By Jaymie Baxley
Though North Carolina still has far fewer nurses than it needs, incremental gains have been made in addressing the shortage.
That was the key takeaway from an analysis released Sept. 15 by the NC Health Talent Alliance, a public-private partnership of the NC Center on the Workforce for Health, the NC Chamber Foundation and the state’s network of Area Health Education Centers.
Emily McCartha, a senior policy analyst for the NC Center on the Workforce for Health, said the group’s analysis is based on data from a survey of 110 health care organizations that provided information on nearly 80,000 nursing positions at more than 1,560 facilities across the state.
The data showed roughly a third of the state’s positions for licensed practical nurses, who provide basic medical care under the supervision of registered nurses and physicians, are vacant.
That’s worse than last year, when about a quarter of LPN positions were unfilled.
Registered nurses, who make up the largest segment of North Carolina’s nursing workforce and provide more advanced patient care (such as administering medications, coordinating treatment plans and supervising LPNs and nursing assistants) are also in short supply.
About 13 percent of the state’s registered nurse positions are unfilled. While higher than the national average of a 10 percent vacancy rate, the number is an improvement over last year’s rate of about 17 percent.
But Andy MacCracken, director of the center, said the improved rate comes with a caveat.
He said persistent shortages among LPNs and other support staff create additional pressures on registered nurses, a dynamic that has ripple effects throughout the health care system.
“We know that RNs rely heavily on the full care team, and when we don’t have allied health professionals and LPNs at sufficient staffing levels, RNs have to take on a whole lot of extra duties and responsibilities,” MacCracken said in an interview with NC Health News. “That contributes to untenable situations where we see folks either leave the employer or leave the profession overall, and that’s not good for anyone.”
Long shifts and heavy workloads
There are several factors driving the nursing shortage.
Low pay is a major concern, particularly in rural parts of the state. A workforce needs assessment commissioned last year by the North Carolina Healthcare Association, the umbrella organization representing the state’s hospital systems, noted that many rural health care systems and hospitals “cannot match rising wages offered by more urban healthcare systems and robust wage growth in the broader private sector.”
Difficult working conditions are another factor. In addition to long shifts and heavy workloads, nurses are often subject to verbal and physical abuse from patients.
Forty-eight percent of respondents in a 2022 survey conducted by the North Carolina Nurses Association said they had “personally witnessed violence” at work in the past two years. Twenty-seven percent reported being victims of violence.
The state’s staffing woes are not new.
Lawmakers in the N.C. General Assembly have been aware of the problem for decades; they passed legislation acknowledging a “nursing shortage in the state” back in 1989.
And, MacCracken said, the issue existed even before then.
“We’ve identified a nursing shortage in North Carolina for close to half a century,” he said. “So as we are tackling these issues, we know that there’s an ebb and flow to what the shortage looks like and the nature of what might be driving the shortage.”
The challenge, he added, is “making sure that there’s sustained focus on where we need to go next.”
Vincent Ginski, director of workforce competitiveness for the NC Chamber Foundation, said that’s partly the purpose of the alliance’s analysis — the second produced by the partnership since its founding in 2023.
“While anecdotal evidence of staffing challenges has existed for years, the survey — combined with complementary secondary data — offers a more detailed and contextualized picture of workforce needs across the state,” he said in a news release. “We’re using this to develop regional strategies to address workforce needs since they vary greatly across the state.”
Signs of progress
During a webinar unveiling the new data, McCartha said the state had seen an uptick in “educational output.”
The number of newly licensed registered nurses with bachelor’s and associate degrees has increased nearly 15 percent in three years. That growth has helped drive a 10.6 percent rise in the overall supply of licensed registered nurses during the past five years, with almost half of that increase occurring in the last year alone.
That increase will be needed, given that a 2023 survey conducted by the American Association of Colleges of Nursing found that the median age of nurses nationwide is 46 years, and more than a quarter of RNs said they planned to retire or leave nursing in the coming five years.
For licensed practical nurses, the pipeline has also improved, with educational output climbing about 13 percent in the past three years. Still, the state’s total number of LPNs is about 4 percent lower than it was before the COVID-19 pandemic.
Members of the alliance believe the rising number of graduates can be attributed to increased public and private investments in nursing programs.
Melissa Smith, senior state director of health science programs for the North Carolina Community College System, noted that the General Assembly appropriated $55 million in 2023 to expand programs in nursing and “other critical shortage fields” at all 58 of the state’s community colleges. About 44 percent of those funds have gone to colleges in rural counties, she said.
“They have seen great growth,” Smith said of the schools, adding that the money has created a “spark of excitement” among their students and staff. “As I’ve visited some of the colleges, it’s like, ‘We’ve got this whole new lab, and we would have never been able to afford this [without the legislative funding].’”
Looking ahead
MacCracken said it will be crucial to maintain and continue building that school-to-workforce pipeline for nurses in the coming years.
It has been estimated that North Carolina will need 17,500 more nurses over the next decade to keep up with the state’s aging and growing population. The population of people ages 65 and older in North Carolina is projected to grow from 1.9 million in 2022 to more than 2.8 million by 2042, according to data from the N.C. Office of State Budget and Management.
“In the near future, the people math gets really scary as we think about North Carolina’s population growth and projections for us to have a million additional seniors living in North Carolina,” MacCracken said. “In really the near future, we have waves of retirement that we would expect from the health workforce, and I think we’re already seeing some of that bear out in our data.”
He expects the shortage to have a particularly negative impact in long-term care settings, which could, in turn, place strain on other providers.
“As we’re looking at how these pieces fit together, it’s really important to acknowledge this as an ecosystem,” he said. “As we look ahead at the significant demand that we’re going to have on long term care, our ability to tackle that is going to have an effect on our hospitals, can have an effect on primary care. All of this works together.”
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