To help address the shortage of nurses in the state of Utah, the University of Utah College of Nursing will increase enrollment in its prelicensure track by 25% over the next year. College leaders say this increase addresses the rising need for registered nurses in the wake of COVID-19 and because of other factors that are reshaping the nursing profession.
“This initiative is a major undertaking, and it is the right thing to do given the contemporary challenges we face,” says Michael Good, M.D., CEO of University of Utah Health. “It’s vital that we educate, train, and deploy enough nurses in Utah and elsewhere in the Mountain West to provide the health care that residents of this region have come to expect and deserve. This new approach to nursing education will be beneficial to all. I am grateful to our nursing faculty for proactively addressing this challenge.”
To meet this commitment, U of U Health’s College of Nursing will accept an additional 36 prelicensure students each year, increasing its annual enrollment from 144 to 180 students. In the past, the College of Nursing accepted 72 students for either spring or fall semester enrollment. Now the college will accept 60 students three times a year by adding the option of summer semester enrollment.
“We can’t unilaterally solve the nursing shortage. We’re fully aware that a 25% increase in our enrollment will barely put a dent in it. But we care about the people of Utah who need health care, and we’re doing our best to be responsive.”
The college will commit more than $400,000 per year to achieve this goal. Additional personnel devoted to this increase in students will include full-time faculty adjunct faculty, a student advisor, a clinical placement coordinator, and patient simulation specialists, says Marla De Jong, Ph.D., RN, dean of the College of Nursing.
“It’s important that people in Utah, as well as the rest of the country, have an adequate number of nurses to meet their health care needs 24 hours a day, 7 days a week, 365 days a year,” says De Jong. “We are trying to graduate more registered nurses to meet the growing demand and, in particular, ensure that there are enough nurses in Utah to provide quality care for patients now and in the future.”
More than 2,500 unfilled registered nursing positions in the state
The change comes at a time when the profession is facing a potentially crippling shortage of nurses nationwide. In fact, the US Bureau of Labor Statistics projects nearly 176,000 new job openings a year for registered nurses through 2029.
In Utah alone, more than 2,500 registered nursing positions are currently unfilled, according to De Jong. This gap is particularly striking given that 88% of College of Nursing graduates live and work in Utah. It is also one of the major reasons the college is expanding its enrollment, she adds.
The severity of the shortfall hit home earlier this month, when 20 US Navy medical personnel, including 14 nurses, were deployed to University of Utah Hospital to help alleviate staffing shortages that had kept 52 beds out of service. The shortage led the hospital to defer hundreds of surgeries and limit acceptance of transfers from outlying hospitals.
However, this short-term solution will not resolve the long-term problem, according to Melody Krahulec, DNP, M.S., RN, assistant dean for Undergraduate Programs at the College of Nursing. Long hours, physical stress, and mental strain have taken their toll on nurses for decades, leading many of them to leave the profession. The COVID-19 pandemic has merely exacerbated that trend, with perhaps as many as one in five considering leaving nursing within the next two years.
Add to this that almost one in five Utah nurses are approaching retirement age, and the future of health care in the state could be challenging. “That’s why an influx of a new generation of highly trained and competent registered nurses is vital,” says De Jong.
“We can’t unilaterally solve the nursing shortage,” De Jong adds. “We’re fully aware that a 25% increase in our enrollment will barely put a dent in it. But we care about the people of Utah who need health care, and we’re doing our best to be responsive.”
In addition to new faculty, the College of Nursing will be seeking additional preceptors in community hospitals and clinics to oversee the 900 hours of clinical experience required for each nursing student prior to graduation.
“We’re grateful to our health care partners within the Salt Lake Valley for doing their best to accommodate the experiential aspects of our nursing education,” says Krahulec. “As we expand, their continued support in providing clinical placements that ensure our students are exposed to a multitude of caregiving situations is fundamental.”
Enrollment for the summer 2022 semester has been filled, and the fall 2022 application cycle is closed. Spring 2023 semester applications are due by September 1, 2022, and fall 2023 applications are due by February 1, 2023. The deadline for summer 2023 applications will be announced soon.
The $125 million donation by Leonard A. Lauder, Chairman Emeritus of The Estee Lauder Companies, to create this first-of-its-kind, tuition-free Program is the largest gift ever to an American nursing school. Mr. Lauder is a Penn alumnus. The gift comes at a time when the COVID-19 pandemic has magnified the nation’s acute shortage of primary care providers, and persisting inequities in access to quality healthcare.
“This is the most timely and consequential gift not only for our university but for our country. It is unprecedented in its potential to address America’s most critical need of providing primary health care to all who currently lack it by investing in nurses,” said former Penn President Amy Gutmann.
“Growing the number of nurse practitioners who are prepared and committed to working in underserved areas is the most practical and inspiring way to ensuring a healthier country. I am grateful and honored that Leonard would make this gift to Penn Nursing, and thrilled to know that it will have an immediate impact that will last far into the future.”
Nurse practitioners are leaders on the front lines of care, a role never more important as Americans confront a primary healthcare shortage in their communities. With their advanced clinical training and graduate education, nurse practitioners have the knowledge and skill to supervise and manage critical aspects of care in a decision-making capacity, from patient diagnosis, to ordering and interpreting tests, to prescribing medication. Nurse practitioners deliver high-quality primary care to people of all ages, such as treating common illnesses, managing chronic conditions, and providing preventive care that helps patients stay healthy.
Nurse practitioners are also able to take on key leadership roles, from managing and operating walk-in or community clinics to leading interdisciplinary teams within health systems. The new Program will better the lives of patients and communities most in need, while providing a pathway for the many nurses interested in advanced education who may not otherwise have the means to pursue it.
The Program
Structure: Leonard A. Lauder Community Care Nurse Practitioner Fellows will enroll full-time in a two-year, rigorous Primary Care Nurse Practitioner Program at Penn Nursing.
Community Practice: Fellows will complete at least 50 percent of their clinical education at community partner sites in the greater Philadelphia area that provide direct patient care, an invaluable experience that will prepare Fellows to meet the complex needs of patients and families throughout their careers. Every Fellow will be expected to commit to practice or service in an underserved community for two years after graduation.
Recruitment: Penn Nursing will select 10 Fellows to begin classes this fall, growing the program enrollment through 2026 when it will reach its annual target enrollment of 40 Fellows, continuing in perpetuity. By 2027, the program will have enrolled 140 excellent nurse practitioner students. Fellows will need to show a demonstrated commitment to working in underserved neighborhoods, where they are needed most, and to promoting health equity.
Tuition: All participants in the program will enter the workforce free of graduate school debt, receiving student aid to cover their tuition and fees and thereby eliminating any potential financial barriers for nurses and others who wish to enroll. Fellows with greater financial need will also receive stipends to help with living expenses.
Program Leadership: Penn Nursing will name the first endowed Leonard A. Lauder Community Care Nurse Practitioner Professor, who will oversee curriculum innovation, support of community sites, and program implementation.
Penn Community Partnership: Penn Nursing will provide support for select community partner sites to support the clinical education of Fellows while providing professional development and networking opportunities and access to School and University resources.
“Penn Nursing has a long history of advancing science, promoting equity, practice excellence, and preparing leaders. That’s why Mr. Lauder’s gift is so meaningful. The synergy between Penn Nursing and the Program will improve the health of underserved patients and families, by uniquely preparing primary care nurse practitioners, who will work with them in their communities. The sustained investment in the education and careers of primary care nurse practitioners and communities is unprecedented. We are excited by the opportunity to lead this important Program and to extend its impact beyond Penn Nursing,” says Penn Nursing Dean Antonia Villarruel. “We are deeply grateful to Mr. Lauder for recognizing and investing in this critical need, and for partnering with us in this ambitious endeavor.”
NPs are “key” to health care in underserved communities
Stephen P. Fera, Executive Vice President of Independence Blue Cross, which is one of the community partners that will be involved in the new initiative, noted that nurse practitioners are key to improving individual and community care. Said Fera: “Bolstering the nurse practitioner workforce is a means to improve access to care and strengthen the health care safety net provided by health centers. This is a key priority of the Independence Blue Cross Foundation and our partnership with Penn Nursing has been synergistic in efforts to prepare nurses to work in community-based settings. The Program will build and strengthen our individual and collective efforts toward improving the health and well-being of communities.”
“Now more than ever, the country needs greater and more equitable access to quality primary care—and highly-skilled nurse practitioners are the key to making that happen,” said Leonard A. Lauder. “The program will ensure that more Americans receive the essential health care services that everyone deserves, and I’m so pleased to be working with Penn Nursing on this initiative. I look forward to welcoming our first class of future nurse practitioners this fall. I know their expertise will be matched only by their commitment to serving our communities.”
A University of Arizona College of Nursing researcher was one of only four recipients of a $4 million American Cancer Society grant to develop a “Cancer Health Equity Research Center” with the goal of improving health equity for Hispanic cancer survivors and family care givers.
“We will be developing and testing interventions that can be incorporated into clinical practice,” said principal investigator Terry Badger, PhD, RN, professor and Eleanor Bauwens Endowed Chair in the University of Arizona College of Nursing and UArizona Cancer Center member. “By looking at health care utilization and many social determinants of health, we’re hoping to come up with ideas of how we can decrease health disparities and enable people to access the health care they need.”
According to the American Cancer Society, which designated the funds for Minority-Serving Institutions, the centers will implement solution-based research addressing cancer health disparities that will contribute to achieving health equity and reducing cancer mortality. The University of Arizona is designated as a Hispanic-Serving Institution by the U.S. Department of Education.
UArizona Health Sciences researchers will focus on three areas:
assessing care and treatment needs of kidney and liver cancer patients
assessing the impact of diet and physical activity interventions on lifestyle behaviors
symptom management and health care utilization in rural and urban underserved populations.
“Terry has laid the foundation and is a national leader in supportive care, research and training,” said Joann Sweasy, PhD, the Nancy C. and Craig M. Berge Endowed Chair and UArizona Cancer Center director. “She is most deserving of this prestigious award.”
Dr. Badger will use her experience to increase participation in clinical intervention trials for underrepresented cancer survivors and their caregivers.
“We are going to work with our communities to develop and test effective, accessible interventions that will benefit cancer survivors and caregivers,” Dr. Badger said. “I have a very successful history of including underrepresented cancer survivors and their caregivers in my trials. We have over 450 cancer survivors and their caregivers in one of my studies right now and about 40% of those are Hispanic.”
Additionally, the grant will allow Dr. Badger and her team to train the next generation of researchers and develop synergistic relationships with other UArizona Health Sciences and UArizona researchers to foster more projects focused on cancer health equity.
Nurse researcher and educator Kasey Jordan, RN, PhD knows the stereotypical image of a school nurse – overworked, underpaid and, over the past two years, often on the front lines of controversial COVID policies.
And while those things are true, they aren’t the complete picture, says this Nurse of the Week.
“We don’t always present them as these strong, capable expert professionals that they are,” she said.
The same could be said for nursing in general – or for any traditionally “female” job. But Jordan sees the power in the interpersonal connections that nurses build with their patients and, from that, their capacity to create community change.
“If we’re serious about having better patient outcomes for society, then it’s areas in which the traditional nursing role can lead that really, I think, have a lot of potential to make a big difference. Things from communication to health promotion to what happens outside of that time when people are sick,” she said.
School nurses as “change-makers”
The possibilities inherent in nursing have inspired Jordan ever since she accidentally ended up in a nursing class in high school in rural Georgia.
“In high school, there were vocational classes that we took with all the other classes, and I wanted home ec, but I got stuck in health occupations against my will. Well, it stuck, and it really resonated with me,” Jordan said. “I ended up including those classes as part of my program of study, and I did an apprenticeship program with a local family practice and just never looked back.”
Even with the limited work that a high school apprentice could take on, she felt a meaningful engagement with patients and saw the role that the nurses played in their patients’ health journeys.
Jordan went on to study nursing with the expectation that she would be a bedside nurse, but by the time she finished her program, she knew she wanted to be in public health. Her first nursing job was in the cardiothoracic unit at Duke University Hospital to gain experience. Then she worked at the health department for a time before taking a job in the emergency department so she could complete an internship while earning her master’s degree.
Through the public health department, she spent a year and a half as a school nurse in Durham, North Carolina, at five alternative schools, each geared toward a different student population that needed extra attention.
“Every school had its own flavor,” she recalled.
Yet she also started to see constraints in the system.
One small example: The alternative schools were well-connected to mental health and behavioral resources for the students. But Jordan saw that some students weren’t having truly basic needs met, like good nutrition, decent sleep and adequate physical movement. Jordan approached an administrator about this, and the answer was, “Well, there’s no grant funding for that.”
“It was like, there’s all these high-level treatments that are so valuable. But then there’s also these basic processes that are so impactful on our outcomes. And it was sometimes harder to work on those things,” she said.
In both public health and school nursing, Jordan found herself surrounded by “incredibly smart people with great ideas” who faced numerous obstacles in bringing those ideas to fruition.
“That core challenge is really what led me to go back for my Ph.D. and what, in different ways, I’ve tried to explore since then,” she said.
Now an assistant professor in the College of Nursing at MUSC, Jordan focuses on innovation management. She especially values how school nurses and other health care providers find ways to develop resilience in communities and address disaster risk.
“What I’m most excited about is nurses and health professionals finding ways to make our communities more resilient to disaster. School nurses are incredible change-makers, and so are our students,” she said.
For instance, students in the accelerated Bachelor of Science in Nursing classes are learning the change-making skills that school nurses often learn, by necessity, on the job, Jordan explained.
Innovative projects the ABSN students have tackled recently included a podcast geared toward mental health challenges during the pandemic and support for educators to understand how COVID-related changes could affect student health.
School nurses play key role in community resilience
Jordan noted, too, that local disaster response requires flexibility to adapt to specific circumstances, and that’s where she’s interested in seeing who’s doing what.
“If you consider disaster response, there’s this piece of improvisation that is in it. It’s such a fascinating area, and school nurses have been on the ground improvising to meet these needs,” she said. “It’s really inspiring – and important to understand.”
“So much of responding to disaster is locally driven,” she continued. “So understanding what professionals in community spaces need is important.”
Jordan said she loves seeing school nurses who understand how comprehensive the role can be and are pushing expectations of what they’re there to do.
“One of the amazing gifts of school nursing practice, because you are outside the traditional system, is there is so much freedom and independence,” she said.
On the other hand, that requires skills that nurses don’t necessarily come equipped with. Unlike nurses in a health care setting, school nurses may need to be more entrepreneurial to “sell” innovations related to health.
“School nurses really have to build their teams and raise whatever kind of capital is needed – social or financial – to see their changes move forward,” Jordan explained.
While there’s general agreement that addressing health and physical needs will ultimately help with academic outcomes, Jordan said, the rub is the school nurses actually have to negotiate to get what’s necessary to address that health. That’s where those skills of teambuilding in a multidisciplinary environment come into play.
“There’s good evidence that school nurses are a great return on community investment, but I think there is more to tell about the community resilience they are building that is outside the traditional expectations of what school nurses have done,” she said.
In follow-up to a previous study she conducted, Jordan is currently looking at how school nurses are leading resilience-promoting change in school settings.
Since coming to South Carolina, Jordan has been working with the South Carolina Association of School Nurses to determine what subject areas need more research to help nurses in schools. That’s how she came to do an analysis of continuing education needs for school nurses, which led to her examining how school nurses are leading resilience-promoting change in school settings.
Throughout her journey, one fascinating thing that she has discovered is that innovation can come from anywhere.
“There’s not a single profile of an innovator,” she said. “It’s something that happens in all parts of an organization. But definitely there are skills we can learn to make it more effective.”
Flight nurse Morgan Hand, BS, RN is never in the same place for too long.
Her employer is Sanford AirMed, and she calls Fargo, North Dakota home, but when Hand clocks in each day, she never knows where her shift will take her.
“One of my very first flights, we actually had to fly all the way out to the Montana border, and then fly that patient all the way to Rochester. It was basically a really big triangle. I want to say maybe seven, eight hours.
“With (Sanford) AirMed, we could transfer anywhere within the United States. We even do transports to Canada if it’s necessary. We can go pretty much anywhere,” Hand explained.
And she’s gone pretty much anywhere, even escaping the wind-cutting-right-through-ya Midwest winters for a much more temperate climate.
Empowering other nurses across the globe
Hand returned from a working trip to Costa Rica on Feb. 19. It was part of Sanford World Clinic’s newly launched Global Nurse Mentor Program, aimed at impacting health care across the globe.
In this program, which was launched at the beginning of 2022, providers like Hand share their skills and experiences with international providers.
“Really what it’s designed to do is to take nurses within the Sanford system and mentor nurses throughout our different partnerships throughout the world,” Hand said.
Hand was sent to Hospital Metropolitano, a hospital in San José, Costa Rica.
“With my World Clinic mentor, my person who I work with directly in the World Clinics, we decided pretty early on that trying to empower nurses and looking at the culture was going to involve me going there right away,” she said.
Always looking to get better
Hand spoke highly of the already existing care at Hospital Metropolitano, saying, “their foundation is already there.”
She added the providers at Hospital Metropolitano keep their egos at the door and only focus on what’s best for the patient.
“A lot of the workers, whether it’s physicians or the nurses, they want to grow. They want Sanford’s help. So, that was really enlightening to see that they wanted me there. Even if you are the best health care in the world, you could still grow and learn,” she said.
Hand said it’s humbling that Hospital Metropolitano asked to partner with Sanford Health.
“A couple of their physicians have worked here in the United States. Their chief medical officer trained in the Twin Cities. So, he had known about Sanford. They saw that Sanford had grown and has done all these things with quality and safety, really helping them be one of the best. They saw that and said, ‘We want to take that in and be just like them,’” she said.
Hand will participate in the mentor program for the rest of 2022.
Reaching beyond Costa Rica
Initially, Hand was excited about growing health care in Costa Rica. Once she was there, she realized just how much of a reach Hospital Metropolitano has.
“There’s actually a lot of different patients that they serve from around the world. There was a patient there from Argentina. I got to talk to a family that was from Canada that actually had to have a procedure done while they were there.
“So, it’s not only impacting Costa Rica, but it’s truly impacting multiple countries around the world,” she said.
Hand said she considers the Global Nurse Mentorship Program a once-in-a-lifetime opportunity.
“I love that Sanford’s doing this. It’s a really good partnership. I think we all went into health care to help people get better. To do that on a global scale is something that honestly, I can’t really put into words.”
When Ingrid Johnson, DNP, MPP, RN, FAAN was an undergraduate, she wasn’t really sure if she was on the right path. At the time, she was pursuing a Bachelor of Science in nursing.
“I was ambivalent as a BSN student and early on questioned my decision to be a nurse as I wasn’t sure I really fit in the box of what a nurse was supposed to be,” Johnson said.
Pursuing a DNP presented Johnson with the usual stresses and challenges: she continued to work a full-time job throughout and juggled job, parenting, and school duties. She recalls, “One day, my youngest approached me and said, ‘Mom, we never see your eyes anymore. You are always studying or working.’ It knocked me off my feet and I realized I needed to figure out some different habits so I wouldn’t miss my kids’ lives.” But the experience was also a game-changer: “Now I have a job that didn’t even exist when I first became a nurse. More education is never bad. I am so pleased I didn’t stop learning.”
Johnson, who is the president and CEO of the Colorado Center for Nursing Excellence, continued to work full-time at the center (though in a different role) during her time in the DNP Innovation Leadership program.
Her DNP project was focused on growing programs for advanced practice registered nurses in rural areas. Johnson’s passion for that work carried over to her day job after graduation. “I continued to work on that and brought in several million dollars of funding to support building APRNs in rural and underserved communities across Colorado,” she said. The United Health Foundation read my initial article on the project in Nursing Administration Quarterly and we have now expanded the project from an FNP focus to add PMHNPs.”
Even as she was promoted, Johnson remained committed to the program, and in 2021, she was inducted into the American Academy of Nursing on the power of that work.
Johnson has always understood the importance of lifelong learning for a nurse and sounds almost like a Greek philosopher when she says, “The real reason I sought a doctorate was that I knew education teaches us to think differently and ask different questions. One of the hardest realities for me was identifying that the more I learn, the more aware I am of how much more there is to learn.” Her DNP, she adds, “reminds me of that as I continue to learn new things from my staff and the world around me on a daily basis. It has been humbling and very gratifying.”
“We were not only permitted to think outside the box, we were also expected to do so and seek the evidence to support it.”
For herself, Johnson’s DNP journey helped her find her place as a nurse innovator. In her very first DNP course, “[Faculty members] Kathy Malloch and Tim Porter-O’Grady… pulled no punches and told us to think bigger, more creatively, and get out of our own way. I realized that in my whole career as a nurse and life as a student, we were told to follow the evidence and only do what we were told to do. Nurses follow evidence-based practice, so there was never the space to think outside the box. Now, we were in an innovation leadership program and we were not only permitted to think outside the box, but we were also expected to do so and seek the evidence to support it.”
To Johnson’s mind, “It was scary because over the years, I had been slapped down for not fitting the mold or for thinking of alternative ideas. When they told us that our job was to stop being a linear thinker and to find evidence around other less obvious solutions, it was incredibly freeing. I think we are born creative, and in an effort to learn evidence-based care and practice, we lose that, and often we are not permitted to find that side of ourselves again.”
The learning experience behind her DNP, Johnson remarks, also has made her a more perceptive nurse leader. Her doctoral work “opened my heart to look outside my own ideas and better listen and learn from those around me so we can innovate to support… I didn’t have the tools to really do that prior to this degree, but now I often have the right tools, and if I don’t have the right tools, I have the resources to figure out what tools I need and how to get them.”
What advice does she have for current and future DNP students? “Enjoy the process and embrace the reality that for the rest of your life, you will have more questions than answers … and that is OK. Stay curious. Remember that when you get feedback that doesn’t feel warranted, listen for what is true in the feedback. It can be your greatest gift. Even if only 2% of the negative feedback is correct, it may be exactly what you need. If you knew everything and did everything perfectly the first time out, you wouldn’t need to be there!”
Hand returned from a working trip to Costa Rica on Feb. 19. It was part of 