AHA study: State short of nurses, other professions

Arkansas in 2021 had only 76% of the registered nurses required to provide the national average level of care demand. The state fared better or worse compared to other states among other health professions, but it nevertheless remains short of health care workers in crucial areas.

Those were some of the conclusions of a study by GlobalData PLC that was commissioned by Arkansas Hospital Association Services, the AHA’s for-profit subsidiary that markets products to hospitals.

The report defines demand as “the amount and types of healthcare services patients are willing and able to purchase at prevailing prices and the number of healthcare workers that employers are willing and able to hire at prevailing salary levels.”

It calculates demand as the number of healthcare workers that would provide the national average level of care to Arkansans, accounting for the state’s demographics and prevalence of disease and health risk factors.

“Demand” differs from “need,” which the report did not calculate. It said need “represents the services that patients would use based on clinical or epidemiological considerations combined with an assessment of the level of care that would be considered appropriate.”

It said demand estimates “do not imply an optimal level of staffing independent of economic and other realities.”

The study calculated that Arkansas had 27,916 full-time equivalent registered nurses in 2021, which was 76% of the 36,900 that would be needed to meet the national average level of care demand.

The study projected 8% growth in the RN population to 40,000 by 2035, about twice the rate of population growth. The demand shortfall was projected to fall to 4,700 full-time equivalent RNs by 2035, or 88% of the expected comparable demand.

The situation is better with licensed professional nurses, which have less training and provide more basic care. Research calculated that the state has about 9,189 LPNs, which is 1,839 more than the national average level of care demand of 7,350. To maintain the state’s current usage of LPNs, the workforce would have to grow by 55 FTEs per year above expected status quo growth.

It noted that Arkansas’ hospitals and other healthcare providers employ fewer RNs and more LPNs than the national average. Hospital administrators told researchers the state has a shortfall of RNs.

The study noted that Arkansas’ population of 3 million was 0.9% of the nation’s population in 2021, and the state had 0.9% of the nation’s filled RN positions and 1.6% of its filled LPN positions. But the state has 1.4% of the nation’s 65-and-older population, which requires more care. That part of the population is growing faster than any other age group in Arkansas – 18%, or 97,000 more residents, by 2035.

The state has 2,025 respiratory therapists, which was roughly equal to the national average level of care demand, but the supply is expected to fall by 610 by 2035, when the shortfall will be 240 to 580 therapists to meet the demand standard, or 65% to 85%. The study said that respiratory therapists leave their jobs at high rates. Hospital administrators said it is difficult to raise wages, and many move into other health care jobs.

The state had 1,398 emergency medical technicians working for EMS agencies in 2021, which was slightly below the demand of 1,480. By 2035, the shortfall will reach 490 EMTs, with supply meeting only 69% of demand. The report noted that EMTs are only a part of the Emergency Medical Services labor force, which also includes paramedics.

The state has more nurse practitioners, 3,701, and fewer physician assistants, 630, relative to the national demand standard. Both professions are growing at the state and national levels. The report said the state’s higher number of nurse practitioners could be related to the state’s shortage of physicians.

In addition to crunching the numbers, the study’s authors interviewed three health system CEOs, five chief nursing officers, four other administrators, the dean and vice chancellor of two health professions education programs, and representatives of the state ambulance association.

The administrators faced what the study called a “triple threat of slim financial margins, capacity constraints and an imperative to grow with anticipated future demand.” It said those challenges existed before COVID, which merely accelerated them. Hospitals have emerged from the worst of the pandemic “into a new normal of persistent exacerbated shortages.”

The administrators said their hospitals are spending more money than ever before to fill their shifts, and all said they were still requiring mandatory overtime for their employees. There are fewer applicants for open positions, and health systems were still using many traveling professionals that were not loyal to the hospital and negatively affected team cohesion.

“Hospitals have really tried to reduce the number of travel nurses that they have,” said Bo Ryall, Arkansas Hospital Association president and CEO. “That’s an obvious thing to do to reduce costs, and they’ve been working hard to try to do that at each hospital. Every hospital I talk to, that’s one of their main focuses is to reduce the dependence on travel nurses.”

The administrators told researchers the workforce strategies they have been using are becoming unsustainable, leading the administrators to consider long-term changes to the way they provide care. Hospitals are using more technology and making staffing changes, such as using a team nursing model where RNs supervise LPNs to increase nurse-to-patient ratios. Chief nursing officers say they are dealing with large numbers of new, inexperienced staff members who must provide more complex care for longer time periods. Educators say they can fill the seats for RN programs but are seeing fewer applicants. EMS educators reported that only 32% of their programs’ seats are filled.

The report recommends 18 action items to increase the supply of health care workers, including programs to educate students about health care careers, stipends or financial incentives, increasing nurse educators’ pay, developing new care delivery models that delegate tasks to assistive personnel, using technology, and expanding training programs in underserved communities.

Four recommendations involved advocating for policy changes. Those included:

– Exploring options for expanding scopes of practice and reducing reporting burdens;
– Potentially supporting policy changes to help recruit foreign health professionals to Arkansas;
– Supporting establishing a national minimum for the Medicare Area Wage Index. Arkansas has one of the lowest reimbursement levels by Medicare because the program deems wages to be lower here; and
– Improving healthcare reimbursement rates.

Ryall said the AHA is pursuing a number of initiatives with the state Legislature, including increasing pay for nurse educators. With nursing salaries increasing, it’s been harder to fill those positions. The AHA will also seek to incentivize workers to go into the healthcare field and will advocate for increased reimbursement rates.