. She recently created an innovative pilot program funded by a $145,000 Innovation Challenge grant from the Bedford Falls Foundation Charitable Trust, a donor-advised fund established by philanthropists Bill and Joanne Conway. The UMSON Nursing Professional Residency for Outstanding Faculty (N-PROF) is a yearlong pilot program aimed at facilitating nurses who are transitioning from careers in practice to careers as nurse faculty. The program, scheduled to launch this year, is modeled after the nurse residency programs (NRPs) that have become a gold standard for new graduates in acute-care settings. NRPs help attract and retain new nurses as they transition from being students to working in a professional setting. The N-PROF program offers a similar model to new educators as they transition into teaching roles, providing structure and support to meet the needs of new faculty through a cohort model as they learn about effective ways to develop curriculum, deliver content, advise and grade students, collaborate on grants and projects, and more.
“Sometimes that first year can be very bumpy for faculty because of the expectations of the faculty role, especially in a school as large and complex as ours,” Bindon says.
This pilot program continues the work of the institute to advance the art and science of nursing education. “Students learn that there are learning theories — there’s science around teaching and learning,” Bindon says. “We’re debunking the idea that there are natural teachers or born teachers. It’s really a skillset like any other that one needs to practice and learn.”
NPs in Demand
Nurse practitioner (NP) is tied with wind turbine services technician for the fastest growing occupation in America, according to the U.S. Bureau of Labor Statistics, which predicts a 45% surge in the number of NPs needed by 2032, equating to nearly 124,000 new NP positions.
UMSON is a leader in preparing advanced practice nurses to meet the growing need for health care in the region and beyond. In response to a 2004 position statement from AACN, the School transitioned its NP program from a Master of Science degree to the Doctor of Nursing Practice (DNP) degree. Since that change took place in 2006, the school has graduated nearly 1,000 doctorally prepared nurses.
UMSON DNPs are positioned to reduce faculty shortages and adapt to the ever-changing and increasingly complex health care system faster.
UMSON has increased the number of available primary care providers, in particular, by expanding the School’s DNP Family Nurse Practitioner (FNP) specialty to its Universities at Shady Grove (USG) location in Rockville, Maryland, in 2017, enhancing the output of FNPs who can make a substantial contribution to the well-being of Maryland’s communities and, in particular, better meet the needs of underserved areas in the western and southern portions of the state.
Caring for New Nurses
It has come increasingly to the forefront of public consciousness that the professionals caring for patients also need to be cared for. Health care organizations are recognizing that a commitment to nurse well-being is essential to employee retention. The AACN Essentials call for nursing schools to prepare students with specific competencies related to developing wellness and resilience for themselves and others.
The School’s new BSN curriculum introduces these competencies in a first-semester course that addresses how to manage stress and counter burnout as a student and future nurse by practicing evidence-based skills to promote resilience. The course utilizes resources from R3: The Renewal, Resilience, and Retention of Maryland Nurses Initiative, a state Nurse Support Program II-funded initiative that aims to address root causes of burnout and disengagement to improve well-being, strengthen the bridge from education to practice, and increase retention.
Kelsey Bradford, MD, MPH, assistant professor, was appointed as the school health officer at the beginning of the COVID-19 pandemic, and her role has expanded to include a focus on student wellness.
In 2022, Bradford surveyed students about their feelings regarding the School’s commitment to their wellness. The results revealed that students believe UMSON cares about student wellness, but students don’t have the time or available resources to prioritize their personal well-being. Bradford is working with the School’s student affairs team and her counterpart at USG to create more resources for students. “The hope is to incorporate wellness strategies into the curriculum since our students feel like they don’t have the time outside of class to focus on them,” Bradford says.
The changing demands of the profession are straining nursing schools, faculty, and new graduates, but passionate nursing champions are adapting and innovating. Increasing the number of students, faculty, and educational opportunities is essential, but the right support ensures that “each student is ready to hit the ground running,” McElroy says. “We want to increase the longevity, and the quality of their careers, so when they do go out into the workforce, they’re going to stay at that first job for longer. And stay in the nursing profession longer because they have those tools and those skills to take care of themselves in this incredibly demanding career.”
Residencies to Retain Nurses
Supporting new nurses through their first year of clinical practice is essential to retention. “When students graduate, they pass the National Council Licensure Exam, but they don’t just hit the ground running — there are gaps,” says Jennifer Zipp, DNP ’18, MS ’12, BSN ’00, RN, executive director of the Maryland Organization of Nurse Leaders/Maryland Nurse Residency Collaborative (MNRC). “New graduates need training and support.”
The MNRC supports Maryland hospitals in offering the 12-month Vizient/AACN Nurse Residency Program™ model, which features a series of synchronous, asynchronous, or simulation experiences that support new nurses as they transition from students to professionals. “The NRP supports growth in three basic areas that are critical to new nurses: competence, confidence, and professional identity,” Zipp says. After completing the NRP, new nurses reflect an increase in those three areas, and hospitals have seen improvements in patient safety and quality of care.
The program is a boon for the workforce, too. In 2022, MNRC organizations saw an 89% retention rate of nurses in their first 12 months of hire, compared to a national retention rate of 67%.
THIS ARTICLE FIRST APPEARED IN THE SPRING 2024 ISSUE OF NURSING FOR/UM MAGAZINE.