In recognition of a shortage of healthcare workers in North Dakota, shortly after being sworn into office, Governor Doug Burgum convened a taskforce comprised of a diverse group of stakeholders to examine the issue, identify causes, possible solutions, and to make recommendations to address this critical shortage. With the support of the Governor’s office, the taskforce (or sub-committees thereof) is in the process of developing detailed recommendations, plans and timelines to achieve measurable outcomes to address North Dakota’s nursing shortage, liaising with the Workforce Development Council and Main Street Initiative team.
Theme 1: Entry into Nursing Programs
While interest in nursing programs in North Dakota is strong, other barriers to entry to North Dakota nursing programs require resolution to maximize nursing program capacity. This understanding will be critical to ensure that available seats are maximized. Strategies include:
- Develop and implement a standard nursing program application and coordinated application review/acceptance system (including application deadlines). Verify that there is a consistent pre-nursing curriculum across all programs and standardize pre-nursing curriculums.
- Finalize career pathway map (including CNAs) and develop distribution strategy for maximal impact.
- Study impact of prioritized acceptance of ND high school students into North Dakota nursing programs, including success and retention rates, student loans, etc.
- Study the impact of health science CTE classes on students entering nursing programs in ND
- Study attrition and graduation rates for nursing programs to determine whether our existing capacity is optimized.
Theme 2: Expanding Program Capacity, Focusing in Rural Areas
In 2015-16 there were 305 LPN seats, 663 RN seats, and 101 APRN seats across the fifteen ND programs (1069 seats total). Current projections indicate a shortage of nurses (LPN’s, RN’s, and APRN’s) that will continue for the next ten years due to many factors, including aging nurses, the aging population in general, and the increase in chronic disease that accompanies an aging population. Current estimates suggest the need for net new additions of more than 370 nurses per year for the next ten years (3,700 in ten years). This shortage is particularly acute in North Dakota’s most rural areas. Strategies include:
- Explore the impact and lost revenue to ND education programs of out-of-state utilization of ND clinical sites.
- Promote development of remote nursing education programs sites to address rural needs, including a comprehensive study to determine which programs possess this capability; cost; facility needs/benefits; framework for connecting programs with partners; etc.
- Promote development of additional rural clinical sites, including housing and community inclusion programs.
- Promote development of financing opportunities, tax incentives, loan re-payment programs (FACULTY).
- Develop a best practice model for a “dual role” practitioner/faculty member and pilot. Refine and implement “dual role” model.
Theme 3: Develop strategies to retain North Dakota nursing program graduates and practicing nurses.
In the past six years, more RN’s have transferred into the state than were produced through ND nursing programs – a positive trend that would be beneficial to continue. Further, data shows that ND-educated nurses tend to stay in North Dakota post-graduation for a time, but data also indicates an increase in the likelihood for a nurse to leave the state 2+ years after graduation, and that at 5-7 years post-graduation, the average retention rate is 48.68%. (Less than half of RN graduates that graduated in 2010-2012 are still employed in ND.) Finally, survey feedback indicates the need to improve workplace cultures to create a more engaging and safe working environment for nurses, for greater longevity and continuity. Strategies include:
- Address salary disparity through creating a mechanism to assist healthcare organizations in evaluating the return-on-investment that could be achieved when replacing the cost of traveling nurses with pay increases for local, permanent staff.
- Develop a chart or map to compare the clinical practice hours and required contract hours of ND in comparison with other states. Include obtaining, maintaining and reactivating a nursing license.
- Promote development tax incentives for employer/employee, and student loan repayment programs contingent upon ND retention for period of time.
- Develop a framework for organizations to assess and improve workplace culture, accompanied by a designation acknowledging the attainment of a best-practice nursing culture.
- Study the reason for post-graduation nurse exits to determine reasons for nurses departing the STATE (after graduation).
- Study the reason practicing nurses are leaving the WORKPLACE, including reason for leaving the employer (salaries, preceptors, mentors, orientation, nurse residency, flexibility, work-life balance, incivility, safety, travel, etc.). Develop strategies to address issues identified in the study. (NCSBN Research Study)
- Study populations with barriers to employment such as New Americans, Native Americans to determine if there are opportunities to engage them more in the nursing profession.
- Study barriers to success of tribal programs, including federal grants, nursing programs (faculty salary, retirements), etc.
Theme 4: Develop strategy for in-migration of qualified nurses.
Even if nursing program capacity is increased and retention strategies are effective, there will still be a need to recruit qualified nurses to North Dakota to address the nursing shortage. The taskforce understands that the need to recruit talented professionals from out-of-state to address the workforce shortage is not unique to North Dakota, thus recommends a unified in-migration action plan that differentiates North Dakota from other states with regards to qualify of life, and the nursing profession specifically.
For questions or more information contact Michelle Kommer, Labor Commissioner/Executive Director of Job Service ND at firstname.lastname@example.org, or Patricia Moulton, Executive Director, ND Center for Nursing at email@example.com