Cost of educating nurses, lack of clinical opportunities limit workforce

The national nursing shortage is threatening to limit health care, and Maryland is no exception. Though the dearth of nurses is not new, the coronavirus pandemic brings the problem into stark relief. With a the COVID-19 surge in full swing, Maryland hospitals have staffed up as many nurses as possible. Still, that may not be enough.


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How did Maryland — and the rest of the country — get to a point where there just aren’t enough nurses to go around? For starters, educating nurses is not cheap, said Rebecca Wiseman, University of Maryland Maryland Nursing Workforce Center.

“The cost of educating a nurse is a whole lot more than the tuition they pay,” Wiseman said.

Contributing factors include low student-to-faculty member ratios and the high number of faculty members needed, she said. There are typically six nursing students per faculty member, and a different type of clinician is needed for each discipline.

“It’s cost prohibitive to add more nursing students,” she said.

More funding from the state would help, but she doesn’t expect that will happen in the near future.

There is also a shortage of clinical sites willing to take nursing students in Maryland, which is similar to the national problem of too few clinical learning opportunities.

“Hospitals, particularly right now, are limiting the number of nursing students they are willing to take in,” Wiseman said. “It’s an upstream problem. If students can’t get in, they can’t learn. That makes getting into clinical settings more difficult.”

An aging workforce contributes to the problem, Wiseman said. The average age of a nurse is between 50 to 52 years old, which means many nurses are nearing retirement age. Also, the role of nurses has expanded over the years into different specialities — further stretching the workforce. Wiseman ticks off several growing fields including home care, that allows for aging in place, and outpatient surgery, which is exponentially expanding.

“The good news is that the numbers of nursing students have increased, even during COVID,” she said. “People are seeing what we are doing, so the numbers of people coming into the profession are very high. Lack of clinical opportunities, however, is going to make it difficult for the nurses to get the preparation they need.”

As part of Gov. Larry Hogan’s surge plan, the state fast-tracked the licensing process to allow nursing students to graduate early and allowed for retired nurses to return to the workforce.

“I’d like to emphasize that though our schools are being challenged, those in practice setting are working with us hand-in-hand to address these issues,” she said. “I’m completely blown away by how cooperative and collaborative they are.”

A Medscape report conducted over the summer, prior to the fall COVID-19 surge, shows 31 percent of registered nurses reported feeling burned out. Prior to the pandemic, only 17 percent felt that way. Another 66 percent of all nurses were worried about transmitting the virus to a family member. Still, 93 percent of registered nurses say they are glad they chose this career path.

“COVID is burning out doctors, nurses, respiratory therapists, everyone,” Wiseman said. “It’s discouraging to see people in the community not helping, not wearing a mask and traveling. We don’t want to be called heroes. We want people to see us as doing a really good job. And we want people to do their part.”