Kentucky hospitals are grappling with an ongoing shortage of healthcare workers, particularly nurses, and the deficit continues to grow each year. According to a workforce survey conducted by the Kentucky Hospital Association (KHA) last year, the state’s hospitals faced a shortage of 5,400 registered nurses and licensed practical nurses, with the most significant shortfalls observed in medical-surgical units.
“The bottom line for hospitals is that our costs are skyrocketing, healthcare workers are retiring in large numbers, and not enough people are entering health professions to meet the growing need,” said KHA president Nancy Galvagni in comments to the state legislature’s Interim Health, Welfare & Family Services Committee.
“The crisis has been in the making for a while,” she said. “Burnout from understaffing during the pandemic, staff retiring or quitting at record rates, and staff, like RNs, choosing to leave and travel for more competitive pay.” The last part, regarding the number of travel nurses, is “jaw-dropping,” said Galvagni.
Kentucky hospitals rely on contract nurses traveling to Kentucky from other states, often temporarily, to fill in where they’re needed most. They are paid premium rates, a hospital cost that is unsustainable, says Galvagni.
Earlier this year, the Kentucky Nurses Association (KNA) predicted a potential shortage of 20,000 nurses in the state by 2025. Many nurses are leaving the profession due to exhaustion and demoralization caused by the COVID-19 pandemic.
In 2021, the KNA conducted a statewide survey of 850 nurses, revealing their concerns and suggestions for addressing the nursing shortage. Nurses emphasized the importance of nonfinancial factors such as adequate work breaks, involvement in decision-making related to nursing and patient care, improved communication with management, and measures to reduce abuse from patients or their families.
The survey also highlighted financial solutions, including increased staffing to reduce heavy patient assignments, higher pay, additional nonclinical staff to handle nonessential tasks, and financial incentives such as student loan forgiveness.
In late 2021, Governor Andy Beshear declared the nursing shortage a state of emergency. He said the crisis could have long-term repercussions for patients and the entire healthcare delivery system if solutions are not found.
The governor issued an order in early 2022 requiring the nursing board to approve nursing school enrollment increases, requiring schools to report every vacant student seat monthly, and to keep the board informed of needed faculty. The order also allows nursing schools to open new campuses more quickly and facilitates reciprocity with other states.
But enrolling more nursing students is not enough, experts say. Nurse-candidates must also pass the National Council Licensure Exam before they can practice. Not all do.
The KNA recommended various measures to alleviate the nursing shortage, including involving nurses in finding solutions, providing funding for faculty retention and recruitment, rewarding schools for high pass rates and graduation rates, offering student loan forgiveness, creating a nurse emeritus program to attract retired nurses, and providing retention bonuses for local nurses.
Adequate funding, faculty, and resources are key to support Kentucky’s nursing schools in enrolling new students, training them quickly and thoroughly, and getting them into the workforce.
Dee Polito is an advanced practice registered nurse and a full-time faculty member at Frontier Nursing University in its certified nurse-midwifery program.
“In my view, the nursing shortage, especially in Kentucky, is because of a lack of nursing staff and a heavy patient load,” Polito said. “But also, not enough pay. In addition, COVID influenced nurses being overworked.”
Polito says concerns raised in KNA’s survey of Kentucky nurses are valid. She agrees nurses should have an equal voice in discussions with administrators, legislators, and policymakers about the shortage. She also believes nursing schools should be financially rewarded for having high pass rates for the Nursing Board Exam and for high graduation rates.
Frontier Nursing University (FNU), headquartered in Versailles, specializes in distance education programs offered through online coursework. Polito thinks Frontier’s system could be a model for how some nurses receive an advanced education while finding greater workplace satisfaction.
“When I was an RN, I wanted to obtain an advanced degree and become a certified nurse-midwife. But there were no midwifery schools where I lived,” Polito said. “I didn’t want to uproot my family and move to where there was a university. FNU was innovative, even in the early 1990s, by developing a distance learning program so each student could stay in their own communities, do their coursework, and then find a clinical practice site in their area. That is a good system.”