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  • Writer's pictureMario Nicolais

The quiet nursing shortage threatening our health care system

My mother graduated from the prestigious Saint Vincent’s Hospital School of Nursing just over 50 years ago. When she returned to New York City recently for her reunion, she found the school shuttered and replaced by expensive apartments in Greenwich Village. With National Nurses Week beginning today, I can’t think of a more apropos metaphor for the greatest silent threat to health care in our country. Quite simply, our state and country face a nursing shortage that very soon will reach catastrophic proportions.

Nurses comprise the rigid backbone of the entire health care industry. Without them, the entire thing collapses. At every level, the quality of care and human touch necessary for positive outcomes link directly to the quality of the nursing staff. That is true in hospitals, skilled nursing facilities, and in home care. Good health care cannot be created without good nurses.

Of course, I’m biased. My mother worked for a half-century as a nurse. She worked in emergency rooms, dialysis units, STD clinics and community resource centers. As general counsel for a post-acute and long-term care provider, I interact with several nurses from across the state every day. There are several nurses in my MBA class for health administration. Even the heart surgeons in the program take note when one of the nurses in class speaks up. I’ve been privy to the important role nurses play all my life.

My bias doesn’t change the fact that between 2009 and 2030, just as Baby Boomers reach retirement and need additional nurses available to provide care, the country will have more than a million nursing job openings — and only about 439,000 new nurses to fill those positions. States in the South and the West will bear the brunt of the impact. The projected scorecard for Colorado in 2030 grades out as a “D,” which sounds terrible until you realize only a few surrounding states do so well — most get an “F.”

If you go to any industry conference on health care, there will be a panel talking about this issue. Last year I sat with colleagues from across the country talking about our greatest concerns in as health care providers. While topics such as insurance exchanges under the Affordable Care Act and potential Medicaid cuts under the Trump administrations were discussed, everyone agreed the impending nursing shortage posed the greatest long-term impact to health care in our country. While regulations and funding issues would be burdensome and troubling, the inability to provide enough nursing care would be crippling.

Given the ramifications, the primary cause seems almost ridiculous. The bottleneck preventing the nurse supply and demand curve from ever intersecting are the nursing schools just like Saint Vincent’s. They simply cannot churn out enough nurses. Limited staff and resources at the teaching level have led some schools to close and others to turn away tens of thousands of qualified applicants each year. When nurse practitioners earn almost $100,000 per year, schools have difficulty recruiting the same people to teach for an $80,000 salary.

The nursing school logjam means companies like mine, where we will help pay for nursing aides to become licensed practical nurses and then again to become registered nurses, have to look for alternate means of addressing the problem. We have innovative leaders who have worked with high schools and colleges to help guide interested students through the process. We have considered partnering with nursing schools by paying for an educator in their program.

When my mom retired, she took decades of knowledge and skill with her. While the hole in experience she left couldn’t be replaced by anyone right out of school, our biggest concern should be that the hole isn’t being filled at all. That creates holes in a system that will need more nurses in the coming years, not less. The health of our state and country depend on it.

Mario Nicolais is an attorney and Denver Post columnist who writes on law enforcement, the legal system and public policy. Follow him on Twitter: @MarioNicolaiEsq

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