Crookston Times - News

A global nursing shortage is affecting health-care systems everywhere, but rural areas are hit particularly hard. The Northwest Minnesota Area Health Education Center (AHEC) is working to address this shortage within a 14-county and two-reservation area, but first it needs to know what's behind the problem.

A dialogue session between area health-care professionals, two University of Minnesota, Twin Cities staff members and Garth Kruger, director of EvaluationGroup, LLC took place at RiverView Health Thursday in which Kruger presented a study on nurse workforce recruitment in northwest Minnesota his firm had conducted. He worked with Joan Porraz, executive director of the NW MN AHEC, on the study.

In his PowerPoint presentation, Kruger explained that the study involved surveys of area RNs and LPNs as well as data from other sources. At the time of the study, the Minnesota Board of Nursing showed 3,925 licensed nurses -- 57 percent RNs, 43 percent LPNs - in the NW MN area.

The number of RNs and LPNs per 100,000 people in this region - 1,306 in 2005-2007 - fell only slightly short of the state ratio of 1,389 for 2005. The national figure was 1,039, considerably less than state and regional ratios. However, the region has considerably more LPNs per 100,000 than the state and nation - 598 versus 349 and 240, respectively. On the other hand, the state listed nearly a third more RNs than LPNs regionally.

Salaries of both nursing categories in the region, as expected, also fell short of the state average, although not significantly lower - approximately $7,000 being the largest gap, in the highest pay category. Metro pay rates, which tend to run considerably higher than rural rates to compensate for higher living costs, bump the state average up, said Kruger.

"I don't see the salary as a big issue here," he added.

A nurse recruitment survey was distributed to a random sample of 300 area nurses, with 182, or 61 percent, returned. Respondents indicated the highest position recruitment factors (highest to lowest) as: hours required, opportunity to gain experience, desire to live in certain geographic region, benefits package and proximity to family.

Another part of the survey showed the type of facility or position respondents worked in. Most RNs, 33 percent, were in a hospital in-patient setting, while 36 percent of LPNs worked in a nursing home. More than half were full-time employees and a third working part time, with 8 percent licensed but no longer employed as a nurse, 3 percent unemployed and 3 percent retired. The average age of respondents was 46.5 years. The vast majority, 94 percent, were female.

Nearly 60 percent have worked 16 or more years in the field. Turnover rate indicators showed 14 percent of respondents anticipating leaving the workforce within three to four years. The Minnesota Department of Employment and Economic Development reported a 2008 RN vacancy rate of 4.5 percent. The study indicates that 135 to 180 nurses in the region could leave the field. An estimated cost for these turnovers is $8.2 to $12 million.

The group discussed the research and what it means to the region's supply of nurses after the presentation. Although one of the attendees is a male, Terry Watne, who's been in the nursing profession for nearly three decades - starting out as an orderly and working his way up to administrative director of the Medical Specialty Care Division for Altru Health System - all agreed that nursing has been primarily a women's profession.

"In the 1940s through 60s, your (women's) options were pretty limited," said Watne. "You had marriage, housewife, secretary, hairdresser, teacher or nurse. That was about it."

"We were discouraged from even considering anything outside of those," Barbara Brandt, Ph.D., director of Minnesota AHEC and assistant vice president for education at the UMTC Academic Health Center, said.

So while women are pursuing other areas of study and more advanced degrees, men aren't exactly clamoring to become nurses, either. This leaves a gap in the profession, even as the need for more nurses is increasing.

One thing about nurses working in a rural setting is that they get a more diverse experience that those at larger, busier facilities in metro areas, said Kruger. They need to know a little about everything rather than a lot about one thing.

A number of smaller communities are now realizing that it's not feasible to have a medical doctor on staff, Watne explained, so the need for mid-level providers such as physician's assistants and advanced-level certified nurse practitioners is growing.

"I think the nurse practitioner's role in the community is becoming more prominent," said Connie Delaney, Ph.D., dean and professor of the UMTC School of Nursing. "They're a phenomenal asset to communities in the school system and beyond."

She said the AHEC is looking at creative ways to retain and attract people to the nursing profession and the amount of dollars that can be used to invest in educational programs.

"We have the capacity to grow so much more," she said. "We're particularly concerned with primary care, as there's been a shortage here. Everyone wants to specialize in something, but we mostly need primary providers in rural areas."

Part of the difficulty in recruiting workers to smaller more rural communities is the lack of other available jobs, said Watne. Although a physician or other health care provider might easily get a job in an underserved area, his/her spouse can't as easily, so they either don't come there or remain for a short time and leave.

Another aspect the group talked about was generational differences. Watne sees many of the younger generation "not willing to earn their stripes. They want to get in, get that experience, get that advanced degree, start a family and move on."

Lifestyle is a big factor in recruitment, he added. Incoming nurses are no longer willing to work long hours and frequent weekends traditional to the field. Rather, "they want to work regular 40-hour weeks, work only an occasional weekend and have fun at work. They also want it challenging. They're not going to be workaholics like we were."

Coming up with innovative educational options "can't be emphasized enough," said Watne, as those who wish to advance in their careers don't usually have the time or money to be able to take time off to pursue their education.

"We are exploring different educational opportunities such as online courses and degrees," Porraz pointed out. "I'm going to be speaking to area employers to find out what they're looking for a willing to do, and hopefully we can marry the two."

Sandy Henneberg, project coordinator for NW MN AEHC, said as a former teacher, she'd like to see more health career education courses in high schools. An online course will soon be available high schoolers through the AEHC, but hands-on courses right in the schools might bring in more students, she said.

She'd also like to see more recruitment efforts with the Latino population, as it's been steadily increasing in the area.

Porraz noted that Kruger would also be doing studies in other health-care fields such as dentistry and pharmacy, as well as follow-up, more in-depth research on nursing.

"This is a good starting point," she said, "but it is nowhere near the end of our research. We have much more to do."

Kruger said more in-depth future studies could look at ideas and strategies for recruitment and retention of nurses and advanced practice professions like nurse practitioners.