As published in Seven Days by Colin Flanders
Vermont has long needed more nurses than its colleges can train, and the gap has only widened during the pandemic as burned-out health care workers retire or quit faster than they can be replaced. Hospitals are filling hundreds of vacant nurse positions with expensive traveling workers, while the state has assembled its own team of temps to prop up long-term care facilities.
The supply-and-demand equation is expected to worsen. A third of Vermont’s registered nurses are at least 55 years old, meaning that the next decade will likely bring another wave of retirements. It’s now estimated that Vermont will need to add 1,800 nurses in each of the next five years to keep pace with the demand. That’s about three times as many graduates as Vermont’s four colleges with nursing programs — the University of Vermont, Castleton University, Vermont Technical College and Norwich University — produce annually combined.
Concerned by these trends, Vermont’s elected leaders say the state’s nursing shortage has become a true crisis, one that can only be resolved by enlarging the training pipeline.
“We have to be aggressive in addressing this shortage now,” state Senate President Pro Tempore Becca Balint (D-Windham) said at a news conference last week, alongside Sen. Bernie Sanders (I-Vt.) and Gov. Phil Scott. “We need to do this for all Vermont communities, because when we need medical care, we want to make sure that somebody is there to help us.”
Vermont nursing programs have steadily grown over the last two decades and now graduate about 500 to 600 people annually, though a fourth of those end up leaving the state. College leaders say a number of common barriers prevent them from further increasing their enrollments. One of the biggest: a lack of teachers.
Vermont needs about 50 more full-time nursing instructors on top of the 75 it already has to begin preparing an adequate number of new nurses, according to estimates from Sanders’ office. That’s a daunting figure given how difficult it can be to fill the positions already available; several nursing faculty jobs have been vacant for months at Vermont Technical College.
College leaders blame their recruitment challenges on salary disparities: Nurses can make far more money working in the field than teaching others how to be a nurse. The average faculty gig pays $65,000, Sanders said. By contrast, the average registered nurse in Vermont makes $72,000, while the top 10 percent earn $98,000 or more, according to data from the state Department of Labor.
Helen Papeika, who chairs Castleton’s nursing program, supplements her income by picking up shifts at a hospital. She would make far more money were she to focus solely on clinical work, but she said her love of teaching makes the sacrifice worth it. That’s not a decision everyone can make.
“You also have to live,” she said. “It’s a tough balance.”
Educators acknowledge that boosting instructor pay would help lure people into faculty jobs but say they’d be unable to afford it without help from the state or federal government. They’d get that money if it were up to Sanders, who used his remarks at last week’s nursing workforce news conference to highlight the “abysmal” pay of nursing educators, pointing out that hospitals expect to spend upwards of $75 million on their temporary workforces this year.
“Instead of spending money to educate nurses who will be part of a long-term sustainable workforce, we are spending huge sums of money on people who come into the state and then leave,” Sanders said. He vowed to work with state leaders on increasing instructor pay, though he offered no specific plan or funding source.
Vermont nursing faculty are required to have master’s degrees, something few nurses have earned. Castleton recently launched an online graduate program to join UVM and Norwich in offering a master’s degree in nursing, so there’s hope that the pool of potential faculty will increase over time. Uptake has been slow so far, though; in its first year, Castleton’s program has only five students.
“There’s nurses working in hospitals who would love to teach but say, ‘I don’t want to pay for another degree,'” said Sarah Billings-Berg, the associate dean of nursing education at Vermont Technical College.
Inadequate infrastructure represents an additional barrier for some nursing colleges. Vermont Tech has 14 nursing class locations around the state. Some of those classrooms can accommodate fewer than a dozen people. Others have old equipment in need of replacement. “We have some investment to do before we can grow too much,” Billings-Berg said.
Every department at UVM is looking for more classroom space, said dean of nursing Noma Anderson. “More space to teach our students — even office space,” Anderson said. “Our faculty are sharing offices. The chair of nursing has told me: ‘If I had more space, I could bring in more students.'”
Vermont colleges are far from alone in these challenges. U.S. nursing schools turned away some 80,000 qualified applicants in 2019 due to shortages of faculty, classroom space and other resources, according to the American Association of Colleges of Nursing.
Even if Vermont found more space and faculty for its nursing colleges, it would still likely need to get more people interested in becoming nurses. One way to do that is through financial incentives.
Nursing programs aren’t cheap; in-state tuition at Vermont Technical College and Castleton costs $15,000 a year. Two state scholarship programs seek to reduce this burden by giving money to people who agree to work in Vermont for at least a year. But the programs are highly competitive and distribute only $1.2 million annually — enough for only 200 or so nurses.
Last year, the legislature spent $5 million in federal funds to set up a free-tuition program at the Vermont State Colleges System to support students pursuing nursing and other “critical” occupations. It was wildly popular — so popular, in fact, that the system ended up with about 230 more requests than it could fulfill. The system eventually funded $2.4 million in additional scholarships and is now seeking reimbursement from the legislature.
Vermont Technical College employs a “1+1+2” ladder approach that allows students to obtain lower-level nursing certification and join the workforce before continuing their education. Students on the lowest rung go through a one-year program that certifies them as licensed practical nurses, or LPNs, who work under the supervision of doctors or nurses and provide more basic care: taking vital signs, collecting samples, administering medication. From there, students can earn a two-year associate’s degree and seek certification as a registered nurse, then pursue the final two years of a bachelor’s degree.
The free-tuition initiative was announced after the application deadline for the one-year LPN program, so it did not lead to an enrollment boom. But it did help double the online nursing bachelor’s program from 50 to 100 students, Billings-Berg said.
The state college system has asked for $10 million in the upcoming budget adjustment act to re-up and expand the free-tuition program. Nursing college leaders are also pushing for additional loan repayment programs and say they could use money to increase support services such as advising and tutoring, in hopes of cutting down on student attrition.
Meanwhile, Gov. Scott’s administration has proposed two initiatives to bolster recruitment and retention of health care workers. One would allocate $15 million for organizations hardest hit by staffing shortages so that they could offer bonuses to workers who agree to stay in the state for a year or two. The other would use $18 million in federal funds to support home- and community-based providers with bonuses, training and career advancement opportunities.
As the legislature gets back to work this month and begins to divvy up the latest trove of federal funds, Democratic leaders say addressing the nursing shortage will be one of their priorities. That’s welcome news to college leaders such as Anderson, the UVM dean of nursing, who believes that her school can help solve the crisis.
“We are proud of what we’re doing, but we know we could do more,” said Anderson. “We certainly want to educate more.”
The original print version of this article was headlined “Dearth of Nurses | Training isn’t keeping up with demand for crucial health professionals in Vermont”