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Poor state of care

Though USF graduate student Carly Paterson obtained both a bachelor’s and a master’s in nursing before working as a registered nurse, she said these degrees weren’t enough to develop the career she desired.

“While I was working as a nurse, I realized there were a lot of areas (in nursing) that still needed empirical investigation,” Paterson said. “I think that motivated me to go back to school and pursue a Ph.D. so I could do the research I thought needed to be done.”

Now entering a teaching role in nursing with a post-doctorate fellowship with the National Cancer Institute, Paterson is urging future nurses to plan on also pursuing higher nursing degrees — not only for themselves but for the profession as well.

“I always try to tell the students I teach to remember there are (positions) past an RN (registered nurse),” Paterson said. “(They should) keep in mind a goal to pursue a nurse practitioner degree or higher degree to support the nursing profession.”

This impetus for a higher number of nursing graduate students is driven by a statewide shortage of nurses, highlighted in a recent health gap analysis by the State University System’s Board of Governors (BOG). 

The periodic analysis examines if Florida universities are producing enough medical professionals to meet the needs of the state’s health care industry, and the draft of the BOG’s latest report (the final version will be presented next week at the BOG meeting at USF) found Florida lacking in both nurses and physicians.

The draft projected 6,979 annual openings for RNs, 357 annual openings for nurse practitioners and 1,934 annual openings for physicians from 2014 to 2022.

While the draft of the BOG’s health gap analysis was just performed in May, professionals and educators in the state’s health care industry have known about the shortage of nurses and physicians in Florida for years.

Additionally, according to the Dean of USF Health’s College of Nursing Dianne Morrison-Beedy, the lack of nurses in Florida is not expected to improve in the near future if current trends continue.

“Florida has faced a nursing shortage for quite some time,” she said. “Over the next few years, the shortage will be about 50,000, and that’s just for RNs; it doesn’t include what the shortage for nurse practitioners will be.”

Despite this large need for nurses in general, Morrison-Beedy said one of the shortage’s largest contributors is specifically the scarcity of nursing educators and faculty who are responsible for educating the overall nursing workforce. 

As the average age of a nursing professor in Florida is currently over 61, she said finding the next generation of nurse educators is of utmost importance. As of the spring 2015 semester, USF had only 51 students in the nursing education program with only three on the doctoral level according to USF’s InfoCenter.

“The most pressing issue in nursing … not just for the state of Florida, but for the nation, is the faculty shortage in nursing,” she said. “Without sufficient faculty, no matter how many people want to become a nurse there will not be enough faculty to educate the nursing workforce.”

Another significant cause of the nursing shortage is the quality of the nursing education programs in the State University System. Morrison-Beedy said while there are plenty of nursing programs available, the state is not increasing its nursing workforce at a proportional rate.

“That is a major challenge in Florida — you don’t see that existing across the nation,” she said. “(There are) hundreds and hundreds of programs available, but yet (there’s) a workforce shortage.”

In order to improve the quality of the nursing programs available, she said universities and hospitals in the state need to prioritize support for programs which focus on preparing students for the nursing workforce by graduating them in a timely manner with, at the very least, a baccalaureate degree and the ability to enter the workforce as a licensed nurse in a professional practice.

Morrison-Beedy said one new nursing program USF has created was designed specifically for those leaving the military and will help veteran students find employment in the nursing workforce.

“(There) was a great need to take our veterans and move them through programs where they’ll be employed at a high salary (in) the profession of nursing,” she said.

The expense required in properly training nurses combined with Florida’s need for so many, however, makes supporting new programs a costly endeavor, and Morrison-Beedy said this is a problem which requires more than just the effort of Florida’s universities.

“Politicians, health care agencies, universities, professional organizations — we all need to work together because … how we’re going to figure out the answer requires everybody being on the same page,” she said.

Concerning the shortage of physicians in Florida, Dr. Charles Paidas, vice dean for clinical affairs and graduate medical education at USF, said the lack of physicians is largely due to the gap between the amount of physicians who graduate from Florida colleges and those who stay to practice here.

This is because of the limited number of medical residency slots in Florida, which allow graduate medical students to continue their education after medical school at a residency and obtain medical board certification in order to practice at hospitals.

“We are considered exporters of medical students because we have no place to put them,” Paidas said. “We only have slots for 3,600, but we’re graduating almost 500 more than that.”

Florida’s passage of the Balanced Budget Act in 1997 placed a cap on the amount of residency slots hospitals and medical institutions in Florida could fund with Medicare.

Besides certain exceptions for rural hospitals made by the Medicare Balanced Budget Refinement Act of 1999, Paidas said the cap on the amount of residencies funded by Medicare has remained the same since the 1997 bill’s passage. Over time, this has led to a disproportion amount of physicians compared to Florida’s growing number of citizens.

“It’s generally accepted…in the United States that (states) should have a ratio of 35 residents per 100,000 lives,” he said. “Florida has 17.2 residents per 100,000 lives … We need to double our workforce … (which) means we need to add close to 3,000 positions.” 

Paidas said one solution to the physician shortage in Florida would be for Florida Legislature to adjust the cap on residency slots. This, however, would require additional funding from the federal government or possibly state funding.

“That’s a two-edged sword because the federal government … has no idea where they’re going to get money for release of the cap,” he said. “We’ve seen most congressional panels close the door on it.”

Another remedy for the physician shortage would be for Florida universities to focus on acting as consultants to new hospitals and help them create brand new residency programs for accepting new graduate physicians — something Paidas said USF has been recently exploring.

“We can act as consultants to make that … decision about whether or not they would like to get into the business of training physicians,” he said. “USF GME (Graduate Medical Education) has played a major role in the state as a consultant … and we look for ways to enhance our GME portfolio.”

Regardless of how the shortages of nurses and physicians in Florida are addressed, both Paidas and Morrison-Beedy said either will affect the way patients are cared for if they go unchecked.

“It won’t be just about wait times,” Morrison-Beedy said. “It will be about the quality of the caregiver you have — the nurse at your bedside, the nurse in your home taking care you of, the nurse in your school taking care of your children — it’s going to impact all of that.”