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Career education is a vital pipeline to high demand jobs in the workforce. Students from all walks of life benefit from the opportunity to pursue their career education goals and find new employment opportunities. Join Dr. Jason Altmire, President and CEO of Career Education Colleges and Universities (CECU), as he discusses the issues and innovations affecting postsecondary career education. Twice monthly, he and his guests discuss politics, business, and current events impacting education and public policy.
(upbeat music)
- Hello, and welcome to another edition
of "Career Education Report."
I'm Jason Altmire, and
today, we're gonna talk
about the nursing shortage.
We've spent a lot of time focusing
on the workforce shortage across America
in the different professions,
and today, focusing specifically
on the nursing shortage,
which is an acute problem across America,
and our guest today is Patty Knecht.
She is vice president
and chief nursing officer
for Ascend Learning Healthcare.
Patty, thank you for being with us.
- Thank you, Jason, I appreciate it.
- And the reason I had you on
is you are a thought leader in this space,
and we very much appreciate
you joining us for the episode.
You've done a lot of work
on this, you've studied it.
I saw an opinion piece that you wrote
that made some strong recommendations
on what we can do about the shortage.
I wanna, before starting into
the details of the issue,
I just wanna ask about
Ascend Learning Healthcare.
Can you tell us a little
bit about what you do?
- Sure, I would love to.
So at Ascend Learning Healthcare,
I'll start with our motto,
because I think it really
tells a quick story,
is we help to change lives,
and we're committed
to accelerating the learning
pathway for all people
that allow them to move into careers
across healthcare, education,
wellness, and safety.
Essentially, we're a
software-based company,
we're data-driven educational support,
and how we accelerate that learning
is we do it through
educational technology.
We also do it through focused remediation.
We use analytics in order to help
both the individual
learner and the programs,
the schools, the universities,
improve their outcomes,
and thus, create a graduate
that will feel more confident
and their retention will be improved
in that healthcare space.
So our sole purpose is to
really open up those doors wide
to that healthcare education pathway,
and allow students to
have the great success
of being a healthcare provider,
which I have loved over
the last four decades.
- And can you talk about,
as we think about the shortage of nurses,
I think everyone kinda takes for granted
that nurses exist in the
healthcare ecosystem,
you see them wherever
you go in healthcare,
but, you know, globally,
across the healthcare system,
what is the role of nurses?
And I would include within that discussion
the assistants, nursing
assistants, physician assistants.
There's a lot of public policy debate
about what level of education is necessary
to carry out certain tasks
in the nursing profession.
How do you see all of that play out?
- So I think what's important, first,
for the public to know and understand
is that there are various
entry points for nursing
within the healthcare system,
and each one of them is
unique and important.
from that frontline worker,
who is that potential
certified nursing assistant,
could be a medical assistant,
what's their first step
into a health career?
That could occur even while
they're in high school,
depending on the criteria
and the certifications available to them.
They could start that career
in a technical setting,
then, as they take that next step,
it could be a career ladder
that they choose to follow,
or they could decide
right out of high school
that they're gonna enroll
in a university baccalaureate RN program.
That's one choice.
They're essential within both
your acute-care settings,
your outpatient settings,
long-term care, you name it.
When you enter a healthcare setting,
you'll highly likely
interact with a nurse,
and that nurse could be that RN,
or a very important other licensed role
is the licensed practical nurse,
or in some states, called the
licensed vocational nurse.
That's a much shorter program,
often housed in our career
and technical schools,
could be in other educational settings,
and also could be in
our community colleges.
So I think, first, what I
love to help people understand
is that nurses are present
in our healthcare settings
in order to ensure safe, effective
continuity of healthcare.
They're often that pivotal
wheel, cog in the wheel,
that ensures that all of your healthcare
is gonna go smoothly,
whether it's that entry-level person
who's trained at a certificate level,
or your licensed LPN, RN,
or your advanced practice nurse,
who could be your nurse practitioner,
or could be your certified
registered nurse anesthetist,
and then if we go on the
medicine side of the house,
could be your physician assistant.
All of those roles come together
as an interdisciplinary team
to ensure that we, in the
United States, have access
to high-quality care
that's based on evidence.
So in our recent, most
intense times, as Covid hit,
these nurses, you heard them on the news,
you heard about the LPNs
that were in the long-term care settings
and were dealing with
countless hospitalizations
that were causing their elderly
patients to become more ill.
So in many times, in that
particular situation,
that LPN might have tried
to stabilize that patient
in that environment, in that
long-term care facility,
or determined,
in collaboration with
the RN and the physician,
that they needed to move
to a higher level of care
in an acute care setting
or a critical care setting.
So all of these different,
various points of care
involve nurses,
and the nurse's ability to
interact with the patient
is essential to their recovery.
- So with that as background,
we talk about the gap that exists
in the available jobs for nurses
and the people that are able to fill them.
What does the data show?
What exactly is the shortage
of nurses in this country?
What are the numbers?
- Yep, so we have a lot of
different reference points
that we can look at,
but it's estimated that the
United States will have a gap
between 200 and 450,000 nurses
available for direct patient care
by the year 2025.
That's right around the corner.
Why has that happened?
It's happened because the
average age of a nurse
continued to increase over time
from a workforce perspective,
so we ended up having a slightly
aging nursing population.
Thus, these baby boomers are
ready and in retirement mode,
and so we have seen an
exodus of our nurses
from a retirement perspective.
That alone could have
implicated the shortage
and could have really caused some unrest
in our healthcare system,
but what has complicated that is,
particularly after covid,
although there are many pieces of evidence
that will also point to before Covid,
we were starting to have
some workforce impacts
to our nurses,
where the amount of
burnout, extreme stress,
the workplace violence,
was increasing,
and as a result of that,
we know that there's statistics
now that are telling us
that even our 30-and-under
nurse age category
is leaving nursing and moving to other,
maybe other areas that are
still requiring a license,
but are less direct patient care,
but there are some nurses
who are leaving the profession completely,
and that's really the part
that woke up the country
and said, okay, it's not just
all about the retirements,
it's also about the workplace
and our need to ensure
that we are creating a safe workplace
for our nurses to practice
and serve our communities.
(chiming music)
- So as we sit here in 2024,
and you said, and you've written,
that more than 610,000 registered nurses
have the intent to leave
the workforce by 2027,
so we're talking three years from now,
that America, if that is true,
would need to double the number
of new nurses entering
the workforce yearly,
every year, for the next three years,
just to meet that demand,
not incorporating any growth that occurs,
so this is a nationwide problem
that has real implications,
as you have mentioned.
And I know that, for example,
the Department of Health
and Human Services
has recognized it.
They made an investment of $100 million
prioritizing nursing
workforce development.
Do you think that that is enough?
Is there more that can be done?
And how has that $100 million working
to help address the problem?
- So that $100 million is
honestly just a start, Jason.
There are many of my
colleagues who are concerned
that that's only a little ping
in the large ripple of what we need to do.
The problem is multifaceted, though.
Let me talk about the $100
investment just for a minute.
In that $100 million dollar investment,
there are some fabulous programs.
To start with, there's 8.7 million of that
that is gonna be used to train
LPNs and LVNs to become RNs,
so part of where we need some help
is to make sure we have
really strong pathways
so that we're able to bring
people into a healthcare career
and quickly move them along the pathway
so that they recognize that
they have a sustainable wage,
particularly in the impacts of inflation
that we're feeling today.
So that's one of the areas
that's critically important.
There's also 26.5
million that is allocated
to the nursing faculty loan program.
That's across many types of nursing,
I talked about some of
them briefly before,
and again, it's to encourage individuals
that are in a situation
where perhaps they couldn't
take on the full burden
of the cost of education,
and it gives them the likely ability
to be able to recoup some of that money
when they graduate
and they provide service
to our communities.
And aligned with that, remember,
we also have even more
of a critical shortage
in some of our underserved
and rural areas,
So some of this $100 million dollars
is strategically focused on making sure
that we reach those particular areas.
The other piece that I
would love to mention
is there's $30 million that is invested
in residency and fellowship programs,
and what we have learned over time is,
when someone enters in a nursing program,
we are graduating a generalist
who is able to practice
at a minimum entry level,
and remember, when a nurse
graduates, they are...
Yes, they have an onboarding program,
they have a residency program,
but not all programs look
alike across our country,
and what we wanna ensure
is that there's a very solid entry point,
that the nurses are feeling guaranteed,
that they will walk into an environment
where they are supported,
where they're able to transition
to a larger patient load,
and really be able to engage
as quickly as possible
in what we refer to as clinical judgment.
Clinical judgment is part of
what makes a nurse a nurse,
and particularly when you get
into the area of licensure.
And why is that so important?
It's so important
because there is evidence
that has confirmed for us
that 46% of tasks
performed by entry nurses
are linked to clinical judgment,
and 50% of novice nurses are involved
in patient safety events
and critical incidents.
That's a 2020 statistic.
So think about that.
If you're a brand new nurse
and you enter your first job,
you're excited, you love nursing,
and then you make a mistake,
it really is impactful to retention,
it is impactful to that
nurse feeling very confident
in their new career,
so the need for nursing education programs
and then that segue and
some of that invested money
to help ensure that we
are transitioning nurses
from the education environment
to the practice environment
in a way that is more seamless
is essential, right now.
- And what's the role of nursing
schools in this equation?
- So in the last year, so April 1st, 2023,
we have an exam, which is
the entry to practice exam,
it's called NCLEX,
and it is administered
by National Council
State Board of Nursing.
They had done some very extensive research
in the previous, probably,
about seven years,
where they, every couple of years, engage
in an in-depth practice analysis.
They observe what nurses
are doing every day
in their healthcare setting,
and what they identified
is that we needed to ensure
that on that exam,
we were testing the student graduate
for competency in clinical judgment,
so what became important
is that there were new ways of measuring
from a psychometric perspective,
so a very fair perspective,
of whether a nurse had
gained the knowledge,
and the skills, and abilities
in order to perform those
clinical judgment decisions.
And so that's what nursing schools
in the last two years, in particular,
have laser-focused on,
ensuring that they were using
different types of modalities,
like a simulation.
Simulations became core
to nursing education.
You can't expect that every student
will have the exact same
clinical experience,
and one of the barriers to enrollment,
one of the barriers to increasing
the pipeline of students
and being able to get them
through a nursing program
is the lack of clinical sites,
along with the nurse faculty shortage,
which I can get to in a minute.
And so nursing schools have
focused strategically on
how do I balance and be able to use
educational technology tools,
like a simulation.
Very similar to what originally grew up
in the airline industry,
it's how pilots were trained
for emergencies that could occur,
and now we use it extensively
in the healthcare environment,
and it allows students to
be able to make mistakes,
it allows students to be involved
in adaptive learning technology
so that they're able to
really learn real time,
with realistic scenarios
that then transfer much
easily, much more easily,
to that environment in healthcare,
that that will be very quick
to be part of their job role.
- And you've made a
number of recommendations
on things that can be done
that'll make a real difference
in solving the problem of
the workforce shortage,
and you mentioned the
shortage of nursing faculty
in schools.
You also talk about
student support services
for a very, very challenging
and rigorous academic journey
that some students may
not be prepared for,
and you talk about the general issue
of student preparation
moving into a nursing education
in a higher education setting.
What are some of your top recommendations,
as we draw to a close,
in helping to solve this problem?
- The one thing I would like to highlight
is that there is demonstrated
academic learning loss
that has occurred as a result of Covid,
and we are still experiencing that
in all of our schools
throughout the country.
Now, when I opened up,
one thing I didn't mention
is that Ascend Learning ATI Nursing,
we're in almost 70% of
the nursing schools,
so we see firsthand what's happening,
and the nation's report card confirms
that we have delays that are being noted
in reading and math skills.
In addition to that,
we administer an entrance
test called TEAS,
and in that entrance
test, it was clearly noted
that the people who did not decide
to enroll in nursing schools,
the majority of them, 69%, cited
that it was a lack of
academic preparedness,
so top priority is
that we prepare and
provide for our schools
educational technology environments
where students can learn and relearn
some of those key attributes
of math and reading
that are critical to their
success in a rigorous program.
So what does that look like?
It looks like immersing a student
in some what I'll call
very basic skills in math,
but then reinforcing it
throughout, even, their journey
in the nursing program
or healthcare program,
making sure that there
is focused remediation,
that there's a adaptive learning,
that we are cognizant of the fact
that students no longer learn
by just reading information,
that we have to meet
them where they're at,
and they live in a world
in which they expect
to infuse and become deep in knowledge
by having multi-senses being impacted,
so animated videos, case studies,
simulations, predictive testing
that focus them very quickly
on short tidbits of learning
that they can easily digest,
and then we can stack the
next piece of learning on it
so that we get them to the end result
of that comprehensive
knowledge base they need
in order to make those good
decisions at point of care.
So that's critical to
where we need support.
In addition to that, we need
support for our nurse faculty.
We have had a significant turnover.
We have a 9% vacancy rate
in our nurse faculty seats
across the country,
and as a result of that,
we're seeing really strong
clinicians coming in
and joining our nursing faculty,
and we love it,
but what we know to be true is
they maybe didn't have education programs
and education principles
as part of their journey,
they're a strong clinician,
so we need to have our
government support funding
that will immerse these new
leaders, these new faculty,
in really understanding
how to engage students
in the year 2024,
and making sure that they
have adequate resources
and infrastructure
in order to create those programs,
and provide that access.
You know, the one point
I would also love to make
is there is incredible evidence
that says people respond
better to healthcare
when there is someone who looks like them,
who they can relate to,
who's providing that frontline care,
so our ability to diversify our workforce,
and have those doors open,
and support those students
through their educational
journey in healthcare
is adamant,
from that medical assistant,
nursing assistant,
right on up to that nurse
practitioner, physician,
whoever it might be,
in that healthcare system.
Lastly, to expand that
capacity of nursing schools,
we talked about the
need for clinical sites,
so our ability
to look at new, emerging clinical
technologies, telehealth,
definitely got wings during Covid,
and remains to be a very important part
of our healthcare delivery system.
Our students need to be educated
in those types of environments,
and we need to recognize
that that's part of the
educational process,
and thus, the pathway to ensuring
that we provide really solid healthcare
for all of our people
in the United States.
And immigration's part
of this whole story, too.
We can have fabulous
impacts to our shortage
if we look at really positive ways
in which we can support people
who might come here
through various programs,
and how can they enter that health career
and get in that pipeline.
- Well, we have covered
a lot of ground here
in this discussion,
and I think there's probably
a lot of folks out there
that would like to learn more,
both about the data and the problem,
but especially the solutions.
If they wanted to learn more
about the work that you do
or Ascend Learning Healthcare,
how would they find you?
- Well, they are more than happy
to just go on Ascend Learning Healthcare,
and we always have a
way that you can chat in
and get information.
They also can certainly
reach out to me directly
at Patty, P-A-T-T-Y, dot,
Knecht's my last name, K-N-E-C-H-T,
at atitesting.com.
We would love to connect.
We spend a fair amount of effort
making sure that we are connecting
with our external
partners, our associations.
There are so many people
for which are passionate
about this problem right now,
and together, we are several
million strong as nurses,
even larger as a larger healthcare entity,
and our voices need to come together
to be heard, and really make an impact,
and ensure that our legislators consider
and move forward, quickly, funding
to avert this shortage.
- Our guest today has been Patty Knecht.
She is vice president
and chief nursing officer
for Ascend Learning Healthcare.
Dr. Knecht, thank you for being with us.
- Thank you so much,
I appreciate your emphasis on this issue.
(chiming music)
- Thanks for joining me
for this episode of the
"Career Education Report."
Subscribe and rate us
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or wherever you listen to podcasts.
For more information, visit
our website at career.org,
and follow us on Twitter @CECUed,
That's @-C-E-C-U-E-D.
Thank you for listening.
(lively music)
(dramatic music)
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