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Solving the Nursing Shortage Crisis

Born out of crisis, driven by data, the Kansas Nursing Workforce Center is trying to provide more nurses for Kansans

Nurses posed and smiling
Amy Garcia DNP, MSN, RN, FAAN, and Barbara MacArthur, MN, RN, FAAN

What if you walked into a clinic for your cardiac procedure and learned it had to be canceled because there were no nurses available to staff your stress test and echocardiogram? No one to take your blood pressure, no one to start the IV? What if you sat with your elderly mother at the small hospital in your rural community and waited for hours for an available bed because there weren’t enough nurses to provide care for the patients already admitted? Right now, these problems occur, but they aren’t yet common. Unfortunately, we may be heading for a day when every health care service routinely slows due to a lack of nurses.

As the Baby Boomers age, the Gen Xers retire and echoes of the pandemic continue to resonate through the health care industry, the national nursing shortage threatens to deepen its impact in ways that will bring dramatic results to patients in communities large and small.

“The nursing profession is in crisis — both nationally and in Kansas,” said Sally L. Maliski, Ph.D., FAAN, dean of the University of Kansas School of Nursing.

Sally Maliski portrait
Sally L. Maliski, Ph.D., FAAN

Maliski said the problem is on track to get worse as the pandemic’s negative effect on nurses, combined with the number of aging nurses retiring, means that the entire profession is facing challenges at all levels like never before.

“Statistics show how critical the situation is,” Maliski said. “The Kansas Department of Labor’s 2022 Occupational Outlook report shows that by 2026, the state will need more than 28,000 nursing assistants, 18,000 registered nurses and 6,000 home health aides. Rural Kansas hospitals are facing nursing shortages that could mean hospital closures. These looming problems keep me up at night.”

While the obvious solution is to educate more nurses, the crisis extends to all levels, from shortages in nursing faculty and advanced practice nurses to shortages of nursing aids.

“Nursing schools graduate only about 10% of the nurses needed to stem this tide,” Maliski said. “Simply put, we will not educate our way out of these shortages. We must find solutions that tackle the whole picture, including education, retention and pipeline. These are systemic problems that require a broad stakeholder coalition to work together so that Kansans can access nurses when and where they are needed.”

Maliski announced in May her own plans to retire from the KU School of Nursing, where she has served as dean since January of 2016. Her 46 years of work in nursing and higher education will come to a close when the university hires a new dean. But before leaving, Maliski set into motion an effort that could make a significant difference in Kansas and beyond.

On Aug. 3, 2023, the Kansas Nursing Workforce Center launched, becoming the 40th such center in the United States. Housed in the KU School of Nursing — but intended to serve the entire state — the center will be part of an important national effort to combat shortages in nurses and nursing faculty at all levels.

“We were able to start the center because Dean Maliski had the vision to see the need and provide the startup funding from the KU School of Nursing,” said Amy Garcia, DNP, MSN, RN, FAAN, director of the Kansas Nursing Workforce Center and a clinical associate professor at the KU School of Nursing. “This will be a part of her legacy as she retires.”

"“We must find solutions that tackle the whole picture including education, retention and pipeline. These are systemic problems that require a broad stakeholder coalition to work together so that Kansas can access nurses when and where they are needed.”

- Sally L. Maliski, Ph.D., FAAN

National problem, local stakeholders

The Kansas Workforce Center is part of the National Forum of State Nursing Workforce Centers, a nonprofit national network of state nursing workforce entities created to share best practices with each other as all seek to address nursing shortages in their states.

“Some of the centers are established by statute, some are established by coalition, like ours (in Kansas),” said Barbara MacArthur, MN, RN, FAAN, co-director of the Kansas Nursing Workforce Center. “Some are established in university settings, and some are in state commerce departments. Many of our goals are the same.”

MacArthur had the opportunity to help establish and later work with the Florida Center for Nursing, once as a vice president of nursing for the Florida Hospital Association and then later when she was chief nursing officer of a hospital in Tallahassee.

“We’ve learned many lessons from other nursing centers,” she said, pointing out that a variety of stakeholders will be a part of the advisory board. “We want questions and different perspectives. We are still garnering support and information. We want to share ideas, share resources and share economy of scale as we think about common goals.”

Those common goals were discussed extensively in meetings across Kansas this spring prior to the formation of the center, beginning with one in Topeka and continuing to similar gatherings in Pittsburg, Hays and Junction City. Co-hosts included Hays Medical Center, Pittsburg University, Baker University and Stormont Vail. MacArthur said that it was conversations in stakeholder meetings this spring that helped solidify both support and direction for the new center in Kansas.

“We have seen that Kansas has nursing workforce needs that can be attributed to the entire state and needs that are regional in nature,” said co-host representative Terry J. Siek, MSN, RN, vice president of patient care and chief nursing officer at Hays Medical Center. “If the Kansas Nursing Workforce Center works on the common needs, the regions will be able to work on their own unique needs. We want all stakeholders to be actively involved.”

Garcia and MacArthur (who joined as the co-director in September) have been crisscrossing the state having conversations with known stakeholders, potential partners and other organizations and individuals interested in supporting the Kansas Nursing Workforce Center.

“This is a really good time to move from despair to solutions and to do it collaboratively with stakeholders,” MacArthur said.

Linda Adams-Wendling, Ph.D., MSN, MBA, APRN, president of the Kansas State Nurses Association and a longtime nursing educator, represents one of those key stakeholder organizations. Adams-Wendling said she believes it is essential for Kansas to have a nursing workforce center. “We plan to participate, collaborate, and advocate with all stakeholders for the Kansas Nursing Workforce Center and to assist in securing solutions for sustainability of the center now and into the future,” Adams-Wendling said.

Economic impact, economic success

Nurses are a central element of health care, but they are also a major factor in the Kansas economy, Garcia said.

“Nursing is the largest segment of health care, and there are 5 million registered nurses in the United States,” Garcia said. “About 1.5 percent of all Kansans are nurses, and 14 percent of the Kansas economy is health care.”

Garcia and MacArthur both point out that nurses are an essential component of the Kansas economy, with nursing jobs and the need for nurses all throughout the state.

“Nursing shortages impact the health of the community. If you go across a state like Kansas, you will see nurses and other health care workers are a big part of the economy and the community,” MacArthur said.

MacArthur, who has worked in nursing in nearly every capacity, from the bedside to roles as an executive in multiple big healthcare systems, is excited by the prospect of how the center can increase interest in nursing among young people.

“I tell young people, ‘Come with me. I’m going to show you nursing like you never imagined it,’” she said, noting that nurses can work at a student health center, at a county health center working with the underserved, as an ER nurse, as a first responder, as a researcher — and yes, as a C-suite-level executive at an enormous health system.

“We can do our work anywhere, and there is no stigma to changing career tracks or going back to school,” MacArthur, said, noting that nursing is a career that can support a family, be flexible and also be portable. “There are endless opportunities for employment, and endless opportunities for contributing in a meaningful way that makes a difference in people’s lives.”

Many hospitals and health systems offer financial support to enable their employees to gain additional nursing credentials, allowing for someone to work a meaningful well-paid job while advancing in their field. There are many different needs, and many diverse paths.

One of the goals of the Kansas Nursing Workforce Center is to build a pipeline of future nurses, perhaps by encouraging programs in STEM, perhaps by encouraging people to pursue nursing as a second career. It’s clear that some careers will begin at community colleges in the state, while others may begin at universities, Garcia said.

“We will be working systematically on the pipeline to nursing and the education of nurses, the development of nurses,” she said. “Our goal is to make the pathway to careers in nursing as clear as possible,” Garcia said. “While the Kansas Workforce Center is based at the University of Kansas, we are very supportive of all nursing schools in Kansas, at every level. This is a statewide organization, and every corner of the state is important.”

Data-driven decisions

With that first investment from the KU School of Nursing funding the fact-finding, launch and initial efforts of the Kansas Nursing Workforce Center, Garcia and MacArthur know their next task is to secure the funds to do much more.

While work is under way to build all the different elements of the Kansas Nursing Workforce Center, which will produce a wide variety of research and initiatives designed to impact the nursing field, it’s clear that the initial need is data. An informaticist herself, as well as a former lobbyist and former health care technology executive, Garcia is working to land support from different sources to fund the data-gathering element of the center first. It is difficult to attack a large, complex issue, especially without clear data to provide direction.

“Gathering data will allow us to build a strong model for supply and demand of nurses,” Garcia said, noting that information will be the cornerstone upon which the rest of the center will be built.

Siek, the chief nursing officer at Hays Medical Center, welcomes that approach, noting that the Kansas Nursing Workforce Center is going to make an immediate impact with data collection and analysis.

“The data we have tells us how many nurses are licensed in Kansas but not how many nurses work in Kansas,” he cited as an example.  “There are many more nurses with a Kansas license than there are nurses working in Kansas.  Because of this disparity, it is difficult to put the story together for key stakeholders needed to help solve the nursing shortage.”

Chad Austin, president and CEO of the Kansas Hospital Association, agreed that more data is essential.

“Health care leaders rely on data to drive decision making, and that is particularly true when it comes to workforce,” Austin said. “Kansas will benefit from having a nursing workforce center to provide more robust data to ensure hospitals can build, sustain and retain the nursing workforce in Kansas.”

 Garcia said the center’s leadership is working with the Kansas Board of Nursing toward an agreement that would allow the center to translate their data into dashboards and reports usable by nursing schools, employers, nurses and community leaders.

Garcia said she hopes to start with licensure data and then integrate that with other sources in order to better understand how the presence of nurses and the presence of nursing specialties impact health outcomes in communities.

“We know that having a shortage of nurses puts health at risk, both physical health and economic health,” she said. “We want to measure that, and also see, for example, if there are school nurses in a community, does that change admissions to the local emergency room for asthma? If there are nurses experienced in head trauma or nurses experienced in labor and delivery, does that change outcomes for the better at the community level?”

Garcia notes that the center has already begun funding research projects, with many more to come. It’s the beginning of a very long journey, but Garcia says it will be well worth the time and effort. And it cannot come soon enough.

“There is so much at stake for the health of Kansas and the health of Kansas communities.”

University of Kansas Medical Center

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