Northwest Arkansas schools train more nurses in more ways to meet need

Students in the physician assistance class at Northwest Technical Institute take a test Friday in Springdale. Having enough nurses and other health care workers is an increasingly urgent issue around the country. The population overall is growing and aging while nurses, including the instructors of new ones, are aging and retiring themselves.
Students in the physician assistance class at Northwest Technical Institute take a test Friday in Springdale. Having enough nurses and other health care workers is an increasingly urgent issue around the country. The population overall is growing and aging while nurses, including the instructors of new ones, are aging and retiring themselves.

Training for Northwest Arkansas' nurses is changing to try to meet the region's growing needs and head off a looming shortage, nurses and other experts say.

Some schools and at least one hospital are bringing back an old-fashioned model of nursing that could make joining the health care industry easier, at least in some contexts. Other programs at the University of Arkansas for Medical Sciences and elsewhere are adding slots or tweaking operations to make it easier to pursue higher levels of expertise.

More and more nurses

Arkansas’ nurse jobs and nursing school enrollments are growing quickly amid worries that the state and country will soon need far more nurses than it has.

Licensed nurses by type20062016*Change, in percent

Registered nurse28,71139,648*38

Licensed practical nurse14,94715,557*4

Program enrollment by type20052015*Change, in percent

Registered nurse, seeking associate’s or bachelor’s degree4,6115,599*21

Practical nurse1,5531,809*16

Source: Arkansas State Board of Nursing

Whether these changes will be enough to meet the industry's mounting demands is an unanswered question, said Sue Tedford, director of the state nurse licensing board. The nurse shortage has been around for at least all 37 years of her nursing career.

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"But it doesn't mean we need to stop trying," she said.

Having enough nurses and other health care workers is an increasingly urgent issue around the country. The population overall is growing and aging while nurses, including the instructors of new ones, are aging and retiring themselves. Nursing schools turned away tens of thousands of candidates last year because of the lack of faculty, according to the American Association of Colleges of Nursing.

Cleveland and Johns Hopkins university researchers in 2012 predicted the country would be short almost 1 million registered nurses by 2030 because of how quickly the demand is expected to increase and other factors. The study pegged the future shortage for Arkansas around 8,000 registered nurses.

Health systems are building clinics and hospitals throughout Northwest Arkansas, including Arkansas Children's Northwest, and snapping up employees as soon as they can start work.

Team nursing

A shortfall of nurses showed itself at Mercy Northwest Arkansas last year after the system's Rogers hospital devoted more space to acute care, Charlotte Rankin, chief nursing officer there, said in an email. With little time to hire more staff combined with the normal ups and downs of the workforce, the hospital brought in temporary nurses who did a fine job but cost more and didn't have time to settle in, Rankin said.

The hospital turned to an arrangement called team nursing, a model that popped up decades ago. A registered nurse, a licensed practical nurse and a certified nursing assistant comprise a team.

Each works at a different level, with the practical nurse giving patients medications, for instance, while the registered nurse has license to make more complex care decisions. Certified assistants can read vital signs and other straightforward tasks after several weeks of classes.

"The team model allows all licensed professionals to work at the highest level of their licensure," meshing together and helping each other meet the needs of any group of patients, Rankin said. It costs the same as using only registered nurses, as other hospitals typically do for acute care, but has bumped co-worker and patient satisfaction scores as well, she said.

Northwest Health has seen similar results with a team nursing model combining licensed nurses and unlicensed assistants, said Karen Lebonte, the system's chief nursing officer at its Springdale medical center. Both she and Rankin agreed the model also helps recruit nursing assistants and practical nurses they then encourage to go on and become registered nurses.

Teams can bring other advantages, including reducing nurses' stress and bringing extra pairs of eyes for details, according to Australian studies in 2009 and this year. Good communication skills are key to making it work, however, and it might not always have an effect. A 2015 review from Australia's Joanna Briggs Institute found research was still too sparse to say for sure what difference teams make compared to other models.

Hospitals often favor registered nurses in acute care rather than mixed teams because each individual nurse can legally do more, Rankin said. Several studies from the University of Pennsylvania and elsewhere found better patient outcomes and nurse retention come with higher nurse education.

Washington Regional Medical Center has used several models, including team nursing, but at the moment nurse care comes mostly from registered nurses with nursing assistants helping out, said Tonya Hanle, director of nursing for the center's medical-surgical department.

Siloam Springs' John Brown University's year-old bachelor's degree program for nursing and Northwest Technical Institute's programs for practical nurses and nurse assistants both send students to train at Mercy and explore the team nursing model in their courses, their directors said.

"We have to understand that health care is very interdisciplinary and team-oriented," said Ellen Odell, nursing director at John Brown, where she said students learn the roles of several nursing levels.

Debra Walker, director of the nursing program at Springdale's Northwest Technical Institute, said the model might help the same number of workers provide care for more people. She and Odell stressed students are prepared for whatever model their eventual employers use.

"Our plan is to get creative with the nurses that we do have," Walker said.

Tedford said she liked the idea of team nursing because "it utilizes everybody's capabilities much better," but she emphasized the need for more and more training throughout a health care career, moving from one level of the team to the next and the next.

"Everybody just needs to keep going on and educating," she said.

Growing and changing

More schooling is a rallying cry across the nursing profession, with many seeing it as the most lasting fix to the shortage.

The nursing college association in 2007 said the shortage of nurse teachers stems partly from "advocating for less than a baccalaureate degree," or a bachelor's degree, among nurses and nurse assistants.

"The role of the nurse is changing with the transformation of health care, but unfortunately, the level of education typically remains the same," North Carolina nurses and researchers wrote in the journal Nursing Forum in 2010.

About half of nurses have a bachelor's degree, according to a widely cited 2010 report from the National Academies Institute of Medicine titled "The Future of Nursing." It urged the profession to raise that rate to 80 percent and encourage nurses to earn master's and doctoral degrees as well.

To those ends, Northwest Arkansas' health schools are growing and adding options.

John Brown's program its first year includes 115 students in nursing or pre-nursing courses, Odell said, making it the second largest major on the Siloam Springs campus. At some point she hopes to add graduate degrees and a degree completion program for registered nurses with associate's degrees to work toward bachelor's degrees.

Northwest Arkansas Community College plans to start a practical nurse to registered nurse online program next year in hopes of boosting enrollment, said Carla Boyd, who heads the college's nursing education. Most of her associate's degree graduates go on to the bachelor's level at the University of Arkansas or elsewhere, she said, and every graduate from the past several years who wanted a job found one quickly.

Enrollment in the community college's registered nurse program tripled from 2005 to 2015 to almost 300 students, according to the state nursing board. The bachelor's equivalent at the University of Arkansas Eleanor Mann School of Nursing more than doubled to about 400 in that time.

At the graduate level, the Mann School recently added a master's program for executive leadership. The University of Arkansas for Medical Sciences' College of Nursing this fall will start offering a bachelor-to-doctoral degree program, bypassing or streamlining some redundant master's level classes and shaving a year or two off the process, college dean Patricia Cowan said. Someone with a nursing practice doctorate can lead and adapt the industry, she said.

"We want to have students that are prepared to translate research into practice, to effect changes in practice that improve health care and have an understanding of system issues as well as individual patient care issues," Cowan said. "The community benefits from the knowledge that they gain."

The changes in nursing education parallel broader adjustments in a health care industry also trying to head off shortages of doctors and technicians. Northwest Arkansas health systems are slowly adding more physician residencies, and the state is home to new osteopathic medicine schools in Jonesboro and Fort Smith.

The technical institute is working on boosting its annual class of surgical technologists, who assist surgeons, from 18 to 25, said Robin Eason, who directs all of the institute's health courses. She's also adding a course this fall for phlebotomists, who draw patients' blood for tests.

"If you have a weak stomach, it's probably not for you," Susan Wheaton, a student in the surgical technology program, said of the health care field. But she and other classmates said the work is intense and invigorating.

"It's like a whole new world," said Wheaton, who moved to Prairie Grove from outside the area late last year and is focusing on orthopedics -- "muscle and bone," as she put it. "You have no life outside of school, but it's worth it. The license you get here goes everywhere, too."

NW News on 06/11/2017

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