No answer to the call button: Nursing shortage looms in Michigan

In 2007, warning of a nurse shortage in Michigan and long admission waiting lists for nursing schools, then- Gov. Jennifer Granholm proclaimed: “Something's wrong with this picture and we are going to fix it.”

Well, not exactly.

Six years and millions of dollars later, there are renewed warnings of impending nursing shortages. Hiring bottlenecks persist at the very nursing schools that could turn out more nurses. An aging nursing faculty is poised to leave more teaching vacancies as they retire.

And as more baby-boom nurses also leave work this decade, experts foresee trouble ahead.

“We have an aging nursing work force and our nursing faculty is even older,” said Carole Stacy, director of the Michigan Center for Nursing, a program of the Michigan Health Council.

While Stacy said that some schools have worked through their waiting lists, she said others still have lists “several years long.”

At the moment, however, Stacy believes there are enough nurses in Michigan to meet demand. In her view, job postings in hospitals and elsewhere that are going unfilled are often due to specific credential requirements, as opposed to a general shortage of qualified candidates.

But with thousands of Michigan nurses in their 50s and 60s, that soon could change.

1 in 3 RNs approaching retirement age

“What I am hearing now with the economy getting better, is that nurses who put off retiring are saying they are going to retire. In about two years, we are going to see shortages.”

A 2010 survey by the Center for Nursing underscores her concern. It found that more than a third of registered nurses were age 55 or older and 43 percent of licensed practical nurses were 55 or older. At the time, there were nearly 160,000 nurses licensed by the state of Michigan.

Nursing faculty have a similar profile, one reflected not only in Michigan but across the country.

A national survey of 2010-2011 nursing programs country found the average age of master's degree-prepared nurse professors to be nearly 58 and associate professors 56. In 2011, the Center for Nursing reported that 41 percent of full-time nursing faculty were 56 or older.

According to the American Association of Colleges of Nursing, U.S. nursing schools turned away some 75,000 qualified applicants from baccalaureate and graduate nursing programs in 2011 because of insufficient faculty, clinical sites, classroom space, clinical teachers and budget constraints. About two-thirds of nursing schools that responded to its survey cited faculty shortages as a reason for not accepting qualified candidates into baccalaureate programs.

Demand for nurses will grow

At the same time, numerous forecasts project a rising need for nurses just as baby-boom nurses retire over the coming years. According to the Bureau of Labor Statistics, the number of needed nurses will grow from 2.74 million in 2010 to 3.45 million in 2020. That reflects the inescapable fact that America is aging and that older people require more health care.

The number of those 65 and older is projected to rise from 40 million in 2010 to 55 million in 2020 and 72 million in 2030. In 2008, people 65 and older comprised 13 percent of the population, but accounted for 35 percent of hospital discharges, according to a federal report.

The predicted demand would seem to dictate comparable growth in capacity at nursing schools. But experts say the barrier to hiring remains much the same as when Granholm launched the Michigan Nursing Corps, an initiative to train more nurses:


In 2008, the Michigan departments of Labor and Economic Growth and Community Health awarded $1.5 million in grants to six Michigan nursing schools and four hospital partners, the beginning of the Michigan Nursing Corps. That was expanded to total spending of $7.3 million through 2011. It added 93 clinical faculty through partnerships and 86 master's degree and doctorate teachers.

But faculty salaries continue to lag what a nurse can make in the field, impeding future hiring.

A clinical nurse with experience can earn upwards of $80,000 at a Michigan hospital. The salary for a clinical nursing faculty position at a four-year program – which typically requires a master's degree – might be $20,000 or more less.

A $20,000 pay cut to teach?

“Pay is really the big issue,” said Debra Nault, director of nursing practice for the Michigan Nurses Association. “The pay is not really what you can earn in a hospital.”

Nault recalled that she earned about $80,000 a year as a clinical nurse specialist at Sparrow Hospital in Lansing, when she contemplated taking a full-time nursing faculty position.

“It was like a $25,000 pay cut,” she said.

On top of that, potential clinical nursing faculty candidates typically need to foot the expense of a master's degree in order to qualify for the position.

“You really have to be motivated to be in that academic world,” Nault said.

At Grand Valley State University's Kirkhof College of Nursing, Dean Cynthia McCurren feels fortunate to have most of her open faculty positions filled at the moment. But she said the salary gap between teaching positions and nursing practice remains a problem.

“It's a pretty big discrepancy. It can be a $20,000- or $30,000-a-year difference.”

At Grand Rapids Community College, the wait list for its RN program is 3.5 to 4 years. And it has been that length for several years, according to Michelle Richter, GRCC’s nursing school director.

Richter said it is a particular problem to attract part-time adjunct faculty teachers – who need a master's degree to be hired – given the compensation the school can offer.

“They are starting at such a low salary,” she said.

Richter said the school is further limited in the number of nurses it can turn out by the Michigan Board of Nursing, which authorizes the number of student “seats” its program can offer.

Jeanette Klemczak, who formerly served as chief nurse executive for the Michigan Department of Community Health, credits the Michigan Nursing Corps with steps in the right direction. She is now health care talent director for the Michigan Workforce Development Agency.

But Klemczak said considerable challenges remain.

She noted that the state projects a 21 percent rise in demand for registered nurses and 20 percent for licensed practical nurses by 2018. That's without accounting for the effects of the federal Affordable Care Act – which is expected to add more insured patients – and the proposed expansion of Medicaid, which could add 350,000 more insured individuals.

“This is like the quiet before the storm,” she said.

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Thu, 05/02/2013 - 9:15am
The nursing shortage is just the tip of the iceberg. Where will the doctors be when 30 million patients are added to the system. Who will provide services under medicare when their payment for those services is being continually cut. I've already had friends told by their doctors that they will no longer be treating medicare patients. The time is coming when 75 years old will be the upper limit for treatment of any kind other than a few generic prescription drugs. There is hope that we could get some common sense into the system. 1) Make all medical care in the US come under a single payer, single price system similar to medicare. Why do we have to pay millions to a multitude of private insurance CEO's and the associated overhead of all the insurance companies. Why does the provider charge different prices for the same service when there are differing insurance (or no insurance) payers. 2) Let the government negotiate the price of all drugs similar to Medicare D. Why should a drug cost $183 when no insurance is involved, and $49 when you have a certain card. 3) This will be a hard one to understand, but the facts are that the benefits we receive in medicare far outweigh what we have contributed to the system including compound interest. There has to be some limitation. Does a 90 year old person really need that $100,000 operation to prolong life for 2 months, or even cause that person to die sooner than they would have if nothing was done? 4) Clamp down on durable medical goods. How many ads have we seen for motorized wheelchairs that are "free" to the customer. Then when these are no longer needed in 1 year when the person using them dies, there is no system to reclaim and refurbish them. They sit in a basement or worse, get thrown in the trash. 5) Make people accountable for their habits. If you smoke, or are obese, or have to drink sugar laden drinks all day long, and if you do nothing to alter your bad habits, then perhaps we say that if you need medical care, the system will not provide as much as it would have had you tried to alter your habits and prevent such diseases.
Thu, 05/02/2013 - 9:41am
Rich, It seems you believe that there should be someone deciding on how all things medical is priced and distributed, your items 1),2),3),4),5). AS best I can tell when that kind of control is placed in an agency/person and they are above the market (in this case the medical and patient wants) then they will always distort what they are trying to control and cause more harm than good. It seems that the current problem is being contributed to because those who are primary responsible for the education are slow to respond to pending need and the market place is not allowed to have its impact felt. I would offer it would be better for all if there was more effort put into helping the patients and potential patients have more information so they can make better informed choices.
Thu, 05/02/2013 - 11:15am
Like nubmer 1. Should just make Medicare the insurer for all Americans.
Adam M
Fri, 05/03/2013 - 10:30am
I find it interesting that you complain about Medicare underpaying and then proceed to suggest moving everyone down to Medicare and having Medicare pay less.
Sun, 05/05/2013 - 9:38am
Never said move everyone down to medicare. Only suggested that the system for those under 65 be similar to medicare with a single payer system that would eliminate all the overhead of a multitude of insurance companies. I believe today that 40% of health dollars for those under 65 goes to overhead. Overhead is non-productive in any system.
Susan Black R.N...
Thu, 05/02/2013 - 9:56am
I think it useful to discuss that low salary for nursing faculty is not the only problem with Nursing Schools. If someone really did a research on Nursing faculty, you would find that they have spectacular academic credentials but no "street creds", i.e, most could not operationalize the theory they teach if their life or a patient's life depended on it. Nursing school faculty need to find "preceptors" in clinical settings, those nurses who give direct patient care in OR, ICU's, clinics, bedside,nursing homes, school systems,home care in order to teach. Those nurses, with their licensure and either a bachelors degree or less make up the bulk of those nurses making that $80K plus. Nurse Anesthetists with Masters degrees have broke the 6 digit income bracket years ago. Traditionally, faculty do not do direct patient care. To really fix the nursing faculty problem, we need to recruit our very best bachelors- prepared clinicians in the field, those who are certified in their area, like a CCRN(critical care registered nurse) and give them trainee- ships to acquire their Masters or PhDs. (this is where MOOCs-- massive open online courses come in). IF a nurse has become an acknowledged clinical expert, she could be groomed for that masters or Phd and become a truly spectacular faculty member. I just got a e-mail from the U of Michigan school of Nursing Dean and they were bragging about a new "nurse Researcher" --- all fine and good. But an nurse is noun not an adjective. Keep in mind too, that the big bucks of nursing come with 12 hour shifts, evenings, nights, weekends, overtime, working at least half of the calendar year's worth of holidays and no summers off or sabbaticals --- these are the things faculty don't do that account for that extra $20K. This doesn't get mentioned often by Nursing "experts" or "leadership".
Thu, 05/02/2013 - 10:00am
It seems that Mr. Roelofs can only see one way to appraoch the problem. Maybe it is time to look at the way nurses are used, how their knowledge and skills are applies, in a different way. Why should we only show frustration with how we have always trained and provided nurses? Why shouldn't we be talking about looking at what nurses are currently doing and seeing if there are better and smarter ways to do what they are doing and look to ways to help them be more effective and efficient? We here a lot about how many nurses per patient there are or should be, but is that what really matters, isn't it about the patient and what services they need? We may need to look at how we train nurses, but shouldn't we be looking at how we use them and it they (those with that broad type edication) are the best one doing what they do? It is easy for people to gravitate to a single number (pay, cost, money), but in reality we have to look past that number and start looking at what makes it up and how we can address each of those parts. It comes down to 'how do you eat an elephant? one small bite at a time.' We need to reconize that it is an 'elephant', but we need to start focus on each 'small bite.' There is one easy way to keep those who are considering retirement working, it will cost less money and raises their enthusiasm for the work. Start by asking them why they want to retire. In many cases it is about controling their time, so let them retire and then hire them back as part-time nurses without benefits and at a lower base pay. You might be surprise to find that they enjoy their work and will be enthusiastic in working on a limited basis at lower pay. There are many other ways to make working more enjoyable, but those become local issue that the patients can influence and local administrations.
Charles Richards
Thu, 05/02/2013 - 11:29am
I would have liked information as to how many nurses we have the capacity to train each year, and how many nurses will be retiring each year for the next twenty years, and how many additional nurses we will need above and beyond that. And why are nurse instructors paid so much less than practitioners? And, given that they are, how have we been able to attract the instructors we have? And, above all, why does the Michigan Board of Nursing limit the number of "seats" a school can provide? Is it to drive up compensation by limiting the supply?
susan Black R.N...
Thu, 05/02/2013 - 12:22pm
The larger clinician salaries of nursing come with 12 hour shifts, evenings, nights, weekends, overtime, working at least half of the calendar year’s worth of holidays and no summer academic break or sabbaticals — these are the things faculty don’t do that account for that extra $20K + unless they moonlight.
Sun, 12/29/2013 - 10:45am
Do not believe there is a shortage! Out of the field for 20 years to work in another industry I returned to nursing. To update my skills I took a comprehensive refresher course which included 120 clinical med/surg rotation. I have good credentials, am hard working and despite applying to hundreds of jobs, the only ones I could get were those considered undesirable- low pay/long distance/awful shift/- despite this I took several- most jobs offered are part time only, no benefits. I worked so hard for one home care company only to have them tell me they cannot pay because they are broke. I am now at another company and despite promising that I could work in my area, I am sent all over town. The distance and cost of gas makes the amount of money I earn less than minimum wage. I am trying to remain hopeful and keep applying but despite the number of ads, and applications, getting an interview is the exception and not the rule. Oh I forgot, I am hardworking, healthy, physically fit and 62. They cannot discriminate based on age or technically even ask how old you are. What a joke, they can see when your license was first issued, they get enough information up front that they know exactly how old you are.