Mary Ann Osborn believes a perfect storm is brewing on the state’s health care horizon.
Iowa’s aging population, combined with the thousands of residents who now have access to health care because of the Affordable Care Act, could bring about a nursing shortage.
“For all of us, the next work force is critical,” said Osborn, vice president and chief clinical officer at UnityPoint Health-St. Luke’s Hospital in Cedar Rapids. “It’s not something one organization will solve.”
Iowa is not alone, either. According to the U.S. Registered Nurse Workforce Report Card and Shortage Forecast, a shortage of registered nurses is projected to spread across the country between 2009 and 2030.
Projections from a separate agency, the Heath Resources and Services Administration, state that the nursing shortage will grow to more than 1 million by 2020.
“About 42 percent of nurses in Iowa are 50 years old or older,” said Rita Frantz, dean of the University of Iowa’s College of Nursing. “So there will be an exodus in the next 10 years or so” as the state’s nurses retire.
Corridor hospitals and higher education institutions are working with organizations across the state to combat the potential problems.
The Iowa Action Coalition, which was formed in 2012 and is headed by Frantz, is working with stakeholders in health care to address future challenges in staffing. One of its main goals is to increase the number of nurses who have bachelors of science in nursing, or BSN.
“We really want to promote the move from one degree to another,” Frantz said.
About 26 percent of Iowa’s nurses have bachelor’s degrees — far below the national average of 50 percent. The coalition wants to increase that number to 50 percent by 2020.
“More and more hospitals give preferential hiring to nurses with their BSN, because they are more able to manage the complex health care environment,” she said.
That’s one reason why Kirkwood Community College nursing student Eileen Le, 26, is planning to get her bachelor’s degree after she graduates in December with an associate degree.
Le, originally from Minnesota, said she is considering attending Upper Iowa University or Mount Mercy University. She said she always wanted to get her bachelor’s degree eventually but thought she may enter the workforce first.
As she went through Kirkwood’s five-semester program, though, instructors encouraged her to move straight into the next educational phase.
Studies suggest that a more highly educated nursing base may improve patient outcomes, said Jimmy Reyes, dean of nursing at Kirkwood.
Staffs with higher percentages of baccalaureate-educated nurses have lower mortality and failure-to-rescue rates. Researchers found that a 10 percent increase in the proportion of BSN nurses on staff was associated with a 4 percent decrease in the risk of death.
Reyes said community colleges want to offer more prerequisite classes to make the transition from an associate’s program to a bachelor’s program more seamless for students.
“A BSN shouldn’t be standard, but we should help more community college students attain that standard,” he said.
More nurses with a BSN means more nurses can pursue master’s and doctoral programs. About 13 percent of nurses hold a graduate degree, and fewer than 1 percent hold a doctoral degree, according to the Institute of Medicine’s Future of Nursing report.
If more nurses pursue graduate programs, more can become nurse practitioners, educators or researchers, which can help solve multiple problems, Frantz and Reyes said.
Colleges and universities also must produce nurse educators, Reyes said, to continue to produce a steady number of nurses each year. An American Association of Colleges of Nursing study found that about 75,587 qualified students were turned away from baccalaureate and graduate nursing programs in 2011 because of a lack of faculty, clinical sites or classroom space.
“We had about seven faculty spots open five months ago,” Reyes said. Kirkwood is also at capacity when it comes to the number of nursing students it can accept each semester. “Right now, it’s not a shortage of faculty, but it’s clinical capacity.”
There is also a growing need for nurse practitioners, physician’s assistants and primary care doctors, Frantz said.
“The expansion of the number of people who will soon have health care means that primary care providers will be in greater demand,” she said.
Hospitals, meanwhile, are re-evaluating nursing needs.
Ann Williamson, associate vice president for nursing at UI Health Care and the chief nursing officer for University of Iowa Hospitals and Clinics, said the hospital may not need to increase its 2,400 nurses, but it will have to shift its resources and how those nurses are used.
“Health care is changing from being very task-oriented and moving into a community setting,” she said. “More will need to work in home care or long-term care.”
Health-care delivery is changing, she said. More nurses may soon be needed to do home visits, ambulatory care, participate in telemedicine or coach and track patients who need long-term care, Williamson said.
Baccalaureate degrees better equip nurses to deal with these more complex situations, as well as better prepare nurses for independent practice, advanced clinical roles and acute care.
Hospitals need to do a better job of identifying high-risk patients and offer more complete and preventive services to these patients, said St. Luke’s Osborn.
She said the hospital introduced the role of nurse navigator, which requires a master’s degree, about 18 months ago. The navigator works with social workers, dietitians and a team of other professionals to help with patients’ long-term care needs.
More highly educated nurses have a more complete understanding of how the heath-care system works and topics that aren’t covered in an associate’s program. These nurses are also able to better handle the increasing complexity of technology and medical therapies and treatments.
“We have to make sure skills meet the population’s needs,” said Cynthia Lewis, the chief nursing officer for Mercy Medical Center. “Look at the faces of the community. Most of us are aging. Those relationships with health care providers are more important.”