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Vermont will need nearly 4,000 nurses by 2020

More than 3,900 nursing-related job vacancies are expected in Vermont between now and spring of 2020, according to a new survey of health care providers.
The survey, conducted by Vermont Talent Pipeline Management, also shows that only 26 percent of those positions are projected to be new jobs. The remainder will be “replacement hires” because of retirements and nurses leaving their jobs.
There are multiple factors behind that level of attrition. But some say a key issue is the increasing pressure placed on nurses amid a health care workforce shortage that’s affecting facilities across the state and nation.
“When you consider work environment, the No. 1 thing is that nurses are on the front line, and they’re picking up the slack for all of the workforce shortages occurring at the hospital,” said Mary Anne Sheahan, Vermont Talent Pipeline’s executive director. “And it’s because they’re on the front line. There’s nobody else to do it.”
Nursing shortages are nothing new in Vermont, but the problem seems to be intensifying.
A recent report from the Area Health Education Centers Program showed that there had been a more than 25 percent increase in the number of registered nurses working in Vermont between 2015 and 2017. Nevertheless, the average vacancy rate for hospital-based registered nurses was 9.5 percent, up 3 percent from 2015.
That report cited the rapid growth of Vermont’s elderly population as a primary driver behind the need for more health care workers and services.
Staffing was a primary point of contention in this year’s prolonged labor dispute between University of Vermont Medical Center and its nurses. Also, when Vermont hospitals presented their fiscal year 2019 budgets to the Green Mountain Care Board over the past few months, nursing shortages were a common theme.
Those shortages have implications both for health care quality and for hospital budgets. Green Mountain Care Board Chair Kevin Mullin noted that, when providers bring in temporary nurses known as travelers, “they cost twice as much as what it would cost to employ a Vermonter.”
Vermont Talent Pipeline’s report, which was presented to care board members on Wednesday, adds new information to the nurse-staffing debate.
The survey has limitations: It focuses on employers’ perspectives, and it included only 30 health care providers. But the respondents included all of Vermont’s hospitals, and Sheahan said the process produced some clear results.
When employers were asked to list and rank the jobs that they are looking to fill, nursing-related positions rose to the top. “Those are the most critical jobs in health care right now,” Sheahan said.
The survey shows that, by far, the biggest expected need between April of this year and April of 2020 is for registered nurses. That job category accounts for 1,748 vacancies, or about 45 percent of the total number.
Coming in second were licensed nurse assistants, at 996 expected vacancies. The third-biggest projected need is for personal care aides (491 positions), followed by licensed practical nurses (332 positions).
While some other job categories made up only a small portion of the total, Sheahan said that doesn’t make them less important. For example, clinical nurse educators and clinical nurse managers are “seen as the most important for the development of new and future skilled nurses,” the Vermont Talent Pipeline report says.
“A lack of preceptors and clinical resources is a major consideration for the bottleneck in skilled nurse training,” the report says.
The fact that roughly three-quarters of the expected nursing vacancies are due to nurses leaving their jobs is another problem entirely. About 30 percent of that attrition will be due to retirement, a number that the report calls “unusually high.”
Sheahan cited several factors behind those projected departures, including an aging workforce. The 2017 Area Health Education Centers report said the mean age was nearly 50 for registered nurses, licensed practical nurses and advanced practice registered nurses in Vermont.
The economy is another factor. A strong economy lessens the need for families to seek additional incomes or stay in the workforce, Sheahan said.
But the work environment for nurses also is playing a prominent role in attrition. The Vermont Talent Pipeline report says a “shortage of available health care workers across the industry results in a changing scope of work placed on nurses, who are faced with expanded responsibilities on the front line.”
Those factors may drive nurses to leave their jobs, and they also may drive up retirements. The survey projects “an increasing number of early retirements based on workforce challenges, organizational changes and the expectations to do more with fewer resources.”
As a UVM Medical Center nurse and president of the AFT Vermont union, Deb Snell knows such issues well. The UVM nurses union has approved a new contract after months of labor strife, but members also have vowed to lobby lawmakers for improved staffing ratios.
While nursing wages were a big part of this summer’s contract dispute, Snell told the care board on Wednesday that issues like increased staffing and prohibitions on heavy lifting also could help. “There are other things that can be done to make this an attractive state for nurses to come to,” Snell said.
Sheahan detailed a number of other recommendations, some involving educator/employer collaborations:
•  Increasing awareness and preparation for careers in nursing. This can start as early as middle school, Sheahan said.
•  Developing and improving training for nurse educators.
•  Finding ways around regulatory impediments. For instance, there’s a shortage of clinical placement opportunities for Vermont students; Sheahan pointed out that neighboring states require payment for placements from outside their borders, while Vermont does not.
•  Improving clinical placement strategies. She cited a placement agreement between Vermont Technical College and North Country Hospital as “a model that I think we can replicate in other places.”
•  Developing “employer-sponsored hiring solutions” to better assist nursing students with their training.
In spite of such challenges, some say the number of nursing vacancies expected in Vermont should also be seen as an opportunity.
“One story is that people have to leave Vermont in order to be successful in a career,” Mullin said. “And the reality is, they don’t have to leave Vermont. There are very good, rewarding jobs that are left open in Vermont that have good benefits, good pay, and you can retire with dignity.”

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