The first-ever major study from a massive statewide database, released on Tuesday, provides deeper insight and more precise numbers into a well-known problem in Oregon: a chronic shortage of nurses and nurse educators. The first-of-its-kind multi-agency analysis has provided a much more granular, regional-level understanding of why Oregon continues to suffer from this shortage, and it lays out potential solutions.
The study was compiled by the Oregon Longitudinal Data Collaborative, or OLDC, a cross-agency program governed by the Higher Education Coordinating Commission, the Department of Education and the Employment Department. The collaborative oversees the Statewide Longitudinal Data System, a collection of Oregon data from K-12 schools, colleges and universities and the workforce.
“It quantifies things that nurses and nurse educators have said they were pretty sure were true,” said Ben Tate, director of the OLDC. “We knew from the literature and from what we were hearing that there was an issue, but the magnitude of the issue I think is what this study really helps to identify.”
Chokepoints and gaps worse in rural Oregon
Oregon’s nursing shortage has been well-discussed — an ongoing problem only exacerbated by the COVID-19 pandemic.
But it’s not that there isn’t an interest in nursing. In fact, it’s the opposite. Roughly 6,700 qualified students applied to an Oregon nursing program in 2020, but only about 1,500, or 23%, were accepted. Nationally, Oregon produces the third-fewest health care graduates per capita, according to the OLDC study.
That’s due to a lack of capacity caused primarily by a shortage of nursing faculty and difficulty getting students into clinical placements.
The Statewide Longitudinal Data System, or SLDS, has the ability to track Oregon students from K-12 all the way into the workforce, which the OLDC used to analyze some of the nursing chokepoints.
According to the study, nursing programs in Oregon mostly draw applicants and students from the high schools within the region where they are located. Likewise, when students graduate from their nursing programs, they tend to stay and work in the same region, according to the study.
But access to nursing programs is uneven across the state. While there are 17 registered nursing associate degree programs scattered across Oregon, baccalaureate and practical nursing programs are mostly concentrated in the I-5 corridor. Oregon has only two graduate nursing programs, and they’re both located in Portland.
Tate said the study helped shine a light on the different needs of individual regions.
“You could look and say, ‘OK, Oregon looks like it’s performing poorly,’” he said of national data. The collaborative used the statewide longitudinal data to dig deeper.
“You have varying degrees. Some parts obviously are having more of a pronounced problem than others, but all parts of the state are experiencing a shortage,” Tate said.
The Portland metro area needs to graduate about 10% more nursing students to meet its regional need, or about 500 more students. The analysis found south-central Oregon, where the population is far smaller, needs to graduate 20 more nurses, which is an increase of roughly 70%.
Faculty pay gap and clinical placement contributing to shortages
Part of the squeeze to get more nursing students through programs across the state comes from the lack of people to teach them. Much of that is because nurses make a lot more money working directly with patients than they do teaching students, as faculty.
The OLDC study found that Oregon has the 12th-largest pay gap in the country between nursing faculty and nurse practitioners. Both jobs require graduate degrees, with faculty earning salaries of nearly $49,000 less than their counterparts in health care settings.
“This report confirms what has been known in nursing circles for decades; that there is a nursing faculty shortage in Oregon, that nurses avoid teaching because they can earn more in other nursing roles, and that student cohorts could be larger if only there were more faculty to support them,” Barbara Holtry, interim executive director of the Oregon State Board of Nursing, said in a statement.
Another barrier to getting more nursing students into the workforce is the lack of opportunities for clinical placements — a requirement for nursing students.
As it stands now, individual nursing programs are required to build individual relationships with health care clinical placement sites. The study says that can cause competition between programs.
According to the report, 95% of Oregon nursing programs were denied either an individual or cohort clinical placement from 2016 to 2020.
OLDC offers solutions
The OLDC included four recommendations to leaders across state agencies, higher education institutions and the health care industry.
Those recommendations include establishing a workgroup to address the pay gaps within nurse faculty salaries and establishing a centralized, statewide clinical placement system.
The OLDC is also recommending that leaders address additional needs and limits to the expansion of nursing programs, such as possibly expanding bachelor’s degree programs across the state. A bill in the state legislature, Senate Bill 523, would give the community colleges the ability to offer bachelor’s of science in nursing degrees if passed.
The program said it’s also worth conducting additional research, such as identifying additional support students may need to finish their degrees.
“We have no authority to say, ‘Thou shalt,’ but the hope is by showing this, that it will lead to some productive conversations,” Tate with OLDC said.
Leaders of the state agencies connected to the OLDC said the information within the report is much-needed and provides direction when it comes to solving a critical problem facing the state’s health care system.
Tate with OLDC said his team has two projects it will be focusing on next: an initial look at educator shortages across Oregon and a longitudinal look at K-12 students and what types of programs help students break the cycle of poverty. He said there’s not yet a timeline for either of those priorities.
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