HJAR Sep/Oct 2023

12 SEP / OCT 2023 I  HEALTHCARE JOURNAL OF ARKANSAS nurses are expected to retire by 2030, with over 20% of all newly graduated nurses leaving within the first two years of practice, and turnover rates as high as 30% in some parts of the country. 2,3,6,23,24 Approximately 100,000 nurses left the workforce during the pandemic, and one-fifth of the 4.5 mil- lion RNs in the U.S. intend to leave by 2027. These are real threats to our healthcare sys- tem if solutions are not enacted. 25 Supply Schools of nursing struggle to meet increased demands due to barriers such as lack of funding prioritization, faculty, clini- cal sites, and preceptors. 3 Each of these bar- riers has multifactorial root causes, such as one out of every three nursing faculty expected to retire by the year 2025. Addi- tionally, less than 2% of the current nursing workforce holds a doctoral degree required for 58% of the 1,695 faculty vacancies nationwide. 26,27 Furthermore, clinical-sec- tor compensation is grossly incomparable to faculty compensation rates with the same degree requirements. Nationally, the median salary for an advanced practice registered nurse is $120,000, while the salary for fac- ulty members with the same level of educa- tion averages $87,325. 28,29 Mismatch The total number of licensed nurses in the U.S. has grown steadily over the past 100 years. Some projections assert that there will be as many as 1 million additional nurses by 2030. 30 However, other statistics show a major decrease in the number of nurses needed to meet demand. Experts say this is the steepest decline in four decades. 2,8 More robust data are needed to determine why we cannot meet the demands for nurses in Arkansas if the number of actively licensed nurses is growing, yet so is our number of vacancies. Informal conjectures imply that nurses may be leaving the profession all together. However, we can only hypothesize answers until additional data are collected and analyzed. We must first understand the root causes of our nursing workforce issues THE COSTS OF POOR STAFFING OF NURSES Since nurses make up more than 70% of all healthcare workers, deficits of these vital personnel can lead to ominous out- comes. 11,12,13,14 Research shows that poor nurse-patient ratios and poor staffing lead to increased patient falls, nosocomial infections, 30-day readmissions, staff inju- ries, needlesticks, medication errors, and increases in patient morbidity and mortal- ity. 11,13,14,15,16,17 Studies in the past have shown that for each additional patient added to a nurse’s workload, the chances of patient mortality increases by 7%, and newer stud- ies have found that it increases by up to 16%. 15,18 Poor nurse staffing often fuels turnovers, negatively influences patient satisfaction scores (thus reimbursement), increases both patient and organizational costs, can damage a healthcare organization’s repu- tation, and impacts profits. 5 The National Health Care Retention and RN Staffing Report states that the average cost of turn- over for a single bedside registered nurse (RN) is $52,350 and counts for $6-10 mil- lion annually of lost revenue per hospital. 5 For each percent reduction in turnover rate, the average hospital will save $380,000 per year. 5 The Centers for Medicare and Medic- aid Services cost report showed that since implementing minimum RN-to-patient ratios in 2004, hospital incomes in Califor- nia rose from $12.5 billion from the years 1994-2003 to over $20.6 billion from 2004- 2010 without a single hospital closing due to ratio implementation. 19 SCOPE OF THE PROBLEM Demand Factors increasing the demand for nurses include an unprecedented population explosion, an aging population with more than 15% of U.S. citizens over 65, increased nurse retirements, poor retention rates, increased timelines to fill vacancies, and historical numbers of nurses leaving the workforce. 2,3,5,6,7,20,21,22 More than one million in Arkansas if we are to inform policy and establish solutions for the long term. LEGISLATIVE INNOVATION During the 94th General Assembly of the Arkansas State Legislature, held this spring, overcoming challenges to sustain a healthy nursing workforce emerged as a top priority. Determined to understand the complexities of nursing workforce chal- lenges statewide, Senator Kim Hammer contacted the Arkansas Center for Nursing (ACN), the state’s sole nursing workforce center. Senator Hammer collaborated with ACN Executive Director Ashley Davis and President-Elect Sarah Bemis to develop a comprehensive nursing workforce proposal while incorporating feedback from diverse stakeholders throughout the process. The proposal included nine initiatives to holis- tically address needs with nursing faculty recruitment and retention, clinical efficiency and site availability, and enhancements for understandingArkansas nursing workforce issues with research and action planning. As of Aug. 1, 2023, four initiatives progressed into formal legislation, included below, and three became law. All four initiatives were included in a separate workforce funding proposal awaiting decisions fromGovernor Sarah Huckabee Sanders. Bill 298: Establish Salary Bases for Nursing Faculty — Did Not Pass Problem In 2022, 98,000 qualified applicants were turned away from schools of nursing due in large part to inadequate numbers of nurs- ing faculty and clinical sites. 2 Like other states, Arkansas nursing programs have multiple reasons for the inability to accept additional applicants. Arkansas has an aging nursing faculty population, and the state is currently losing 8.8% of the nursing work- force annually to retirement. 2,5 Deans and directors in higher education have reported that nurse faculty are in moderate to high demand in their region. The most common challenges to recruitment and retention are