Four years after the COVID pandemic reared its ugly head, the days of perpetual crisis mode are mostly over at North Carolina’s healthcare organizations.
For human resources professionals in medical care, that’s provided a chance to relax just a little, to sit back and take a deep breath.
“It’s been a journey,” says Jeronica Goodwin, chief people officer at Raleigh-based WakeMed. “But I’m glad to say that we’re practically back to pre-pandemic levels of staffing, with vacancy and turnover rates that are well below the national average. The market is normalizing. There’s finally a little relief.”
Good news, but it may not last long. Goodwin and other healthcare execs know another staffing crisis is looming. Healthcare concerns are staring down a labor shortage in the next few decades. North Carolina will be short 17,500 RNs and LPNs within a decade, according to a report this fall by the state departments of Commerce and Health and Human Services. That assumes no major healthcare event, like another pandemic, between now and then.
Industry leaders agree that there’s no single cause for the coming shortage. Issues include education, retention and workplace safety. Nursing schools need to turn out more graduates, but that means addressing a shortage of instructors. Hospitals and healthcare systems should make workplaces more inviting, which can require more resources.
North Carolina is also affected by its aging population, with the number of adults age 65 and older expected to double by 2040. That group will outnumber children (17 and under) by 2031, a first in North Carolina history, according to state data. More elderly residents means greater need for healthcare services, including nurses.
In response, industry and political leaders are priming the pump to add more nurses. About 12,000 students were enrolled in North Carolina’s 145 nursing education programs through last fall. Later numbers aren’t available.
Those programs churned out 3,634 graduates, including both RNs with four-year or two-year degrees and LPNs. Enrollment increased slightly from the year before, but the graduation total is 1% less than the previous year.
To change that direction, legislative leaders set aside about $546 million in the two-year state budget that runs through mid-2025. There are 45 different programs and initiatives to boost enrollment and graduation of nurses. The vast majority of money is coming from the $1.64 billion federal bonus that North Carolina received when it expanded Medicaid insurance to more low-income, working-age adults in 2023.
The feds didn’t restrict how the state spends that money, and lawmakers opted for a lot of construction. The biggest piece, about $292 million, is for new buildings and equipment and equipment for healthcare instruction. All but about $25 million is directed to community colleges, including four new nursing education buildings within 70 miles of each other in the western Piedmont counties of Burke, Caldwell, Gaston and Rutherford.
The community college system is also receiving $55 million to help create new programs or expand existing ones, while the UNC System is getting $40 million for similar reasons. Though smaller in scope, a $7.1 million recurring appropriation to increase pay for nurse educators at UNC System schools is hailed as especially impactful.
Appalachian State University started its graduate-level MSN Educator program because of increasing demand, says Marie Huff, dean of the school’s Beaver School of Health. “But the compensation needs to be attractive, too, or they won’t stay with us to teach.”
Nursing educators often don’t earn as much as peers on the frontline of healthcare. The average gap in North Carolina is a little more than $10,000 per year, according to the Bureau of Labor Statistics.
Some nurses lose as much as $30,000 in annual salary when they move into teaching, says Trish Richardson, president of the 10,000-member N.C. Nurses Association. “That’s really a step in the wrong direction. There are tradeoffs and most understand that nurses (in healthcare settings) will be paid more, but we do need to improve the pay for educators if we’re going to have more nurses.”
The legislative appropriation provides a 4% increase this year and 3% increase next. In certain situations, based on qualifications or long-time disparities, educators may see an additional 15% bump.
The UNC System has set a goal of increasing the number of graduates by 50% in five years.
Hitting that target shouldn’t be a problem if new funds lead to more instructors, says Tammy Haley, the chair of App State’s nursing department. “Every year we know that we have, and other schools have, qualified students who can’t find a seat,” Haley says. “A lot of that is the faculty question. This will go a long way toward fixing that.”
N.C. Rep. Donny Lambeth, a retired hospital president in Winston-Salem, says the legislature heard the community colleges and the universities “loud and clear. They’ve got students who want to attend, but they don’t have a way to educate them. I think we’ve stepped up there.”
But more is needed. Lambeth says retention must be addressed, and greater marketing would help attract more newcomers to the field. He plans to file a bill creating a “nursing fellow” program at Winston-Salem State University, similar to the N.C. Teaching Fellows program that was formed in 1986 to address a teacher shortage.
The teaching program funds full, or nearly full four-year scholarships at 10 partner campuses (eight public universities, plus Elon and Meredith), for some 400 prospective educators every year. The competitive program has attracted high-caliber students, proponents say.
Back at WakeMed, which employs 4,700 nurses, Goodwin says the focus will remain on sound fundamentals. The Raleigh-based system didn’t take a deep dive into the bonus pool during the pandemic, when competitors were throwing cash around like it was made of used facemasks.
A significant number of nurses who left have returned to WakeMed as their bonus-fueled contracts end, Goodwin says. “I think that speaks well to a culture of safety, of providing adequate resources, of training, basically of just treating people well. That’s pretty simple, but it does tend to bring people back.” ■
