The pandemic has placed an intense burden on health care workers and efforts are underway to increase the health care workforce.
In September, the American Nurses Association (ANA) urged the U.S. Department of Health and Human Services (HHS) to declare the nurse staffing shortage a national crisis. In a letter to HHS Secretary Xavier Becerra, ANA president Dr. Ernest Grant called for the administration to acknowledge and take concrete action to address a “crisis-level nurse staffing shortage that puts nurses’ ability to care for patients in jeopardy.”
“ANA is deeply concerned that this severe shortage of nurses, especially in areas experiencing high numbers of COVID-19 cases, will have long-term repercussions for the profession, the entire health care delivery system, and ultimately, on the health of the nation,” wrote Grant.
According to the Bureau of Labor Statistics, the U.S. lost 17,500 health care workers in September and 524,000 health care employees since the start of the pandemic. In mid-October, the Biden administration announced its plans to direct $100 million to the National Health Service Corps (NHSC) to help address the health care worker shortage, which, in addition to nurses, includes physicians, physician assistants, nurse practitioners and other health-related occupations.
While the start date for the funds is in September 2022, individuals engaged in higher education as well as organizations supporting the education and career success of these workers are focused on current and future solutions to keep the health care workforce strong.
“It’s taken the pandemic to expose how heavily ingrained racism is in our health care system,” says Dr. Danielle McCamey, founder, CEO and president of DNPs of Color. “My hope is that we … improve health care to make a bigger leap to achieving health equity.”
ANA urged that HHS convene stakeholders to discuss staffing challenges and potential solutions. This includes payment equity for nurses and additional resources from HHS, including recruitment and retention incentives. It also suggested removing regulatory barriers for advanced practice nurses, such as nurse practitioners (NPs), so that they can work to their full scope of practice.
NPs are trained to assess patient needs, order and interpret diagnostic and lab tests, diagnose disease, formulate and prescribe treatment plans. They may focus on several specialties, and many are primary care providers. According to a fall 2020 survey of the American Association of Nurse Practitioners (AANP), 37.7% of NPs work in communities with less than 50,000 people.
“Many NPs have been on the frontlines, providing life-saving measures to patients in desperate need of quality care, and that has led to instances of burnout,” says Bryan Black, vice president of communications at AANP. “Through our podcasts, video messages and daily newsletters, we have directed members, when necessary, to seek professional assistance for any mental health needs.”
The Physician Assistant Education Association (PAEA) represents 282 accredited physician assistant (PA) programs across the country, including Puerto Rico and Hawaii. PAs work in all areas of medicine, including emergency medicine, and many are on hospital frontlines. They examine, diagnose and treat patients, usually working together with physicians. PAEA programs are typically situated within graduate education and work collaboratively with public and private health care systems.
“We recognized the significant disruption and isolation due to the pandemic and worked diligently as an association to prepare our members for the shift to online learning and the adoption of Telehealth,” says Dr. Mary Jo Bondy, CEO of PAEA. “More importantly, we worked to create a space where our members could come together to discuss their concerns and challenges and find creative solutions."
“We supported our faculty and students with town halls in response to the social unrest and tragedy we experienced in 2020 to create brave and safe spaces for difficult conversations, inclusion and mental wellbeing,” she adds.
Easing pathways to education
PAEA has invested in resources such as toolkits, webinars and guidance for its graduate school-based programs. Mindful of budgetary constraints, faculty development workshops all transitioned to virtual events. The board of directors increased the number of application fee waivers, so that those seeking to become PAs would have as few financial obstacles as possible.
AANP has dramatically reduced AANPConnect conference fees so NPs could take continuing education courses and stay updated on the latest information about COVID-19.
Twenty years ago, Sacred Heart University’s (SHU) College of Health Professions consisted of four health profession programs; today it is a group of 13 different programs. In addition to adding programs such as speech language pathology, PA and public health, SHU has added pathways into graduate programs, developed and transitioned some undergraduate programs to master’s degree programs and is developing a doctorate in health sciences.
“We are partnering with local health care systems and government agencies to develop academic programs that meet workforce needs,” says Dr. Maura Iversen, dean of the College of Health Professions. “Physician Assistant studies, occupational therapy, physical therapy, speech language pathology and health care informatics have all seen substantial increases in applications and enrollments.”
Nutrition is a new program at SHU that will start in January. There are applicants in rural areas who will access the program remotely, and Iversen is currently developing relationships with preceptors (clinical supervisors) in rural communities to support them.
SHU students work with multiple populations in the Bridgeport, Connecticut, community on and off campus. Examples include daycare centers, addiction recovery programs and community reintegration programs for individuals recently released from incarceration. Many students do their clinical rotations in federally qualified health care centers.
“Social justice is part of the mission of the university and our college and therefore all of our programs,” Iversen says. “We deal with issues of social justice with respect to inequities in health care delivery and access to care. With respect to the technology, we are teaching our students how to engage in telehealth. Telerehabilitation provides an opportunity for those that have less access to care to actually receive care, even if it is in a different format.”
McCamey hopes the NHSC uses some of the funds to alleviate the financial burdens on health care workers from student loans. “[The] majority of us want to be of service and to be able to do so without the stress of repaying loans increases our capacity to use that energy in the care and management of our patients,” she says.
Black notes that increasing the size of the NHSC State Loan Repayment Program will strengthen the pipeline of NPs and help ensure access to high-quality health care for patients in underserved communities. Last year, in addition to the association’s annual grants and scholarship program, AANP selected five students to receive $10,000 each in scholarship funds through a one-time Loretta Ford Centennial Scholarship.
Today, says Bondy, many PA programs are experimenting with hybrid instruction as students return to campus. Interactive and hands-on learning receive priority time on campuses, while lectures are offered both synchronously and asynchronously to allow students flexibility.
“[Programs] were innovative, providing kits to students and leveraging video instruction to teach and practice common procedures, like learning suturing and other skills,” Bondy says. “Many of the innovations will likely remain in the curriculum post COVID.”
Recruitment and retention
“Our impact areas are to increase diversity in nursing practice through mentorship, networking and advocacy,” says McCamey. “We hope to offer solutions that will support more educational opportunities for nurses of color to go back to school to become nursing faculty because there is a shortage in the amount of nursing faculty to teach nursing.”
Bondy notes that PA students are eligible for NHSC student loan repayment and service, and member institutions are anticipating a positive impact. There has been some attrition of PAs due to the pandemic, but PAEA is seeing an increase in PA programs each year.
“We are working to raise awareness about the PA profession as a career opportunity through outreach to high school students, community colleges and ongoing advocacy to develop a pathway to the profession,” says Bondy. “Through our investment and our research, PAEA is also helping to identify barriers to application and acceptance and working to improve diversity, equity and inclusion in our student and faculty populations.”
Two SHU students in the PA program were recently awarded a NHSC scholarship, which pays for the entire PA tuition, any required fees and educational costs as well as a monthly stipend. In return, NHSC scholars must practice at a NHSC-approved site in a Health Professional Shortage Area for a minimum of two years. Iversen notes that the NHSC does not include physical therapists and she believes more PTs would work in rural and other high-need areas if they were eligible for NHSC grants.
“The Loan Repayment Program portion of the NHSC could be a big boon for many health profession students and may well increase access into master’s and doctoral health professions education programs to people who otherwise could not consider them,” says Iversen. “Scholarships would be even better because loan repayment sometimes is daunting for individuals. The person has to pay the tuition, graduate and then be employed to qualify.”
This article originally appeared in the November 25, 2021 edition of Diverse. Read it here.