Kim Giglio has worked in healthcare for 25 years, long enough for her industry to experience big, headline-grabbing milestones — from the completion of the Human Genome Project in 2003 to the passage of the Affordable Care Act in 2010.

But for Giglio, director of talent acquisition at MultiCare Health System in Tacoma, the biggest industry change has been more personal and firsthand: namely, a deepening paucity in the number of trained nurses available to work in hospitals, clinics, and other healthcare facilities.

“The bottom line is that I’ve been involved in nurse recruiting long enough, and I’ve seen about three nursing shortages,” explained Giglio. “But this one is different. This one is more severe, and it feels like it’s going to be longer.”

For Giglio, who is tasked with hiring qualified nurses to assist physicians and care for patients at MultiCare, a nursing shortage has made her job acutely challenging.

Between October 2017 and September 2018, MultiCare accounted for a majority of the 107,000 unique job postings in Pierce County, according to data compiled by University of Washington Tacoma’s Urban Studies Department. Of all those MultiCare postings, there were 9,600 unique job postings for registered nurses by occupation.

“Being a healthcare recruiter is not for the faint of heart right now,” said Giglio, who noted the company’s nearly 3,800 nurses represent approximately 20 percent of MultiCare’s statewide workforce of 18,000 employees (the company employs approximately 7,700 people in Pierce County, making it the county’s largest private employer; CHI Franciscan Health, also headquartered in Tacoma, employs approximately 6,700 people, making it the county’s second-largest private employer). “I happen to be an economics geek, so I’m fascinated by workforce economics. This is a great example of that, and I love it. But it is challenging. The supply of registered nurses is not even close to being enough to meet 100 percent of the demand.”

Giglio’s observation is not anecdotal.

The U.S. Department of Health & Human Services estimates that by 2025, Washington state will be 1,200 licensed practical nurses (LPNs) and 7,000 registered nurses (RNs) short of the numbers needed to meet employment demands.

The Washington Center for Nursing (WCN) reports the number of LPNs per 100,000 people in the state dropped 28 percent, from 209 to 135, between 2008 and 2018. Meanwhile, the number of RNs per 100,000 people in Washington state rose just 1.5 percent, from 962 to 977, during that same period.

Farther south, in counties that include Cowlitz, Grays Harbor, Lewis, Mason, Pacific, Thurston, and Wahkiakum, the number of RNs per 100,000 people dropped from 915 in 2008 to 904 in 2018, according to the Washington Center for Nursing.

Add an aging and retiring nurse workforce to an aging population, and you have what healthcare professionals often describe as “the perfect storm.”

 

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How did the nursing industry arrive at this point?

For starters, the average age of nurses in Washington has been pegged at around 45 years old for the past decade, according to the WCN, and healthcare professionals locally and nationwide have braced for a wave of older and aging Baby Boomer-era nurses to retire. An exodus of retiring nurses was anticipated in 2008, but a deep U.S. recession meant many of those nurses chose to remain in the workforce and ride out the economic downturn.

Fast-forward 10 years: The economy is healthy, and aging nurses are revisiting their original retirement plans.

“Now that things are a little bit more stable in the economy, we are seeing nurses retire who maybe worked longer,” said Gerianne Babbo, professor and associate dean of nursing at Olympic College in Bremerton. “That’s kind of catching up to us.”

Another factor is education. From as far south as Longview to as far north as Tacoma, the South Sound has a robust portfolio of more than a dozen colleges and universities that offer a range of programs for aspiring LPNs and RNs. A challenge, however, is finding active nurses willing to obtain teaching credentials and join the faculty at one of these educational institutions — all while taking a cut in their salaries.

Babbo at Olympic College noted new graduates, right out of college, often earn more money than their teachers. According to the U.S. Department of Labor’s Bureau of Labor Statistics, the annual mean salary in Washington state is $53,150 for LPNs, and $79,810 for RNs.

“I’ve had many faculty (members) leave over the years because their kids hit college and they need to make more money to help support that,” she explained. “I have several faculty (members) who work a second job.”

During her first 12 years as a faculty member at Olympic College, Babbo said, she worked part-time on weekends, holidays, and summers as an emergency room nurse to supplement her salary.

It’s an issue Dianne Nauer, executive director of nursing at Bates Technical College in Tacoma, knows uncomfortably well. Nauer said she lost quality teachers who returned to the nursing industry after, say, a spouse lost his or her job, and it was suddenly difficult to support a family on a salary that earned 50 to 60 percent of what could be earned while working as a nurse in a hospital.

“We have to pay faculty better,” said Nauer.

A different set of challenges exists for nursing school students.

Teri Moser Woo, professor and director of nursing at Saint Martin’s University in Lacey, recently conducted an informal survey of nursing school programs from Tacoma, down to Centralia, and out to Grays Harbor, and found that, annually, approximately 300 people who want to pursue a career in nursing are turned away because there aren’t enough faculty to teach them. Similarly, she found waiting lists of several hundred people hoping to get into many nursing programs.

Another hurdle arises once students are admitted into a nursing program and work toward completing their coursework — specifically, finding a hospital or healthcare facility with the capacity to onboard nurses in training. The state Department of Health’s nursing commission requires students to complete a portion of their training in “clinical placement settings,” such as hospitals, clinics, and other healthcare facilities.

With a shortage of nurses, it’s difficult for a healthcare facility’s already-busy nurses to take the time to carefully manage and train nursing school students in clinical settings.

“Finding clinical placements is extremely difficult,” said Babbo at Olympic College.

According to Giglio, MultiCare can host only roughly 500 aspiring registered nurses in clinical settings annually, and has to turn applicants away. MultiCare would take on more students, but the company needs to balance the training of students, the training of newly hired nursing school graduates, and the workloads of experienced nurses who already are caring for patients.

“I know that our neighbors (CHI Franciscan Health) down the street do their part, as well,” said Giglio. “We are part of a consortium of schools and other healthcare employers who work together to share the load in providing quality clinical experiences for the students. We train hundreds of nursing students, and still there’s an unmet demand.”

Finally, it’s not uncommon for nurses to limit their schedules to three 12-hour shifts per week, splitting that time between different healthcare facilities. For example, a nurse might work 12 hours per week at a hospital ICU and 24 hours per week in, say, a long-term care facility or even in a call center assisting nurses by phone (see “A Career Caregiver,” down below).

Working fewer than 40 hours per week in different locations and environments can keep the work interesting for nurses, while also allowing for work-life balance in a job that is often physically and emotionally draining.

“We would love it if all of our nurses worked (full-time) in our units,” said Giglio. “But that’s one of the beauties of nursing. It’s an incredibly flexible field. Nurses have a lot of options, which is why we are all competing so heavily for them. They are in the driver’s seat.”

 

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So, where is the relief?

For the past several years, a coalition of nursing organizations (Washington Center for Nursing, Washington State Nursing Care Quality Assurance Commission, Council on Nursing Education in Washington State, and others) has championed the Action Now! initiative, which aims, chiefly, to lobby legislators in Olympia to increase salaries for nursing school program faculty, as well as the funding for the programs.

Increasing the pay for nurse faculty could encourage more nurses to become educators. Similarly, ramping up the funding for nursing school programs could help reduce waiting lists, and possibly increase the number of clinical placements in healthcare facilities.

Saint Martin’s University in Lacey is in the process of developing a traditional, four-year nursing baccalaureate program that, if approved, could begin accepting students later this year and graduate four dozen nurses annually. The move aims to make an effort to address the South Sound nursing shortage.

As far as luring more nurses to our region, it’s not uncommon for large hospitals to offer incentives such as signing bonuses and student loan repayments to bolster their nursing workforces. According to Giglio, certain units at MultiCare offer signing bonuses of between $2,500 and $5,000 — with some units offering bonuses of $10,000. The company also offers a loan-repayment program of up to $20,000 over a five-year period.

The company recruits nurses throughout the United States, and even sometimes internationally. And even so-called “agency” or “travel” nurses who work on a kind of freelance basis to support core staff are sometimes hired on at MultiCare.

And though it’s likely the nursing shortage will not be resolved soon, the impacts of this issue already are being felt.

“Not having adequate nurses puts all of us at risk if we need nursing care,” explained Moser Woo at Saint Martin’s Universiy. “People think, ‘This isn’t my problem.’ But it is your problem if you go to the emergency room and there’s no one to take care of you. This is a safety issue for all of us that need nursing care. It’s an important issue to address.”

 

A Career Caregiver

Not everyone’s reasons for becoming a nurse are the same, but we wanted to learn more about what it’s like to pursue a career in this field of healthcare. Puyallup resident Andrew Lehman, 49, has worked as a nurse in the South Sound for 20 years, offering care in settings that range from rehabilitation centers to Intensive Care Units. Lehman shared some of his insights and experiences as he reflected on his nursing career.

Andrew Lehman

Headshot courtesy Andrew Lehman.

was in the Army for five years and worked as a helicopter mechanic. I joined the Army knowing that I didn’t want to waste my time with college until I figured out what I wanted to do. In the Army, it just came to me that I wanted to work in the medical field. I saw the human body as a very complicated machine, and I’ve always liked how everything works together.

I started out as a rehabilitation nurse at (MultiCare) Good Samaritan Hospital (in Puyallup), working with patients going through physical therapy, or recovering from brain and spinal cord injuries, as well as orthopedic surgery.

I was fortunate. Every step of the way, I was trained by people who were much more experienced than me. They passed their knowledge on. It doesn’t matter how long you are doing it; you are always learning new stuff. Even after 20 years, I know that I will still be learning things for a long time to come.

Now I work two jobs: one as a nurse at a hospital ICU in Olympia, and one as a nurse at a virtual acute care unit in Tacoma. Nurses from multiple hospitals contact us with questions or problems that need to be solved. Experienced nurses help new nurses figure out what to do with their patients.

People who haven’t done nursing think there are one or two kinds of nurses out there. There are different kinds of nursing. You can be a dialysis nurse, medical/surgical nurse, emergency room nurse. There are nurses who work in ambulance transport. There are flight nurses who fly in helicopters. There are many different options for people who go into nursing. You don’t have to do the same thing your entire career.

As corny as it sounds, even if you have a bad day as a nurse, at least you help people. It’s a very rewarding profession. It’s also intellectually and emotionally challenging. That’s what drew me toward nursing — I basically get to do something interesting, but I also get to help people. As told to Todd Matthews

 

Taking the pulse of nursing’s workforce shortage

The U.S. Department of Health & Human Services estimates that by 2025, Washington state will be 1,200 licensed practical nurses (LPNs) and 7,000 registered nurses (RNs) short of the numbers needed to meet employment demands.

LPN's and RN's

statistics source: Source: the U.S. Department of Health & Human Services; CENTER FOR HEALTH WORKFOrCE STUDENTs/the Washington Center for Nursing (WCN)