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Maryland's nursing and hospital leaders are dealing with a current nurse vacancy rate nearing 13% in the state. They predict a shortfall of 10,000 nurses by 2016.

With those daunting possibilities ahead, a group of leaders from around the state have crafted a bold strategy to enroll 1,800 more students in nursing programs annually, starting in 2009. To succeed, the first step is for schools to hire more faculty.

"It's critical that we act now," says Janet D. Allan, RN, PhD, CS, FAAN, dean and professor at the University of Maryland School of Nursing in Baltimore and a member of the Who Will Care? The Case for Doubling the Number of RNs Educated in Maryland work group.

Hospital nurse vacancy rates are creeping higher, forcing some facilities to close units. Already, EDs sometimes must divert ambulances to other hospitals and elective surgeries must be postponed.

"We have seen that in Maryland in the last few years and know it is a real phenomenon," says Catherine Crowley, EdD, vice president of the Maryland Hospital Association (MHA). "We have no surge capacity when we get into double-digit [vacancy rates]."

With Maryland's population increasing and a growing number of older adults, the demand for care only will intensify and exacerbate the situation, unless action is taken.

"If there are not enough nurses, we will have a public health crisis," says Jacquelyn D. Jordan, RN, PhD, professor and academic chairperson of the department of nursing at Towson University, in Towson, Md., and a work group member.

Joining forces

At the invitation of the MHA, 27 representatives from academia, hospitals, and other entities came together and worked for several months to figure out a solution. Allan describes it as "an incredible consensus-building experience with members educating each other on the issues related to the workforce shortages in nursing."

The plan calls for doubling enrollment; adding 360 faculty members to Maryland schools to educate the anticipated nursing students; increasing faculty salaries to reflect market conditions; expanding classrooms, simulation labs, and clinical sites; and providing more funding to nursing education programs. With this plan in place, the prediction is the number of graduates would increase from 2,039 annually to 3,539, starting in 2011.

"We consider it bold and innovative, because the plan presents a solution of larger scope and depth to address the shortage," Allan says.

Crowley called the magnitude of the collaboration unusual. The team worked with economists and consultants to help it build a business case for the plan. Approaching the situation realistically, the group did not set a goal of eliminating the nursing shortage altogether. Instead, the plan proposes bringing the vacancy rate down to 8%.

"There is a general positive feeling, at least among the nursing education community, that this proposal will work," says Judith A. Feustle, RN, ScD, director of the nursing division at Villa Julie College in Stevenson, Md., and a work group member.

The plan will cost about $34 million the first year and $25 million in the second. The leaders plan to seek startup dollars from the state and private entities, including MHA, private businesses, and foundations.

After the first two years, contributions from hospitals saving money on nursing agency fees would support the initiative. The group estimates Maryland hospitals now spend $50 million a year on agency nurses to cover staffing vacancies.

The work group estimates the program's total net financial benefit at five years to be $16.7 million. If 2,100 more nursing positions were filled, the state would receive $6 million in income tax dollars, Crowley says.

"This is the first comprehensive plan that's been done, and Maryland is trying to set the standard," Jordan says.

Plenty of applicants

Last year, Maryland colleges and universities turned away 1,850 qualified candidates because their programs were full.

"We cannot increase capacity because there are not enough faculty," Allan says.

The state will need 360 more faculty members, 180 the first year and 180 the second, to admit 1,800 more students annually.

Raising faculty salaries is key to attracting new educators and retaining current ones. The work group estimates master's-prepared nurses working in clinical settings earn $30,000 more than a new faculty member.

"We cannot entice people to come into teaching, although it may be their dream to teach. They cannot afford to do it," says Jordan, adding salaries for existing staff also must increase to avoid bringing someone in at $70,000 to work at the same level as a colleague with more experience who might be earning much less.

The work group benchmarked salaries, using national data from the American Association of Colleges of Nursing, Feustle says, and settled on raising the pay to between the 50th and 75th percentile.

Schools also cited classroom and clinical space limitations as another barrier to admitting more students. To address this issue, the plan encourages expanded use of evening and weekend classes and clinical rotations, greater utilization of distance learning and simulation, participation in a Web-based system for scheduling clinical experiences, and continued state funding of capital projects.

Retention of nursing students presents another concern. Allan says 25% to 30% of community college nursing students drop out because they cannot afford to stay in school. The group aims to address that as well.

Next steps

Most importantly, the plan requires funding commitments. The MHA has met with elected officials. Gov. Martin O'Malley had not seen the proposal as of Nov. 7, says spokeswoman Christine Hansen. She adds, "He looks forward to reviewing it and working with the Maryland Hospital Association to address the nursing shortage."

The proposal has received the endorsement of many organizations, including the Governor's Workforce Investment Board Health Initiatives Steering Committee, the Maryland Organization of Nurse Executives, and the Maryland Board of Nursing.

Allan considers a two-year funding commitment essential. Otherwise, students admitted in the first year would not be able to complete their schooling if funding for salaries disappeared. The University of Maryland admits BSN students in their junior year. Crowley says the MHA is prepared to contribute to the plan.

All Maryland nursing programs will be eligible, but not mandated, to participate in the program. An implementation subcommittee, co-chaired by Cal Pierson, president of the MHA, and Beth Anne Batturs, RN, MSN, director of the department of nursing at Anne Arundel Community College, is working on the details for equitable distribution of the funds.

Feustle expects the group might recommend something similar to the successful Nurse Support Program II of the Maryland Health Services Cost Review Commission, in which institutions can apply for money to support initiatives that will help increase the number of bedside nurses in Maryland hospitals.

Provided funding comes through in 2008 for the program, the University of Maryland, Towson, and Villa Julie all plan to take advantage of the opportunity to expand their BSN enrollments in 2009. Villa Julie hopes to grow its weekend and evening program for people with baccalaureate degrees in other disciplines, as well as its traditional program. In addition, Towson also would like to increase capacity in its master's level nurse educator tract.

Listening to each other and working together, hospitals and educators have forged a partnership and developed a plan that could serve as a nationwide example.

"Nothing has been done like this in any other state," Allan says. "This will be a model for others to use."

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Debra Anscombe Wood, RN, is a frequent contributor to Nursing Spectrum. To comment, e-mail editorDC@nursingspectrum.com.