It’s not difficult to spot evidence of a booming health-care industry in Central Kentucky. Gleaming new hospital towers, advanced diagnostic centers, long-term care facilities and clinics offering expanded services have proliferated across the landscape.
In recent years, local hospitals and health-care facilities have experienced rapid, large-scale expansion as Lexington has grown into a regional hub for medical services. At the same time, an aging baby boomer population has increased the overall demand for health care, across the state and the nation, and finding the workers needed to care for those patients is becoming an increasingly difficult challenge.
The U.S. Bureau of Labor Statistics projects that the number of jobs for registered nurses,
in particular, will increase 19.4 percent between 2012 and 2022, adding 526,800 new positions. The bureau projects there will be more than 1 million job openings for registered nurses nationwide during that time, due to both growth and replacement needs.
In Kentucky, the number of available jobs for registered nurses is expected to jump by an even larger 35.6 percent between 2014 and 2024, according to the Kentucky Education and Workforce Development Cabinet. That would add 16,047 such jobs across the Commonwealth.
“It is getting increasingly difficult to fill positions, because there are certain job occupations where we are feeling a shortage,” said Tiffany Hibbs, director of talent acquisition at KentuckyOne Health.
The need for registered nurses is the strongest, Hibbs said, but the high demand for health-care workers extends to many additional positions, including laboratory technologists, imaging and diagnostic professionals, physical therapists, and mental and behavioral health-care workers.
Health-care support occupations, which include nursing aides, medical assistants and home health aides, are projected to be the fastest-growing occupational group in Kentucky over the next decade, with a 38.2 percent employment increase expected between 2014 and 2024. The projected growth rate for employment of health-care practitioners and technical occupations over the same period is not far behind, at 29.6 percent.
Kentucky's High-Demand Health-Care Occupations
Employment numbers in some high-demand health-care occupations in Kentucky are projected to rise by more than 20 percent – and in some cases, more than 40 percent – by 2024.
The shortage of health-care workers is becoming increasingly critical for the state’s long-term care facilities, said Betsy Johnson, president of the Kentucky Association of Health Care Facilities (KAHCF), which represents most of the long-term care facilities in the state.
“We have more and more people [from our member organizations] telling us they are in a crisis situation and they have never been so low on staff,” Johnson said.
Within the market, long-term care providers also have the disadvantage of being more reliant on government funding, which can lag behind the rising costs of patient care and limit the wages and benefits that employers can offer, Johnson said. The result is high turnover. According to a member survey conducted by the KAHCF in June, more than two-thirds of licensed staff members at the state’s long-term care facilities were staying in their jobs for two years or less.
The KAHCF has been working to increase awareness of the growing problem and seeking help from government leaders, but so far the industry has yet to remedy the growing shortfall.
“The baby boomers are aging, and the need for long-term care services is only going to increase,” Johnson said. “It’s incumbent upon us to be proactive.”
An Aging Population — and an Aging Workforce
In 2010, roughly 18.8 percent of Kentuckians, or 829,193 people, were age 60 or older, and that number is expected to rise to 25.6 percent of the state’s total population by 2030. In addition, roughly one-third of Kentucky’s seniors ages 65 to 74, and more than half of those 75 or older, have some form of disability. These statistics translate into a rising need for medical care and support services for an increasingly older and sicker Kentucky population.
But even seniors without disabilities or serious medical conditions are engaging in more preventative and wellness care, said Karen Hill, chief operating officer and chief nursing officer at Baptist Health Lexington. They also want to be more involved with their care and lead more active lifestyles.
And as the general population ages, the country’s experienced nurses have been aging and moving into retirement as well. Local hospitals report an increase in the number of retiring nurses, particularly since the economic recovery. The loss of experienced health-care workers is being sharply felt at a time when hospitals are working assiduously to increase the size of their workforces.
“At Baptist Health, as long-term and tenured as my staff are, I have some staff who are moving to more part-time hours so they can have flexible schedules, which we accommodate, or deciding to go ahead and retire,” Hill said.
KentuckyOne Health is also launching programs aimed at enticing more retired workers back into the health-care workforce by restructuring work hours and offering more flexible shifts that can better fit their needs, Hibbs said.
At the same time, finding qualified candidates for nursing faculty positions has also become increasingly difficult, said Kim Williams, director of nursing and allied health for the Kentucky Community and Technical College System (KCTCS). A relatively small percentage of nurses are trained at the master’s and doctorate level, she said, which is preferred for faculty positions. And with nursing talent in increasingly short supply, well-trained nurses will earn more lucrative compensation by practicing in a hospital rather than teaching in a classroom.
“We need faculty who are excited about teaching the profession and moving education forward, and they are becoming near impossible to find,” Williams said.
To fill the need for more teachers, Hibbs said, many schools are turning to hospitals and placing working nurses as adjunct professors and instructors.
“The colleges are needing to rely more and more on employers to provide skilled leaders and teachers to help them close the gaps,” Hibbs said.
Educating More Workers
While health-care education programs across the country have been working to increase enroll- ment to help fill the rising demand, the capacity at most schools is limited by the availability of both faculty to teach the classes and clinical sites that can accommodate students.
Nationally, about 80,000 qualified applicants are turned away for a Bachelor’s of Science in Nursing (BSN) education annually, said Janie Heath, dean of the University of Kentucky College of Nursing.
In 2007, UK doubled its enrollment of nursing students from 80 to 160. Last year, because of the increased need for nurses, the school boosted its enrollment by another 25 percent, to 200 students per year, Heath said.
“It’s very competitive to get into not only our nursing program but really into many programs throughout the state and throughout the country,” Heath said. “Every year, we have about 350 students who apply to matriculate into our BSN program with only 200 slots available.”
UK has taken additional steps in recent years to open new avenues of study for those interested in pursuing a nursing degree, said Patricia Burkhart, associate dean of undergraduate faculty affairs. The College of Nursing moved its RN-BSN program completely online, to better serve those students who have already earned an associate degree in nursing. The school now offers a second-career track for students who earned their bachelor’s degrees in other areas
of study and have returned to pursue a nursing career. UK also has added a program for military veterans who served as medics and would like to gain nursing certification.
“We’ve tried to meet the demands of a diverse population of students,” Burkhart said.
KCTCS also has been working to get out in front of Kentucky’s expanding health-care workforce needs for many years, Williams said.
The shortage of registered nurses garners a lot of attention because of the sheer numbers involved, Williams said, but the need for specially trained health-care workers is widening, along with the industry’s increasingly sophisticated technology.
Kentucky’s community colleges have geared their programs in many ways to fit the immediate needs of their local health care systems for more highly trained candidates, often in jobs that previously might not have required additional education, Williams said. Training programs for pharmacy techs, surgical techs and dental hygienists, for example, have been developed at BCTC and other community colleges across the state to address the need for a more highly trained pool of candidates to fill those high-demand positions.
While the entire industry has been affected by the shortage of workers, other parts of the state have been hit even harder than Central Kentucky, Williams said.
“When we look at our numbers, it’s not that they are poor, but they are always concentrated in more urban areas,” Williams said. “The shortage is not as severe in Lexington as it is in eastern or western Kentucky.”
But across the board, Williams said, Kentucky’s students need to be engaged earlier in their educations to make sure they are prepared to fill the health-care jobs of the future.
Encouraging secondary students to develop strong educational foundations in science and math is key, Williams said — especially in Kentucky. Educators and health-care organizations also need to inform tomorrow’s workforce of the many diverse facets of health care that can be pursued as potential careers.
“The most difficult thing is to keep the pipeline going,” Williams said.
Retain and Keep Training
While recruiting and retainment have been challenging, local hospitals have managed to keep their turnover rates in Lexington below the national averages overall.
In part, that reflects the high caliber of health-care services in the area and the attractiveness of Lexington as a regional workplace. But it also is a result of employers here providing opportunities for further education and advancement, administrators said.
Many hospitals have resorted to short-term fixes such as sign-on bonuses in recent years to fill their most pressing needs, but all agree that such recruiting enticements won’t solve personnel shortages in the long-term.
“The sign-on bonuses don’t really work,” said Kathy Isaacs, director of nursing professional development for UK HealthCare. “With sign-on bonuses, [ job candidates] come for the money, and is that really the person you want to hire? And they don’t stay.”
A strong benefits package, along with the complex and challenging opportunities that come with working at a regional referral center, have been stronger recruitment tools for long-term retention at UK HealthCare, Isaacs said.
Hibbs said KentuckyOne’s recruitment strategy focuses first on the staff they already have.
“People want to grow and acquire new skills,” Hibbs said. “They like variety in their work, and so we have found that investing in our current workforce is working for us. Just in the last several years, we’ve invested nearly $15 million in raises and market adjustments for our key clinical health-care worker roles to keep them happy and to invest in state-of-the- art training programs and career advancement structures.”
Larger networks have the advantage of offering employees multiple opportunities for career growth, across a wide range of health-care specialties and geographic regions, while still staying with the same organization, Hibbs said. KentuckyOne recruits in multiple states for its entire network, including Kentucky, Tennessee, Indiana, Ohio, Georgia and Missouri.
The development of a culture that recognizes and rewards its nurses has been a valuable element of Baptist Health Lexington’s recruitment and retention plans, Hill said. In 2015, the hospital attained Magnet recognition for nursing excellence from the American Nurses Cre- dentialing Center for the third time, an achievement attained by fewer than 140 hospitals in the world, Hill said, and it is a direct reflection of the effort to make sure nurses see that their work is valued and appreciated.
Investments in tuition reimbursement also add benefits beyond improved retention rates for hospitals, by bringing more engaged and knowledgeable employees back to the workplace, Hill said.
“If you can invest in your employees who are already good with the culture and they already understand the role expectations, then they are great employees when they graduate,” Hill said.
The Changing Role of Nursing
While the demand for nurses has increased, the job itself also has been transformed in the current health-care environment. From hospitals to clinics to community education, nurses have more variety in their work environments. They have more opportunities to concentrate on specialized care, and their responsibilities are also expanding to encompass everything from community education to patient counseling.
“We are at a different time in nursing,” said Isaacs. “Nurses don’t stay at the bedside in the unit that they were hired in for 20 years like we used to. They come now very goal- and profession-driven. They will stay for two or three years while they are back at school working on an advanced degree, and then they will leave the bedside and insert themselves at a different level in the profession.”
That’s a good thing for the industry as a whole, Isaacs added.
“When you are going to hire people who can handle a complex environment of care, they are high achievers. And we want to support them in that,” Isaacs said. “There are people at the national level who find this concerning, because it is costly to facilities to have this type of movement in our system, but to me, it’s worth it. When they are with us, they are engaged and they want to learn.”
To prepare nurses for today’s complex care environment, more health-care providers are pushing for them to be educated at the baccalaureate level, Heath said. Currently in Kentucky, roughly 60 percent of nurses have earned their bachelor’s degree or higher, but the goal is to raise that to 80 percent or more, for both Kentucky and the nation as a whole, by 2020.
Heath sees a paradigm shift taking place in health care today, as the industry looks toward more preventative initiatives to maintain wellness. As an academic health center, UK HealthCare has seen tremendous growth in the advanced care required by its patient population. In response, the hospital has concentrated attention on high-end treatment modalities and complex and specialized care, Heath said.
“But we know that the need for community-based care is signicant,” she added. “We have so many health issues in Kentucky. The reason we have such high acuity coming into UK Health- Care is because we really haven’t done what we need to do on the prevention side.”
Under this new model, nurses need to be better prepared to contribute at higher capacities in preventive and coordinated care, Heath said.
UK’s School of Nursing is also working to incorporate students into real work environments during their education, so they can hit the ground running upon graduation. After completing their junior year, UK nursing students can participate in the school’s Student Nurse Academic Practicum, or SNAP, which pairs each student with a professional nurse in the workplace for 10 weeks during the summer. In addition, senior-year capstone projects assign students to a 40-hour week in their chosen health-care environment for even more on-the-job training prior to entering the workforce.
Looking Ahead
Although health care will continue to grow, Burkhart said she does expect to see the current shortage level out locally in the coming years, as the market adjusts to absorb its multiple recent hospital expansions. Administrators for local hospitals agree.
“I think we will continue in this shortage for the next four to six years, and after that, we will see some relief,” KentuckyOne’s Hibbs said. “I am encouraged by all of the legislation and the advocacy that we are seeing in our high schools and our colleges to help the students, and the programs to fast-track the education and the certications that are needed to more closely serve employers’ needs.”
Health care contributes substantially to the local economy, Hill pointed out, and the community shouldn’t underestimate the value of its growing health-care workforce.
“Health care is a really big deal to this community, and it is only going to continue to grow,” Hill said. “About 60 percent of the patients at Baptist Health come from outside Fayette County, and we appreciate that our employees are contributing to the tax base and we have the support of the local and regional communities.”
The changing health-care environment and the added emphasis on health-care education and preventative care will require health-care workers to extend their services even more into the community and find new ways to engage and empower consumers in the future, Hill said. That also will mean higher demand and more opportunities for those who choose to enter the field at every level.
“If a young person is looking for a job where there’s fulfillment, great benefits, opportunities for a career really across the world,” Hill added, “they ought to consider something in health care.”