ASU works to address nursing shortage through innovation, accessibility

Editor’s note: This story is featured in the 2022 year in review.

Editor's note: A previous version of this story stated that enrollment in the college's prelicensure programs had increased 71% from 2020–22.

The fear has been building in the nursing industry for years. There would be a nursing shortage. A “silver tsunami,” it was called.

No one could predict exactly when it would happen or how encompassing it would be.

Well, the time has come, and the numbers are stark.

According to the U.S. Census Bureau, the nursing shortage could reach more than 1 million by the end of 2022. And that’s just the immediate crisis.

• More than 50% of nurses in the United States are over the age of 55.
• One in five health care workers quit their jobs during the pandemic.
• The U.S. Bureau of Labor Statistics estimates the U.S. will need more than 203,000 new registered nurses every year through 2026 to offset the losses in a retiring workforce, but the number of nursing graduates has stabilized at approximately 155,000 annually.

“I think we’re in a dire situation,” said Judith Karshmer, dean of Arizona State University’s Edson College of Nursing and Health Innovation.

That’s the problem. ASU is working on the solution.

How we got here

Why the nursing shortage? Several factors:

Start with the fact there are more opportunities for women — traditionally the majority of nurses — in the workplace.

“Back in the dark ages, when I went to school it was, ‘You want to be a teacher or a nurse?’” Karshmer said. “There are many more options now for women.”

Heidi Sanborn, clinical assistant professor and director of the RN-BSN and Concurrent Enrollment Program in the nursing college, said the growth and popularity of the nurse practitioner position also has triggered the shortage.

According to the American Association of Colleges of Nursing and the National Council of State Boards of Nursing, the number of nurse practitioner graduates more than tripled from 2007 to 2017.

“Nurse practitioners serve a really important role. A lot of times they’re utilized in areas where there is a shortage of providers, like rural or medically underserved populations,” Sanborn said. “We’re trying to grow that workforce as well. But, of course, you have to be a nurse typically before you become a nurse practitioner, so that siphons off nursing staff. It’s for a good reason, but it’s just exacerbating the shortage.”

The timing couldn’t be worse. The U.S. Census Bureau estimates that in 2030, 21% of the U.S. population will be 65 or older and, in all likelihood, needing more medical care than they did in their 30s or 40s.

“Every one of us, when we get older, is going to probably have some sort of chronic condition, unless we’re incredibly lucky,” Sanborn said. “That requires a medical touchpoint, whether that’s at a doctor’s office, a cardiac clinic, a heart clinic, all of which need nurses. That’s the downside of living older. We fall apart.”

Finally, the nursing shortage has been accelerated by the pandemic. Not only did one in five health care workers quit their jobs but another one in five nurses age 52 or older indicated they would retire within another five years, according to the 2020 National Council of State Boards of Nursing.

“So, we’ve known that our nursing workforce has been aging and we’re not bringing in enough students to replace the baby boomer generation who’s getting ready to retire,” Sanborn said. “We’ve known for a very long time that projections said we were really going to go off the cliff and get into big trouble around 2024. Then you add COVID to the mix.

“Now you have younger nurses who are moving away from bedside for a variety of reasons. Life choices. Life balance. Nursing is hard. It’s just a very physically and mentally demanding job.”

The good news? (Yes, there’s good news).

Where ASU comes in

ASU’s focus on innovation and accessibility is helping to negate the shortage. Karshmer said enrollment in the nursing college’s prelicensure programs has increased 64% from 2019 to 2022.

How is ASU doing it?

For one, the university has created five different pathways for students to earn nursing degrees.

• The traditional prelicensure clinical nursing program.
• The accelerated BSN (Bachelor of Science in Nursing) in which a bachelor’s graduate in a different field can help complete a 50-credit-hour accelerated BSN program.
• The concurrent enrollment program (CEP), where a student enrolled in a community college's associate degree nursing program can simultaneously enroll in the online CEP with ASU.
• The RN to BSN program, in which a student with a community college or diploma-school nursing degree can graduate with a BSN.
• The Entry to Nursing pathway, where a student with a bachelor’s degree in a field other than nursing can complete a 53-credit-hour Master of Science nursing program.

“That is really the bread and butter of what our industry needs: more nurses,” Sanborn said. “ASU has put an incredible amount of work into growing those programs.”

Karshmer added, “We’ve really worked hard to say it’s not a one-size-fits-all profession. You can be a nurse in an acute-care setting, like an ICU or emergency room. You could be a school nurse, or you could work in a clinic or you could do video visits. I think that’s another reason (our program) has become attractive.”

Marialena Murphy, chief nursing officer at Mayo Clinic, which works in partner with ASU, said she has been impressed by the Edson College’s desire to think outside the box.

“The openness and willingness to try different models and different ways has made it a fantastic partnership,” Murphy said.

ASU isn’t just creating opportunities at its Downtown Phoenix campus, though. To go where there’s need, the nursing college has expanded to the ASU West campus and ASU at Lake Havasu (the first cohort of 32 students will graduate this year), and there are plans to build programs at the Polytechnic campus and the ASU California Center.

In addition, ASU is contemplating a strategy in which it would partner with a rural hospital and clinic, deliver to students the didactic coursework over Zoom and have that hospital or clinic hire part-time faculty to be clinical instructors.

“I like to describe it as a rapid strike force where there are pockets of need,” Karshmer said. “Our goal is to provide opportunities where the people live so they can work where they live.”

The final step: Secure funds for a mobile simulation center. Currently, students from Lake Havasu have to come to the Downtown Phoenix campus at least twice each semester for two to three days to work in the simulation lab, which is run by registered nurses and provides students clinical decision-making skills.

But if ASU could take a mobile lab to the students, it would create a complete locally based degree program and, hopefully, lessen the nursing shortage in those communities.

“What we want to do is bring the program to them so that they can apply their knowledge in those health care institutions, in their own community and then be a fully prepared workforce the minute they graduate,” Karshmer said.

“That’s really the intent of what we’re trying to do.”

Top photo: Edson College of Nursing and Health Innovation Instructor Dawn Bedwell goes over an infusion pump with a group of nursing students at the Mercado building in downtown Phoenix in March. Photo by Charlie Leight/ASU News