Need For Nurses

The nursing shortage is not exclusive to rural areas. While the problem is more pronounced in rural counties across the eastern and western regions of the state, the major metros are not immune.

“Just because it’s worse in rural areas than urban areas, that does not mean we’re OK in the Triangle — that does not mean that everyone has access to the care they need and that there’s no pressure on the nursing staff here,” said Tina Gordon, CEO of the North Carolina Nurses Association.

The solution isn’t as easy as attracting more talent into the profession. While interest in nursing careers remains high, access to degreed programs is constrained. Last year, more than 65,000 qualified applications were denied acceptance at nursing schools nationwide, including over 55,000 applications to entry-level baccalaureate programs, according to the American Association of Colleges of Nursing.

The primary reasons for not accepting qualified students were a lack of resources, including insufficient numbers of clinical placement sites, faculty, preceptors and classroom space, as well as budget cuts for nursing programs.

“We can’t educate our way out of this,” Gordon said. “We’re not going to be able to make enough new people to cover all of our shortage areas. Instead, we’re going to have to be smarter, faster, more efficient and use the technology tools that are available.”

As an example, she cites virtual nursing, where technology monitors patients in their homes with real-time alerts for key health parameters such as glucose measurements or heart rates.

“AI tools are being utilized to help analyze that data and provide recommendations, but there’s still a human component, a person managing the evaluation and response,” she said. “A virtual nurse may be a more seasoned nurse who acts as a consultant to nurses who are in person on the floor and who may support multiple locations.”

The goal is to relieve the workload for nurses, often assuming rote tasks like the delivery of discharge instructions. “Using tools to supplement or enhance patient care and extend staffing is important, but there has to be a balance. Nursing has always had a very important human component that contributes to healing,” Gordon said.

That human component, which invariably entails empathy and engagement, is also a key reason people choose a career in nursing. But it’s also a contributing factor to burnout.

Another misperception is that the nursing shortage has been predominantly driven by pandemic burnout. While the pandemic exacerbated stressors and demands on nurses more intensely than any event in recent history, the potential for burnout among nurses is inherent to the work performed.

In 2019, the World Health Organization defined burnout as “a syndrome resulting from chronic workplace stress that has not been successfully managed. It is characterized by feelings of energy depletion or exhaustion; increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and reduced professional efficacy.”

Felice Carlton, an integrative health coach and nurse practitioner who helps medical professionals and organizations address stress and burnout, said she has personally experienced burnout many times in her life – “not just because of the workload in nursing, but also because of me. I realized there are personality traits that can make a person burn out a little bit quicker than the average person.”

Based in Charlotte, Carlton is frequently a speaker for the NCNA and approaches the topic of burnout from a holistic perspective, coaching individuals: “This is not just something in your head. You’re not just tired and exhausted,” she said.

Currently, the NCNA is also stepping up its support for communities across western North Carolina and working to make resources available so that nurses in the disaster areas can return to reasonably stable conditions as soon as possible.

“Even though the impacts of a pandemic look a little bit different than the impacts of a natural disaster, you still have a similar impact on burnout, mental health and compassion fatigue,” Gordon said. “These are all real things, and what we’re going to have to watch more closely is what happens after the short-term response subsides. For nurses, there’s going to be a longer-term impact, and for those who experienced personal impacts, their ability to serve the community is affected as well.

One opportunity to address the shortage of health care providers would be to address the state’s regulations, particularly relative to nurse practitioners – restrictions that Gordon said are crippling progress.

“There are regulatory tools being utilized in more than half the country with no adverse effects that our state has yet to evolve into,” she said.

In western North Carolina, NCNA has advocated for temporary emergency waivers that would loosen requirements around advanced practice nurses.

“We had similar waivers in place during Covid that gave them more flexibility. These are 1970s regulations that are a holdover from back in the day and that we’ve been trying to retire for a number of years,” Gordon said. “We sum it up by saying we need full practice authority for all advanced practice nurses.”