In a unique effort to jump-start young people into healthcare professions, including nursing, one philanthropy will provide $250 million to create special high schools to prepare students for healthcare careers.
In January, Bloomberg Philanthropies announced an initiative to pair public education systems and hospitals in ten communities nationwide, ranging from Boston, MA, to Demopolis, AL. “By combining classroom learning with hands-on experience, these specialized healthcare high schools will prepare students for careers with opportunities for growth and advancement,” says Michael R. Bloomberg, founder of Bloomberg Philanthropies and 108th mayor of New York City, in a press release.
According to Bloomberg Philanthropies, each school, whether newly established through this initiative or a revamp of an existing school, will offer students robust academic programming, specialized healthcare classes, work-based learning at the partner health system, and the opportunity to earn credentials and certifications.
Immediately upon graduation, a press release notes that students can enter healthcare jobs within the partner healthcare system or advance their healthcare career through post-secondary education. As part of this initiative, all health system partners have committed to providing job opportunities for students who complete the graduation requirements of their programs.
Memorial HermannStaff Teach Alongside High School Teachers
At Houston-based Memorial Hermann Health System, the initiative can help address the nursing shortage, according to Bryan Sisk, DNP, RN, chief nursing executive at the system. “The pressure is on to be innovative and look at unique ways to solve this,” he says.
Bryan Sisk, DNP, RN, chief nursing executive at Houston-based Memorial Hermann Health System
An initial $31 million investment from Bloomberg Philanthropies will enable Memorial Hermann and the Aldine Independent School District to build the Health Education and Learning High School or HEAL High School. Specifically, according to Sisk, the program will refurbish the existing ninth-grade campus at Nimitz High School, creating a mock hospital environment. What students see in their daily interactions at school with the exam rooms “will be the same specification they’ll see when they start their work-based learning programs,” he says.
“The idea behind this partnership is to immerse them,” said Sisk in an interview. Students will start with a summer program before they enter ninth grade and continue it every summer, including the summer after graduating high school. They will participate in job shadowing and rotate through the hospital to see five different career pathways, including nursing, imaging, rehabilitation (physical and occupational therapy), pharmacy, and non-clinical administration.
Starting in ninth grade, Memorial Hermann staff members will teach alongside the high school teachers. “We will create a four-year relationship with these individuals so that we can make sure they have the tools to be successful,” Sisk explains. When students turn 16, usually in the 11th grade, they’ll have an opportunity to start their work experience at Memorial Hermann, according to Sisk.
Sisk hopes this program will excite students about nursing and eventually help stem the tide of nurses leaving the profession. “I think we can turn that tide because these individuals will be immersed in healthcare and nursing over a four-year window. They’ll have nurses working directly with them. They’ll get to know nurses; they’ll get to see what the job entails.” What’s more, after they graduate from high school, they’ll be followed for a year to maintain a connection and help them be successful, notes Sisk.
A side benefit of the program involves promoting health equity. “If you’re truly going to tackle health equity, there’s no better way to do that than to go and get individuals who live in that community, who are invested in that community, and get them on a career track where they can earn a living wage,” Sisk says. They can then, he notes, “encourage future generations to go down this pathway.”
Sisk stresses that the effort is a partnership involving the leaders of Memorial Hermann, Aldine ISD, and the community. “It is something that everybody’s rallying around,” he says. “I think this is going to turn into something that we can do on a much larger scale in Houston,” Sisk says.
The consequences for nursing during the COVID-19 pandemic are serious and potentially long-lasting. Such are the conclusions of a major news report from the National Council of State Boards of Nursing (NCSBN).
Among the findings:
Over the past two years, approximately 100,000 registered nurses (RNs) left the workforce during the COVID-19 pandemic due to stress and burnout. This number represents a portion of the workforce NCSBN would not have expected to leave.
Another 610,388 RNs reported an “intent to leave” the workforce by 2027 due to stress, burnout, and retirement.
Some 188,962 additional RNs younger than age 40 reported similar intentions.
About one-fifth of RNs nationally are projected to leave the healthcare workforce.
“The data is clear: the future of nursing and the U.S. healthcare ecosystem is at an urgent crossroads,” says Maryann Alexander, PhD, RN, FAAN, NCSBN chief officer of nursing regulation in a press release. The research was gathered from a biennial nursing workforce study conducted by NCSBN and the National Forum of State Nursing Workforce Centers.
In normal conditions, the NCSBN would anticipate that some 150,000 RNs would have left the workforce during the last two years, due largely to planned retirements, as well as normal pursuit of education and career change, says Brendan Martin, PhD, director of research at NCSBN in an interview. But the data revealed that 330,000 RNs had departed, combining retirements and those who left the workforce due to stress and burnout.
“In terms of looking retrospectively, we were really floored by that number,” Martin says. With an aging population and an increase in patient demand related to COVID-19, “just treading water and maintaining current staffing levels isn’t sufficient. And so the fact that we have any drop-off, let alone double the number we would anticipate, was really problematic.”
COVID the “Accelerant”
The COVID pandemic, says Martin, brought to light enduring nursing workforce issues. “Many of the issues that are confronting the workforce are long-standing issues. The pandemic itself wasn’t necessarily the driver of a lot of the stress, of a lot of this burnout. It was the accelerant,” Martin says.
The research shows that feelings such as being emotionally drained, fatigued, and burned out were most pronounced in nurses with ten or fewer years of experience. That drove an overall 3.3% decline in the nursing workforce during the past two years, the NCSBN report says.
The number of younger nurses planning to leave poses a special problem suggested Martin. “We’re relying on them to essentially step into more leadership roles to form the backbone of the workforce for the next 30 to 40 years and to really mentor the folks coming up through the ranks.”
Currently, says Martin, there are about 4.6 million licensed RNs in the U.S., with a little over 900,000 licensed practical and vocational nurses.
Solutions from Many Stakeholders
Addressing this problem will take cooperation from many stakeholders, Martin notes. “The impacts of the pandemic were so wide-ranging and so widespread that there isn’t a single key stakeholder that needs to be involved,” he says. “Everybody needs to get involved because it’s about how we educate our future nurses. It’s about how we onboard our new career entrants. It’s about how we support our current workers. And then it’s also about how we leverage the expertise, the built-up knowledge, and the acumen of the older nursing cohort.”
“With intentional policy, there’s a potential to get ahead of the curve and to blunt the impact of some of the things that we’re seeing with intents to leave,” according to Martin. “But more important than that, if we change the way that we mentor new nurses entering the workforce, if we give them the appropriate support and the funding if we talk about mental health services for current nurses, I think that there’s a real potential to build a more resilient workforce. If we make this a more sustainable and enriching environment, I think we’re going to rebound. I really strongly believe that, and I think the research supports it.”
Resilience of Nurses
On a positive note, “We saw a larger proportion of licensed nurses employed in nursing and at the bedside than we have in past and recent cycles,” says Martin. “It was really the resilience of nurses, basically going into the heart of the storm, so to speak, during the COVID period. We saw that come up in the data. That’s not news to anyone. That’s long-standing, how dedicated nurses are to their craft.”
The worst days of the COVID pandemic may be well behind us; still, nurses continue to experience high levels of psychological distress according to a survey fielded in November as part of the American Nurses Foundation (the Foundation) Pulse on the Nation’s Nurses Survey Series that found 84% of respondents say they were stressed or dealing with burnout.
To help address nurse burnout, the Foundation and the United Health Foundation announced in December a three-year, $3.1 million partnership to fight nurse burnout with a Stress & Burnout Prevention Pilot program. According to a press release, the program is designed to transform organizational culture, remove the stigma we are taught to associate with seeking mental health support, and offer nurses a new burnout prevention model to help them use mental health resources earlier and more effectively.
Peer Support at the Core
Peer support notes that Allison Nordberg, Foundation program director, is at the program’s core. In a past survey, two-thirds of respondents, Nordberg says, “Their coworker or peer would be supportive of them, and so we saw that as an opportunity to leverage what we already know within the nursing space, of the connections amongst peers. And at the same time, we also see that there’s still a gap in understanding what resources are available.”
The Stress & Burnout Prevention Pilot program grew out of the Well-Being Initiative created by the Foundation at the start of the pandemic, says Nordberg. “The goal of that was to get mental health and well-being resources into the hands of nurses, those resources that are created by nurses for nurses that could be used quickly and that were all available for free. And we’ve had hundreds of thousands of nurses use one of those resources over time,” she says. However, she notes, there was a realization “that there was going to be a need to do larger work around that structural, organizational cultural rebuilding.”
The pilot, notes Nordberg, also aligns with some of the recommendations from a Nurse Staffing Think Tank. For example, addressing burnout, moral distress, and compassion fatigue were identified as barriers to nurse retention.
Stress Continuum
According to Nordberg, the concept of a stress continuum played a big role in the program’s approach to burnout. This color-coded schema ranks stress using a range from Ready (Green) to Ill (Red). The program wanted to use this concept “to serve as that foundational point for building a larger program that we could implement and bring about that work to address culture and organizational change,” according to Nordberg.
Serving Younger Nurses and Nurses of Color
One particular focus of the program involves meeting the needs of Millennial and Generation Z nurses and nurses of color. “One of the things we know is that for younger nurses in particular, often they don’t know anything other than they came into the profession in the pandemic,” says Nordberg. “So that’s the context that they know. The survey results show that they have higher burnout levels and are less emotionally healthy than their older counterparts. The good news is that they are more likely to have sought professional mental health support, but they still recognize the stigma around it.”
“Nurses of color have echoed similar survey findings of high rates of stress and burnout, and then we also have seen that experiences of racism amongst particularly nurses of color do negatively impact their well-being.”
Phased Rollout
The Foundation will pilot the program in four healthcare organizations. This first year of the pilot program, notes Nordberg, focuses on support of the pilot sites. After that, the program will have a soft rollout to a broader national audience in years two and three. “We see this as a multi-phase body of work,” says Nordberg.
The interventions are not intended to be prescriptive, says Nordberg. Instead, they are “intended to be adapted based on the culture of the unit that’s participating, the person who’s championing the work at their unit level.” The goal is to “take their learnings back and then begin to incorporate that into their organization in their unit.” The specific tools in the program might include online tools and low-tech interventions such as posting a paper copy of the stress continuum in a break room.
“What’s most important is that nurses use the intervention and the tools they’re getting. And we want those tools to be best fit for what their needs are.”
Jennifer Mensik Kennedy, PhD, MBA, RN, NEA-BC, FAAN, the newly anointed president of the American Nurses Association (ANA), comes to her position at a time when nursing faces more challenges than perhaps at any other moment in recent memory.
As the head of ANA, she is faced with a workforce contending with issues such as mental health challenges, burnout, staff shortages, and workplace violence, most of them fallout from a pandemic that has lasted more than two years.
One of the big lessons learned from the pandemic, she notes in an interview with Daily Nurse, is “the importance of well-being for the workforce.” With “so many more deaths and colleagues dying of COVID, we continued to hunker down on that belief that we need to be more resilient or I need to take care of people until people broke, nurses broke. We need to have a continuous structure in place that manages and helps nurses and healthcare professionals to maintain well-being at all times, not just during a massive pandemic,” Kennedy says.
In December, the American Nurses Foundation, an arm of the ANA, along with the United Health Foundation, the philanthropic foundation of UnitedHealth Group, announced a three-year, $3.1 million partnership to fight nurse burnout with a stress & burnout prevention pilot program. According to a press release, the program is designed to remove the stigma associated with seeking mental health support and offer a new burnout prevention model to help nurses use mental health resources earlier and more effectively.
Become a Nurse and Create Change
While nursing shortages can be cyclical, with economic downturns and waves of retirement, the pandemic has worsened the situation, notes Kennedy. “What are long-term sustainable solutions that really will stop us from continuing to go through this cycle?” asks Kennedy. “I think through those solutions, we’ll see that nursing is invaluable to the health of our country and our communities and elevate that voice of nursing and demonstrate that value.”
To that point, In a June 2022 online survey, the American Nurses Foundation and Joslin Insight asked nurses how often their unit has the necessary number of RN staff with the right knowledge and skills. For acute care hospitals, 55% of nurses indicated that less than half the time, their unit needs to have the necessary number, says the survey report.
“Practically speaking, this means that 28% of the time a patient enters an acute-care setting, they are likely entering a unit nurses believe is lacking the appropriate staff to provide quality care,” says the report. This Workplace Survey, a continuation of the Pulse on the Nation’s Nurses Survey Series, also reports on issues such as the ability to take time off from work and intent to leave the profession.
Still, Kennedy notes, for individuals considering becoming a nurse, “there are a lot of excellent organizations with great work environments, great shared leadership who value and listen to nurses. You’ll be able to find your niche and the area you can contribute to. Jump in and help us become part of that voice to make change.”
ANA Focuses on Creating a Safer Workspace
During her time as president of the ANA, Kennedy hopes to work on issues related not only to well-being, but also to workplace violence. “We need to make some serious changes and put into place legislation and practices and organizations that keep our nurses safe in the workplace,” Kennedy says. “We need to operationalize and practice safe staffing, whatever that looks like for the organization, the state, and nationally.” Fighting racism is also on her radar screen, pointing to the work of the National Commission to Address Racism in Nursing.
Listening to Nurses
A repeated concern from nurses is “the failure to listen to nurses from an organizational perspective. That negatively impacts well-being and doesn’t make it a good work environment when an organization doesn’t listen.”
Kennedy says that organizations need to bring nurses to the table through shared governance or leadership to determine safe patient care. This needs to be done “with the nurses’ expertise because they’re the ones that live it, and they know what needs to be done.”
On an individual level, to have nurses’ voices heard, “one way would be to start to participate in their shared governance, shared leadership at their local facility,” Kennedy says.
And, she says, if an organization needs a shared governance model, a nurse can pull information together, present it to their manager, and ask the leadership to start that shared governance model.
Nurses can also join boards and run for elected positions, she notes. But if that’s not feasible, connect with your state or federal representative and “let them know about your experiences as a nurse. We have amazing, fantastic stories about what we do every day.
Nurses tend to say, ‘I’m just a nurse. I don’t know anything.’ Yet, you have such an amazing view of society, and people need to know those stories. Sharing stories with others about what nursing is and what nursing does helps to get our collective voice out there.”
ANA is Creating a Stronger Voice for Nurses
Kennedy feels that “nursing as a profession has never been stronger despite today’s numerous challenges. We are rising to make sure our voice is heard because we are tired of not being seen as valued and not being heard. I feel that people are starting to listen across the country and the world — our voices are getting louder. I want to provide that light for all nurses that we are making and seeing change and that we need to continue working together to create a stronger profession.”
Adaptability, organization, and communication are among the skills you bring to patient care every day and are some of the same qualities that can help you succeed away from the hospital as a nurse entrepreneur.
Nurses have a variety of traits that qualify them for an entrepreneurial path. For one thing, “nurses are the best problem solvers, and that’s a quality that will take them quite far regardless of their setting,” says Michelle Podlesni, RN, president of the National Nurses in Business Association (NNBA), said to be the only nursing organization dedicated to nursing entrepreneurs.
“Nurses have a lot of qualities very similar to what entrepreneur qualities are across the board,” said Podlesni during an interview. Podlesni has compared the traits of RNs and the characteristics of entrepreneurs. She says nurses have excellent communication skills, can prioritize, know how to organize, and are adaptable. In addition, they have sound judgment, dedication, and a commitment to continuing education.
“Serial Entrepreneur”
Podlesni’s path offers a study in becoming a nurse entrepreneur. She started as a Navy corpsman, then attended nursing school and worked as an ICU nurse. She then transitioned to a case management position with an insurance firm. After that, she worked in various other companies, winding up in executive management.
She subsequently started her own senior care company and became an author, speaker, coach, and consultant, becoming president of NNBA in 2014. In addition, she contributed a chapter to the Springer book Evidence-Based Leadership, Innovation and Entrepreneurship in Nursing and Healthcare. “I’ve been a serial entrepreneur for years,” she says.
COVID’s Impact on Nurse Entrepreneurs
As might be expected, COVID has sparked additional interest in nurse entrepreneurship. “We definitely have gotten a lot more interest and membership growth,” says Podlesni.
In 2013, she wrote “UNconventional Nurse: Going From Burnout to Bliss!” Then, 30% of nurses were considered burned out, she says. Now, 50% of nurses are looking to leave, she says, pointing to a recent survey with that finding.
Conversations Podlesni has with nurses about COVID take two forms. The first is the nurse who is looking to do something different. The second is with business owners who need help dealing with the impacts of the pandemic on their businesses. Podlesni says she saw nurse entrepreneurs take advantage of legislation allowing more use of telehealth because of COVID.
Types of Businesses
Consulting services rank as the top type of business for nurse entrepreneurs notes Podlesni. “It’s unbelievable the knowledge and experience nurses have that translates so well to providing consulting services, depending on the specialty they’re involved in.”
Education and training represent another big area for nurse entrepreneurship. Elder care is a further area of opportunity, she notes. She says that with insufficient facilities available to care for those over age 65, how seniors will age in place and maintain their health provides an “endless array of services” in the senior care market. Other popular areas for entrepreneurship include mental health and wellness; holistic nursing; informatics; and legal nurse consulting.
Getting Started as a Nurse Entrepreneur
Nurses, notes Podlesni, need to be mindful of the business aspects of healthcare, including such areas as technology, legislation, and socioeconomics. Such awareness can alert them to opportunities. “Nurses just becoming more aware and understanding that they have potential to practice independently as they choose” is important, she notes.
Achieving Autonomy
Nurse entrepreneurship involves “nurses understanding and believing in themselves, that they can create a business and independence that allows them to have the lifestyle they choose to lead,” says Podlesni. “I think that’s what most nurses want. They want more autonomy.”
