Austin Clark got hooked on nursing while working as a certified nursing assistant at a nursing home in his hometown of Blair, where he cared for several Alzheimer’s patients.

“Working with them, being able to be that person who could bring that calm, meant a lot to me,” he said.

But Clark, 22, also knows the opportunities nursing offers. His goal, after graduating from the University of Nebraska Medical Center’s College of Nursing in May 2018, is to continue his studies and become a nurse anesthetist.

“I can go anywhere in the world to work as a nurse,” he said. “It’s just such a broad field.”

That’s one lure nursing school administrators hope will continue to draw new nurses into the field. After a slight reprieve during the Great Recession, Nebraska and Iowa, like the rest of the nation, are back to a chronic shortage of nurses — registered nurses in particular.

“We see severe need throughout Nebraska for registered nurses,” said Juliann Sebastian, dean of UNMC’s nursing college and chairwoman of the American Association of Colleges of Nursing’s board of directors.

During the economic downturn, older nurses delayed retirement and some part-time nurses added hours, Sebastian said. Now those older nurses are poised to begin retiring. At the same time, demand for health care — and nurses’ services — is increasing with expanded coverage under the Affordable Care Act.

Efforts to reduce costly hospitalizations also have shifted more care into community and home settings. That’s increased the need for nurses there and left sicker patients in hospitals, where they may need more intense oversight.

Local hospital expansions also are adding to the current and future demand. Among them: the new Fred & Pamela Buffett Cancer Center set to open this spring, new Nebraska Medicine outpatient centers at Village Pointe and 41st and Leavenworth Streets, Creighton University Medical Center’s upcoming relocation to an expanded Bergan Mercy Medical Center location, the newly opened Madonna Rehabilitation Hospital in Omaha and the new hospital tower planned for Children’s Hospital & Medical Center.

Nationally, the U.S. Bureau of Labor projects 1.09 million registered nurse job openings, through both growth and replacements, by 2024. The Nebraska Center for Nursing, which the Nebraska Legislature established in 2000 specifically to address nursing supply and demand, projects a shortage of nearly 4,000 nurses by 2020, based on a 2006 study, the latest available.

However, Sebastian noted that it’s easier to predict supply than demand, and there’s no end in sight. No matter what happens with the Affordable Care Act, which the Republican-led Congress and President Donald Trump have vowed to repeal and replace, changes in the health care system already are off and running, she said, with a focus on increasing efficiency, reducing costs and bolstering quality and safety. Part of that effort includes a growing focus on deploying health care professionals in communities to help people get healthy and stay healthy.

Catherine Todero, dean of Creighton University’s College of Nursing, said cycles in supply and demand are not new in the nursing field. While nursing generally is considered recession-proof, the last downturn was so deep in some parts of the country that it did have an impact on nursing jobs. Graduates in some places had trouble finding jobs. Now the tide has turned again.

“We’re starting to see the numbers tick back up again,” she said. “The word is out: Nurses are getting jobs, they’re getting good jobs, they’re being recruited.”

Aubray Orduña, dean of nursing at Clarkson College, said the school’s graduates typically have “quite a few” job opportunities.

The Nebraska Hospital Association’s 2016 workforce report noted a 10.6 percent vacancy rate for registered nurses at hospitals statewide in 2015, an uptick from 5 percent or less the preceding six years.

Sebastian said the shortage is particularly hard on rural areas. Of Nebraska’s 93 counties, 71 have fewer than the national average of 9.2 registered nurses for each 1,000 people.

In the Omaha metropolitan area, registered nurse openings vary by organization. Nebraska Medicine had 300 openings for registered nurses in mid-December and CHI Health approximately 250, while Methodist Health System reported 60 nursing openings.

Kathy Bressler, senior vice president and chief nursing officer for CHI Health, said the 15-hospital system has had high retention in its rural hospitals, contrary to the difficulty some rural hospitals face.

Where the shortage hits the system hardest, she said, is in specialty areas such as critical care and the operating room that require more training than nurses typically have straight out of school.

CHI’s goal is to avoid using traveling nurses from outside nursing services, which tend to be more costly. The hospitals instead provide incentives to fill holes in schedules from within, she said. CHI also has created an internal pool of staff members who agree to go to different locations each day, similar to the substitute teacher pools created by some school districts. Last week the system expanded the pool to cover hospitals as far west as Kearney.

Such efforts, however, don’t appear to have slowed demand at Fusion Medical Staffing in Omaha. While the bulk of the company’s placements are in Nebraska and Iowa, it fills openings in all 50 states.

“There’s a huge demand no matter where you go,” said Meghan Patton, nursing recruiter team lead. Established in 2009, the company has grown about 300 percent in the past two years, she said.

The company connects nurses — many of them younger nurses a few years out of school and empty nesters interested in travel — with hospitals and a few long-term-care facilities under short-term contracts. Though the nurses are provided at a premium, the hospitals don’t have to pay benefits, Patton said. And the company makes sure the nurses are ready to go right to work without a lengthy orientation.

To help fill positions, most large hospitals and health systems in the area are offering referral bonuses for current employees who successfully recruit nurses who meet their criteria. Some also extend sign-on bonuses to new nurse hires. Children’s Hospital & Medical Center last year started paying up to $3,000 to employees who make referrals for most nursing positions; Bryan Medical Center in Lincoln, Nebraska Medicine and Madonna Rehabilitation Hospitals also offer referral bonuses. Methodist and CHI offer both types of bonuses, with CHI paying a $5,000 sign-on bonus over two years.

Several organizations have extended sign-on bonuses just for hard-to-fill positions. At Madonna, it’s the night shift. Children’s has used them for specialties such as pediatric and neonatal intensive care and home care.

“It’s definitely a tough market right now for getting RN’s,” said Jennifer Howard, director of nurse staffing and development for Madonna Rehabilitation Hospitals. “And it’s only going to get tougher.”

Because of its growth, the market is more competitive in Omaha than in Lincoln, said Howard, who recruits in both. The shortage, however, hasn’t slowed Madonna’s efforts to scale up operations at its Omaha facility, which opened in October.

Though pay for nurses varies with experience, degrees earned and shifts worked, wages generally are good, said 
UNMC’s Sebastian. They’re similar across Nebraska and equivalent across the country, when adjusted for cost of living.

According to the U.S. Bureau of Labor Statistics, the mean wage for registered nurses in May 2015 was almost $59,000 in Nebraska and $55,000 in Iowa, compared with median pay of $67,490 nationally.

Hospital officials also have focused on keeping nurses once they’re hired. Many local organizations now offer nurse residency programs to support new graduates and nurses switching to new areas.

New graduates, no matter how well prepared, don’t come out of nursing school 100 percent ready to practice independently, said CHI’s Bressler. “This helps them transition from a student role to a professional role,” she said.

Suzanne Nocita, Children’s director of recruitment, workforce planning and employee health, said many nursing schools don’t focus specifically on pediatric care.

Recent graduates participate in a two-year residency program, beginning with a structured seven-week rotation that ends with a “match day.” During the two-year program they also complete an evidence-based project.

The hospital has adopted many of the ideas it has developed, and some have been accepted for presentation at national conferences. Children’s also has a transition program to help experienced nurses coming from the adult world make the switch to pediatrics.

Most hospitals also offer professional development programs, including tuition reimbursement or scholarships for those who want to return to school.

And the field does have built-in appeal.

UNMC nursing student Renee Gernandt, 41, decided to change careers after 10 years as a corporate accountant. She’d eventually like to work in the neonatal intensive care unit. “I would find it very rewarding to know I had helped a baby get to his first birthday,” she said.

To help meet demand, nursing schools have significantly expanded their programs in recent years. The number of registered nurse graduates, according to a state report, increased about 40 percent, from 832 in 2002 to 1,167 in 2014, the most recent year for which figures were available.

The UNMC College of Nursing, which has five locations statewide, started a division in Norfolk in 2010 and has expanded its Kearney operations. Work began in December on a new building for the Lincoln division.

UNMC’s Sebastian said schools also are working to address faculty shortages — one factor limiting further expansion — and help develop new care delivery methods such as telehealth systems that could help ease the crunch.

Todero, the Creighton dean, said the college has increased enrollment about 10 percent since she arrived a year and a half ago. Creighton also has boosted recruitment at its Hastings campus. Recently the college partnered with Hastings College to offer a dual degree program through which students can graduate in four years with two degrees, including a Bachelor of Nursing from Creighton.

The university also has received approval to set up a nursing program in Phoenix next January, part of an expansion of its ongoing affiliation with Dignity Health St. Joseph’s Hospital and Medical Center.

Nebraska Methodist College has seen a 25 percent increase in interest in nursing over the past several years, said Linda Hughes, dean of nursing. The college added a clinical group this spring just to meet the demand.

Clarkson College, which doesn’t have room to expand, is taking a number of steps to help more students get through to graduation and prepare them to stay in nursing, Orduña said. While the field is rewarding, burnout is a factor.

Clark, the UNMC student, hasn’t found anything he hasn’t liked so far.

“To be honest, it’s the variety I enjoy the most,” he said. “I was genuinely surprised at the diversity and the tasks that you do every day.”

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Julie Anderson is a medical reporter for The World-Herald. She covers health care and health care trends and developments, including hospitals, research and treatments. Follow her on Twitter @JulieAnderson41. Phone: 402-444-1066.

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