Nurses' station | A wave of impending retirements among nurses and nursing faculty prompts a grant to stave off a shortage

As Maine’s already aging population grows older, and with federal health care reform becoming a reality, the state’s health care work force is increasingly coming under scrutiny. According to Maine Department of Labor statistics, Maine’s nurse-to-population ratio currently stands at 11 per 1,000 residents. But only five counties — Cumberland, Kennebec, Androscoggin, Penobscot and Knox — sport ratios equal to or greater than the statewide average. That means several counties are below the average, some alarmingly so. In Sagadahoc County, the ratio is one nurse per 1,000 residents, the lowest in the state.

With the average age of both the state’s nursing work force and nursing faculty outpacing the national average, the state faces a void of trained nurses to replace those who will retire in the next few years. Additionally, the average wage of a registered nurse in Maine is almost 10% below the national median of $62,450, which makes attracting new nurses all the more challenging.

The nursing work force is a subject Lisa Miller, co-program director of The Bingham Program, knows well. The Augusta-based nonprofit has long focused on health care issues and has, in recent years, turned its attention to Maine’s nursing work force. The program is working to raise awareness of — and find solutions for — this potential crisis.

Those efforts recently received a boost in the form of a $200,000 Partners Investing in Nursing’s Future grant from the Robert Wood Johnson Foundation and the Northwest Health Foundation. As an added bonus, local and regional funding will provide a $200,000 match to the two-year PIN grant. To secure the grant, The Bingham Program partnered with Maine Partners in Education and Practice, OMNE — Nursing Leaders of Maine, The Betterment Fund, One Maine Health, the University of New England, former Maine legislator Darlene Curley and the Maine Department of Labor.

With a master’s degree in public health and 30 years’ experience in public health, health care and medical care, Miller has kept a close watch on the state’s evolving health care work force. She’s been with The Bingham Program for 13 years, and for the last six, has also served as a state legislator from District 52 (Chelsea, part of Jefferson, Somerville, Washington, Whitefield and Hibbetts Gore). She’s become known as a health care specialist in the Legislature (she served on the Health and Human Services Committee for her first four years), and has found that her two positions complement each other well. “Working in the Legislature helps inform my work at Bingham, and my work at Bingham helps in the Legislature,” she says.

On the heels of the Robert Wood Johnson Foundation grant announcement, Miller spoke with Mainebiz about Maine’s looming nursing shortage, the potential effects of universal health care and the need to modernize nursing education to serve Maine’s aging population. The following is an edited transcript.

Mainebiz: What’s the state of nursing in Maine?

Miller: We’re not in a shortage right now. The nursing work force seems to cycle over the years, so we do have a looming shortage. The average age of an RN in Maine is 50, which is four years older than the national average, and the average age of our nursing faculty is about 55. So both the work force and the faculty to train new nurses are facing a shortage. It’s very difficult to train nurses to take the place of retiring nurses without the faculty in place.

How soon might we start experiencing shortages?

The state predicts that the first round of retirements will hit in 2015. Also within the next five years, 28% of nursing faculty are most likely going to retire. That’s certainly a scary issue for us.

Could non-practicing nurses help fill the void, even temporarily?

It used to be years and years ago that 50% to 60% of the nursing work force was working. That left 40% out of the work force, either being with their family, working other jobs or something else. Now we have about 87% of licensed nurses in Maine in the work force, so we really can’t pull people out of the hinterlands to help fill the shortage.

What is the current state of nursing education, and what role has it played in creating the current climate?

Faculty is one of three or four things we’re focusing on. Nursing education programs have traditionally been put in one silo, while health care education has been put into another. So the two really haven’t talked to each other, and there’s often been tension between the trainers and the absorbers. However, these two sectors have been getting together more over the last five years. Health care and hospitals have said, “This is the kind of nurse we need: someone who has skills in chronic disease management, leadership skills. Your curricula is outdated, so let’s work together.” Schools have said they need more faculty and are asking the health care side, “Can we train your experienced nurses to serve as adjunct faculty?”

What, if any, additional strain could health care reform efforts place on Maine’s nursing situation and on health care in general?

Massachusetts, with their health care reform in place, was looking at a potential strain on primary care physicians. But primary care doesn’t have to be delivered by physicians. Nurses do a lot, and those who go on to become nurse practitioners do even more. Here in Maine, we may see a siphoning of nurses moving into the nurse practitioner field, which would have an effect on the nursing work force. At any rate, universal health care will definitely expand the role of the primary care nurse.

There’s also a very vibrant network of rural and community health care in the state that relies a lot on nurse practitioners and [physician’s assistants], so of course, nurses serve a very important role in primary care.

What specific training is needed to modernize Maine’s nursing work force and nursing curriculum?

The primary concern for us is geriatrics because of our population’s average age, which is among the oldest in the country. We’re going to need more nurses with geriatric care training at every level and in every part of the state.

Another concern is informatics, or health information technology, at all levels of healthcare. Nurses need to get more comfortable with the technologies and be trained to use them to monitor patients, and be able to pull info out to see how care is being delivered.

We also need more nurses with leadership training who can assume leadership positions, especially in hospitals and long-term care facilities. There’s also a real need for distance-care training, or the use of technology to take care of patients in their homes or on islands in rural, isolated areas. Maine has experimented with telemedicine, and as its use expands, that’s also going to grow the role of nurses in Maine.

Could Maine face similar shortages in other health care professions?

If you look at the plain old numbers and divide the population by the number of physicians, the situation looks OK. But in reality, it’s very difficult to recruit primary care physicians in rural areas. The pay isn’t as high, and creating a connection to a hospital where they will be stimulated and supported is a lot harder when they’re way out in the boonies.

Another contributing factor is that nationally, there’s a smaller number of doctors going into primary care, about five to 10%. It’s no wonder when you have doctors coming out of medical school with $250,000 in debt. It’s hard for them to think about moving to a rural area, starting a family, buying a home, starting a practice and assuming even more debt. As health care gets humming more, and as more people have access to insurance and care, we’re going to have more need for primary care.

What was the Partners Investing in Nursing grant process like?

It was interesting. The Robert Wood Johnson Foundation announced this grant several years ago. At that time, we tried to pull together nurses from both education and hospitals to respond, but unfortunately, they just couldn’t get together. Those education and health care silos were too strong. This time around, a group of senior nursing executives had been working together for four years, so they came to The Bingham Program because they felt like they were finally in a good enough position to respond. The actual process from application to final announcement only took four months, so we had to respond very quickly.

What’s the timetable for implementation of any new programs?

The goal is that nurses in both education and practice will agree on what the new core requirements or competencies are for nurse training. We need a new set of competencies for modern nursing in Maine, and we hope to come out of this two-year process with that. We also plan to test, and have already started testing, to find out what nurses want and need with what they’re doing in the field. We’ve been surveying recent nursing graduates in the field, asking them things like, “How did your first year go? Did you get training in the competencies you needed to start practicing?” We’ll keep going back and forth on this for the next two years to gather real-time feedback to determine if training is preparing graduates for the nursing role.

We’ll also be putting a process for developing new adjunct faculty in practice and hospital settings to help train practicing nurses in after graduation. There has to be a good support system for these new faculty because it’s very difficult for them to be out there alone, versus a university setting.

Going forward, we’re also trying to bring together a lot more different partners and take on an advocacy role. We’ve been getting AARP interested in nursing work force issues, as well as the Maine Office of Rural Health and the Department of Labor. All three are getting clued in to the reality, particularly the Department of Labor. Health care in Maine is a very bright light. It’s one of the top economic drivers in the state, so business groups are also starting to look at health care. It’s a source of excellent jobs, especially in rural areas. Everyone has a nursing home or a hospital.

What, if any, other efforts are in the works to address shortages in the nursing work force?

Nursing executives have worked with our congressional delegation and have gotten a recent HRSA [Health Resources and Services Administration] grant to look at Maine’s health care work force. We also now have a specific grant in Maine to look at planning and implementing for the nursing work force over several years.

The Department of Labor has also received a HCWF [Healthcare Workforce] grant, which is available through the health care reform legislation, and part of that is nursing. We’re going to rely on our grant and the HRSA grant to inform, while the Department of Labor will be looking more at physicians.

This convergence of the three grants surprised all of us. It’s one of those situations where you just sort of cast your fishing pole out there and hope to catch something — and we got three of them.

What are some other areas The Bingham Program is focusing on?

We focus on three main issues. Health care work force implementation and professional training is a legacy focus of ours. We’ve been around for more than 75 years, and our early work was centered around training physicians in the ‘30s, ‘40s and ‘50s. As health care has evolved, we’ve also focused on other fields.

Our other two areas of focus are improving health care in the community, which is a local initiative, and public health policy development, which focuses on statewide issues.

Derek Rice, a writer based in Saco, can be reached at editorial@mainebiz.biz.