Under the strain of a workforce shortage dramatically worsened by the waxing-and-waning COVID-19 pandemic, the patients many new nurses will need to care for first may be themselves.
“They will have to be resilient,” said Dr. Yolanda VanRiel, chair of the nursing department at N.C. Central University in Durham. “And they are. This class that’s graduating in May 2022, they came into nursing during the pandemic.
“COVID is what they know. They understand what they’re getting into.”
What they’re getting into is a health care system that was looking at a growing shortage of nurses even before COVID-19 burdened hospitals with more and sicker patients. The longer hours and emotional challenges of the pandemic have discouraged some people from applying to nursing school and have prompted some long-serving nurses to take early retirement, making potential shortages even worse.
Erin Fraher, deputy director of the Cecil G. Sheps Center for Health Services Research at UNC-Chapel Hill, has studied North Carolina’s health care workforce for more than two decades. Using census demographics, licensing data from the state Board of Nursing and hospital discharge records, researchers in 2018 predicted that by 2033, North Carolina would be short about 12,500 nurses.
In a new model to be released on Nov. 1, Fraher said, the prediction has been recalculated to reflect expected early exits from nursing that could push the shortage to at least 21,000 nurses.
“We know there are people who probably feel like they have lived through about five years over the past 18 months,” Fraher said. “I think there will be people who say, ‘I have had enough. I’m tired.’”
Also, Fraher said, nurses tend to respond to economic trends, leaving the field when they can afford to and re-entering when they need more income.
NC’s nursing shortage
Though North Carolina has 128 public and private nursing schools, aging and steady growth of the state’s population has forced it to bring about half the nurses needed each year from other states, Fraher said. Now, because of the pandemic, other states are facing shortages as well, meaning there’s greater competition for the same workforce.
A report from the N.C. Board of Nursing in March showed enrollment in nursing programs across the state dropped after the pandemic hit, from 10,675 students in fall 2019 to 7,633 in fall 2020. The losses came in associate and bachelor of nursing degree programs; those for licensed practical nurses saw a slight uptick in enrollment over 2019.
Enrollment numbers for the current academic year aren’t available yet.
Even if nursing school enrollment bounces back, schools are limited in how many more students they can take, administrators say, because there aren’t enough qualified nursing instructors to teach them nor space in health care systems for them to get the hours of hands-on clinical experience required to graduate. Many hospitals converted space into COVID-19 wards, and nursing students typically can’t do clinical training in those units, in part because of the costly protective gear required.
To make up for that, nursing programs such as the one at Wake Technical Community College do simulation training with lifelike mannequins so students know how to work with COVID-19 patients.
Nursing schools have taken other steps to keep their students on track since the start of the pandemic, such as pivoting quickly to online courses and then getting students quickly back on campus in protective gear so they could complete labs and other coursework.
Dr. Ann Marie Milner, head of the nursing department at Wake Tech, said she has heard from graduates who went straight to work rather than toward advanced degrees that their employers are offering “self-care” training to fight burnout.
“With COVID, patients are really sick, and it’s the same day in and day out. You don’t see that happy go-home moment, when they’re being discharged to go home and see their families,” Milner said. “It’s a tough situation when all they see is death and dying all the time.”
At N.C. Central, VanRiel said, after the pandemic hit, a faculty member specializing in mental health developed a webinar for students, who then built a peer mentoring and support group that works to keep everyone connected.
“I’m very proud of them for this,” VanRiel said. “With COVID, you were able to see the mental health issues, not only for students but for everyone. They realized, ‘Hey, we need to do something. Our students have issues they’re not always sharing.’”
From student to nurse
Bucking the trend of other nursing schools in the state, NCCU has seen an increase in enrollment in its traditional bachelor of nursing program. It has held steady on enrollment in its accelerated program, which allows students who already have a four-year degree to get a bachelor’s in nursing in 14 to 15 months.
It hasn’t been easy, VanRiel said. Many of her students are working to pay for school, and when the pandemic hit, businesses cut hours and students lost income. Some are struggling financially, she said.
A few already have jobs lined up for when they graduate next year, and she expects that all of those who don’t want to go on to advanced degrees will find work.
“The students are ready,” VanRiel said. “They’re ready to go now if we would let them.”
Most will work in North Carolina; more than 90% of those who graduate from nursing programs in the state go on to work here.
It’s not unusual for nursing graduates to get signing bonuses and shift preferences. But the money and the job security are only part of the allure.
“They want to do good,” said Milner of Wake Tech. “They want to help people.”
Tips on self-care for nurses
Nursing educators say self-care is a critical skill for nurses of all levels of experience, especially during the pandemic.
The N.C. Nurses Association has a collection of online videos offering free advice to nurses on managing stress, building resiliency and preventing suicide. In April, the Journal of American Medicine Psychiatry published the results of a study that said in the years before the pandemic, female nurses were twice as likely to commit suicide as women in the general population. Researchers were concerned the stress of the pandemic could worsen the problem, though data is not yet available.
The association also operates the Hope4Healers Helpline with the N.C. Psychological Foundation, providing mental health support for health care professionals, emergency medical specialists, first responders and other workers and their families. The number for the helpline is 919-226-2002.
They can also get 24/7 support and find crisis resources at the National Suicide Prevention Lifeline at 800-273-8255.
Here are some tips gleaned from sources including myamericannurse.com and Holly Wei, an associate professor at East Carolina University’s college of nursing.
Practice mindfulness meditation. Spending just 20 minutes a day being aware of your surroundings, feelings and thoughts can reduce stress.
Practice deep breathing, inhaling through the nose, holding the breath a few seconds and slowly releasing through the mouth. This can slow the heart rate and help you disengage from negative thoughts.
Exercise. Just 30 minutes a day of moderate exercise can help maintain physical and mental health.
Sleep. Most nurses are said to sleep too little by about 90 minutes a day. Adequate uninterrupted sleep is required for best functioning.
Connect with sources of energy, such as friends and family, spiritual activity, favorite hobbies or time outdoors.
Nurture kindness. Acts of kindness prompt the release of neurochemicals such as dopamine, serotonin and oxytocin, which promote wellbeing. Make yourself happier by brightening the days of others.
Recognize your own uniqueness and value, acknowledging the work you do to save lives and help improve patient health. Make peace with doing what you can for others, knowing it’s not possible to heal every patient.
Practice daily gratitude, acknowledging the good things in your personal and professional life.
At the end of a shift, before leaving the workplace, wash your hands deliberately, “rinsing away” the day and negative feelings it may have brought.
Seek professional help when needed.