The United States as a whole is faced with a looming nursing shortage. This slow-moving catastrophe isn’t new, but it is coming to a head as Baby Boomer nurses start to retire en masse and the rest of their age cohort hits their golden years. States like Texas and California make the news for the number of nurses they need relative to demand, but they’re also two of the biggest states in terms of population. A number of reports have come out saying that Maryland is experiencing one of the worst nursing shortages in its history. We’ll share the findings of various industry reports and the impact the shortage is having on everyday people before discussing potential solutions in the works.
The Data Being Reported on the Nursing Shortage
The state’s health and human services programs have seen their vacancy rate rise from 7 percent in 2010 to 12 percent in 2019. Vacancy rates vary between departments. For example, the Developmental Disabilities Administration has a 15 percent vacancy rate. Vacancies in direct care positions, those held by nurses and physicians, have doubled from 7 to 14 percent between 2014 and 2018.
There is also a shortage of school nurses. Only three in five schools have a full-time school nurse. Some of the institutions get by with a part-time nurse. One attempt to meet demand is to have one nurse shuttle between schools, handling issues and handing out medication. Yet a quarter of schools lack a school nurse altogether. This is despite the growing number of children who require medical assistance and supervision. Roughly a quarter of students have a chronic disorder like asthma or diabetes. Students suffer when poorly trained teachers and administrators try to step in to fill the gap.
Maryland is training about as many nurses as they have retiring. On the surface, this sounds pretty good given that a third of the nation’s nursing workforce is over fifty and ready to retire. However, they aren’t keeping all of their nursing graduates. To make matters worse, the areas with the greatest demand are already experiencing severe shortages of skilled nursing care. For example, a National Center for Health Workforce Analysis report predicts that Maryland will have around eighty thousand nurses and a similar level of demand. The problem is that there is a dire shortage of psychiatric nurses and other specialized nurses. Compounding the problem is the national shortage of nurse educators. There are so few nursing instructors that some nursing schools are turning away prospective students, though these students must earn a bachelors and then a master’s degree to be able to fill vacant nursing school faculty slots.
The Impact the Nursing Shortage Has on the Public
The nursing shortage has forced many families to take on part or all of the long-term care of disabled relatives. This isn’t because there aren’t government programs for home nursing care. They simply cannot find enough nurses to fill in every shift to provide 24x7x365 care. One contributing factor to this is the lower reimbursement rate Maryland pays to nurses through Medicaid than other states. A nurse working in Maryland would be paid about 35 dollars an hour. That’s more than the 20 to 30 dollars per hour they’d make in Virginia, but it falls short of the 45 to 50 dollars an hour they’d make in Washington, D.C., Pennsylvania, Delaware and West Virginia. Other nurses ignore home-bound Medicaid patients to work in hospitals and other institutions that pay more.
The failure to keep reimbursement rates rising at the rate of inflation contributed to the home healthcare crisis for families receiving Medicaid to begin with. The pay rates make a significant difference. While 17 percent of prescribed home health hours aren’t filled in Maryland, that rate is only 7 percent in neighboring Delaware.
The lack of skilled medical staff contributes to the shortage of mental health beds. These beds are desperately needed, but the shortage is causing many mentally ill people to be sent to prison or denied care and supervision altogether. The issue led to Maryland’s Department of Health being held in contempt of court for failing to hospitalize those who had been ordered by the courts to be committed within several weeks. The court case hinged on attorneys equating the average wait time of 87 days for a psychiatric admission to torture.
Those with psychosis have worse overall outcomes and take longer to stabilize the longer it takes for them to receive appropriate treatment. Some end up released from prison to ill-prepared families before they can be committed. Others end up on the streets. Some cycle in and out of prison because they don’t get the care they need. Non-treatment really isn’t an option, since mentally ill offenders have a higher recidivism rate. They cost more with law enforcement and corrections than they do if they receive comprehensive therapeutic care.
The lack of mental health beds hits hospitals, too. The shortage of state-run psychiatric beds led the Department of Health to ignore a law requiring involuntary psychiatric patients in the Emergency Room to be admitted within 30 hours. This results in greater crowding in Emergency Rooms.
Even the shortage of school nurses has a detrimental impact on the public. Over the past few years, several Maryland children have died after they faced medical emergencies that could have been solved had there been a nurse on duty. On a day to day basis, other children wait longer than necessary to be diagnosed or receive assistance.
Advances in technology are also transforming the profession, and higher education is essential to filling these specialized roles. However, the impact here is harder to quantify.
Potential Solutions to the Nursing Shortage
We’ve already mentioned how modestly higher pay rates attract nurses to institutions and nearby states. This is why the Maryland Health Department was considering giving nurses working in hospitals and state facilities an 11.5 percent raise in its 2020 budget; that would be a 5.5 percent raise and roughly 6 percent bonus. This is roughly double the 5.5 percent cost of living raise everyone else would be receiving.
Expanded health benefits were also on the table. This improved compensation package is intended to relieve the 12 percent vacancy rate. The same budget would include additional funding for home, community-based and behavioral health providers. It is unlikely that we’ll see a return to the institutionalization of the severely disabled that was routine forty years ago. Having them live at home with in-home nursing care is considered both the better practice and cheaper overall.
This justification can and should be used to raise the pay rates for licensed practical nurses to the point that they’re willing to provide in-home care instead of working at hospitals and other care institutions. This is why care providers and parents have lobbied the Maryland legislature for a 25 percent raise.
Once the pay rate is competitive, it will be necessary to keep the reimbursement rate going up as fast as the cost of living. This is because neighboring states are in a race for the same talent. Notably, Virginia advocates were asking for a ten percent pay raise for their nurses. These pay differentials matter when it is so easy for Maryland nurses to drive an extra half hour across state lines and earn a few dollars more. They’d love to skip the grinding commute an hour each way, but they may not be able to afford to work for less. Maryland’s cost of living doesn’t give them that choice.
In the meantime, families have to call numerous nursing agencies to get any help at all and tend to have to wing it by themselves on evenings and weekends. After all, nurses want to be home with their families, too. Other families deal with sub-par nurses simply to get relief. They may ignore a nurse who sleeps through a shift because they’re afraid it may be weeks before they could get that slot filled.
Maryland is offering other incentives to attract nurses and train new ones. For example, they’re offering up to 500 dollars in tuition reimbursement and 20,000 dollars in student loan repayments over a ten-year period for those that qualify. A Maryland task force requested additional funds for education and training programs to improve licensed practical nursing or LPN services, as well.
On the flip side, some employers are using sticks instead of carrots. A director of the AFSCME said that nurses are complaining that they have to work double shifts under the threat of losing their day off. However, that’s not a viable long-term strategy. After all, such demands drive newly hired medical staff away. It also causes dedicated nurses to burn out sooner, eventually driving them from the profession altogether if they don’t change employers.
The average RN in Maryland earns more than seventy thousand dollars a year. Nurses with advanced degrees earn even more. The nursing instructor shortage could be solved in part by raising the pay for nursing instructors. However, the long-term solution is to increase the overall educational level of nurses, since you need to have a full pipeline to get many nurses with masters and doctoral degrees.
One of the options nursing students have is to turn to online education. Schools like Baylor University allow students to earn an MSN or online DNP. A nurse practitioner degree from Baylor University online could make you eligible for a salary well over a hundred thousand dollars. You could also become a neonatal nurse or nurse-midwife. Now you’re able to step into areas with critical need and better serve your patients. For example, nurse practitioners are able to provide affordable care in areas where there are not enough doctors.
An MSN in leadership also opens up the door to a job in nursing management and health care administration. They are one of the top 100 universities in the nation, and their online graduate nursing program is in the top 40. The Baylor DNP and online MSN in leadership and innovation are accredited by the CCNE. While Baylor is located in Texas, they accept applicants for their online nursing program from many states, including Maryland.
The lack of mental health beds is being addressed, but not every solution actually deals with the root cause. For example, the state legislature approved a bill that psychiatric hospitals must admit inmates within ten business days after receiving a court order for commitment. However, the legislation does nothing to increase the number of state-run psychiatric hospital beds. There were more than 4000 such beds in 1982 and less than a thousand in 2016. Some jails have stopped asking for hospital placements to avoid getting in trouble or wasting their time, though this doesn’t really help inmates with mental illness.
The only solution for this problem is funding for more psychiatric beds and properly compensated staff to supervise them. This has the side benefit of making communities safer, since it protects the public from those who become more dangerous after being locked up due to insufficiently treated mental illness. Keeping such people for longer in the Emergency Room or traditional hospital beds isn’t good enough, since this takes resources away from those who can only be treated in a proper hospital. Nor do psychiatric patients get proper supervision and long-term care sitting in a hospital next to people who have survived heart attacks and car crashes.
Shrinking school budgets have been blamed for the school nurse deficit. Increased funding and greater appreciation for the need for school nurses may solve the problem. For example, splitting the time and attention of a nurse between two schools shouldn’t be considered good enough, since the nurse has to travel from one campus to the other to deal with a medical emergency. This delay of care hurts kids and has already caused a needless loss of life.
The nursing shortage nationwide is due to an aging population, an aging workforce, and a limited supply of new nurses. Compounding matters are advances in technology and an increasing need for higher education to simply work in nursing. Maryland’s shortage is driven by these factors plus competition for skilled nursing talent with other states that better compensate these key medical professionals. Fortunately, there are a number of solutions working their way from the top down and options available to nursing students themselves.