A pharmacy technician passes items to a nurse from within a sterile area at the James Graham Brown Cancer Center on April 2, 2021 in Louisville. (Photo by Jon Cherry/Getty Images)
Fewer students were studying to become nurses in Kentucky last year than in 2019, the last pre-pandemic year.
Enrollment in educational programs that lead to a nursing license declined in 2021 and 2022. But a variety of statewide efforts could help push the numbers back up in the coming years.
Kentucky needs more nursing students in the pipeline to address staff shortages, especially as the state tries to bounce back from the worst of COVID-19. In 2021, nearly 5,000 nurses left their jobs, most of them to retire.
And, a 2022 Kentucky Hospital Association’s workforce report showed more than 13,000 vacancies in the state’s hospitals.
Experts attribute the enrollment drop to several pandemic-related factors. Those include the conflicting images of nursing that emerged and the learning loss experienced by high school students.
During the emergency years of COVID-19, highly-trusted Kentucky nurses became more visible.
This was a good thing, in part. The label of “Healthcare Heroes” presented nurses and other medical professionals as celebrities, making a career in those fields look exciting and rewarding.
But nurses were also shown as worn down, exhausted, burnt out. The people who stood in for family at the end of patients’ lives. The ones who treated infectious patients early in the pandemic with insufficient personal protective equipment.
College preparedness became more of a challenge during the emergency years of the pandemic as well.
In 2018, 8,253 nursing applicants met admission criteria. That jumped to 11,121 in 2019 and 11,676 in 2020, according to data obtained through an open records request.
But in 2021, 8,925 students — a 24% decline from 2020 — met admission requirements, which bumped up to 10,199 in 2022.
Mary DeLetter, interim dean of the University of Louisville School of Nursing, said many nursing applicants completed most or part of their high school education online.
It’s an “unfortunate situation” and not everyone is college-ready at the same level, she said.
The Kentucky Lantern previously reported that there was an increase during the pandemic of youth not proficient in reading and mathematics.
“The rapid shift to online was difficult,” DeLetter said. “I think that’s one of our biggest challenges, is that variability of how students are coming to college right now, (and) whether they are college ready.”
By the numbers
Pre-licensure nursing programs in Kentucky have seen a decline in “traditional” students coming in – traditional meaning a person who has just left high school and is now going to college, Kentucky Board of Nursing Executive Director Kelly Jenkins told the Lantern.
In 2020-21, there were 14,394 students enrolled in pre-licensure programs. That dropped by 971 to 13,423 students for 2021-22. (Graduate-level nursing programs do not submit their numbers to the Board of Nursing, so those numbers are not represented).
Spread across the commonwealth, in undergraduate and advanced nursing programs and across the two to four years it takes to earn an undergraduate nursing degree, Kentucky has 5,257 “empty seats” that could be filled with students who could eventually help ease the shortage.
None of the state’s 101 programs are at risk of being shut down and “most,” Jenkins said, are meeting the benchmarks required by the nursing board.
Nursing schools also have lost faculty.
According to data obtained through an open records request, Kentucky’s pre-licensure nursing programs had 87 full time faculty vacancies last fall.
No one program had more than six vacancies in the fall of 2022. The programs collectively had 38 part-time faculty vacancies last fall, for a total of 125 part- and full-time vacancies across 30 programs.
That’s an increase from the four years prior, data from the nursing board show. In 2018, there were 50 part- and full-time vacancies.
The total jumped to 79 in 2019 and dropped again to 73 in 2020. In 2021, there were 77 full and part time vacancies.
The University of Kentucky School of Nursing did not make their dean available for this story. A spokesperson said there were no faculty shortages last year, which data confirms.
Financial challenges – and COVID-19
A bill that became law during the 2023 legislative session could help funnel more workers into health care fields.
House Bill 200, which received bipartisan support from legislators, will create a health care workforce fund with private-public partnership administered by the Council on Postsecondary Education.
DeLetter, of UofL, said that the bill should help programs around the state bounce back from any COVID-19 -induced delays.
“Any time we can help students pay for part of their schooling, it is a huge benefit to the student,” she said. “They can focus and they can be more successful when they are less distracted by the need to to work, or to work extensive hours.”
But, financial challenges continue – and HB200 doesn’t have state funding yet.
DeLetter said in addition to how expensive higher education is, nursing programs have more expenses that other programs don’t: stethoscopes, uniforms, liability insurance.
Those items may fall under “fees” and not “tuition,” meaning specifically-designated dollars don’t cover them.
“So,” she said, “those become the burden of the student.”
The image of nurses as heroes during the emergency phase of the pandemic was both inspiring and daunting for students, DeLetter said.
But being a hero can’t happen overnight, she said. You need to have both hard and soft skills necessary to save a life – and comfort the patient.
“One can be a hero when one is prepared,” DeLetter said. “I can teach everyone physiology ’till the cows come home. But if they can’t interact with patients in a positive way, you know, they won’t be trusted.”
In her more than 40-year career, DeLetter said, “I’ve worked in two states and several cities, and we’ve cycled through shortages.”
But: “Never have I seen anything like COVID in my lifetime.”
And: “I never have worked as hard as I worked during COVID.”
Every day was a new challenge. The federal and state governments changed guidelines back-to-back as infectious disease experts learned more about the virus.
Shifting alongside those institutions, hospitals and other clinical settings had to adjust how they let students come in and train. The pipeline could not halt.
“I think what made it daunting for people was to see how incredibly hard nurses were working,” she said. “And some people did not want that for a lifestyle. And, you know, who’s to blame them? I mean, it was hard.”
Her job, then, was to show students the reality of the world, prepare them for it as best she could, and get them out the door and into the workforce as fast as possible.
COVID-19 caused temporary restrictions on clinical availability, causing programs to give their students that experience in creative ways.
“We were able to manage all of our clinical with simulation options,” DeLetter said. “It was very hectic and it was a great deal of work on our part. But we were very committed to graduating those students and giving them the best possible experiences that we could given the worldwide situation.”
“We did not want to send people out into the workforce who were woefully underprepared and thought they were going to be a hero only to be daunted by the reality of the world,” she said. “So we worked really hard to make them ready for what was out there.”
‘A rewarding career.’
The Board of Nursing is focused on the nursing education pipeline, Jenkins said. It’s working with partners who can talk to students early about why they should go into nursing.
The board is partnering with organizations like the Kentucky Hospital Association and long term care organizations to help address shortages.
“We understand … that they’re suffering from shortages and so we’re trying to work with them on creating new avenues” to address those, Jenkins said.
The Chamber of Commerce Foundation and the hospital association, Jenkins said, plan to get “talent pipeline managers” spread out across the state.
These people will go into high schools; they’ll meet with students and other folks and talk to them about the benefits of pursuing a health care career.
Despite the pandemic and its challenges, nursing faculty say the career is a rewarding one.
That’s because COVID-19 helped create newfound appreciation for nurses, Lyons said. It also bolstered benefits, working conditions, helped improve patient ratios, flexibility and more.
And, nurses are in high demand, so “it’s very easy to find your perfect job,” she said.
The best nurses are people who have resilience, flexibility and a caring attitude, she said. Patients remember the tenderness a nurse provides during a hospital stay.
Those qualities help make them the most trusted professionals in the country.
“We can teach the academics, we can teach the skills and we can provide the knowledge. But those innate abilities like … resilience and caring, we can’t teach those,” Lyons said. “And so it helps if people come in with those characteristics already.”
When Jenkins goes home to Union County, people still remember the care she gave their loved ones as a working nurse.
“I always run into somebody who says, ‘I remember when you took care of my grandma.’ Or: ‘I remember when you took care of my husband,’” she said. “It’s a very rewarding career.”
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