Mennonite College of Nursing
Campus Box 5810 | Normal, IL 61790-5810
mcninfo@ilstu.edu | (309) 438-7400
© 2020 Illinois State University, Normal, IL USA
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Mennonite College of Nursing
Campus Box 5810
Normal, IL 61790-5810
(309) 438-7400
© 2020 Illinois State University, Normal, IL USA
DEAN'S MESSAGE
PHOTOVOICE
The nursing shortage
By Emily McMahon & Bryanna Tidmarsh
Sick patients wait in an overcrowded emergency room. A young mother rocks her fever-ridden child, having already waited for seven hours. She runs out of formula.
A patient in the ICU is in critical condition and needs constant supervision overnight. But the nurse on duty has double their usual patient load because there just aren’t enough hands on deck.
A family in a rural community waits for their neighbor to come home
in order to ask for a ride to the nearest city for medical care—50 miles away.
A loved one passes in a busy hospital after family members have gone home to rest. Is someone there to tuck in the blanket—to hold their hand?
Photo:
Scenarios like these play out across our nation, symptoms of a growing problem. Even before the COVID-19 pandemic created abrupt changes for our health care system, the United States has faced a severe nursing shortage—a shortage that impacts us all.
Create more nurses who can teach.
If you're a nurse, advance your education and/or encourage others to do so. Nurses with their associate's degree can earn their bachelor's to help guide tomorrow's nurses as preceptors. Nurses with their bachelor's can earn their graduate degree and/or doctoral degree to become nursing faculty. Learn about our programs here.
Support current students.
You can support current MCN students by sponsoring scholarships.
Partner with us.
If you are a health care facility and would like to offer a clinical opportunity for our students, please let us know. MCN is actively seeking partnerships with organizations that have the potential to increase our clinical capacity.
Help us grow our program.
We are currently working with Illinois State University leadership to explore opportunities to expand our Nursing Simulation Lab to increase the number of prelicensure students we can admit into our program. Please reach out to us with your ideas or donate to our facilities.
Want to help us create more nurses?
Here are 4 ways.
Understanding the nursing shortage
Currently, there are approximately 3.8 million registered nurses in the United States workforce. It’s already not enough, and over the next 10-15 years, changes in population demographics are projected to make this shortage even more critical. As the baby boomer generation ages, they're driving an increased need for nurses and health care. At the same time, many of our nurses are retiring.
Who does this impact?
In short: everyone. A lack of nurses negatively impacts individuals, families, communities, states, and countries around the world.
INDIVIDUAL
Individuals suffer decreased access to quality medical care for themselves and their loved ones. They might not have access to oral health care or even a primary health care facility in their neighborhood. They might face long wait times for appointments and ER visits, as well as decreased attention when in the hospital due to nurses struggling to care for numerous patients at once. They might experience higher health care costs as hospitals expend greater resources in procuring adequate staff.
LOCAL
Communities suffer when there isn’t local access to health care. Health care disparities across geography, class, race, sexual orientation, gender, age, citizenship, and disability become widened. Marginalized groups (such as people of color, indigenous peoples, queer people, people with disabilities, and the homeless) do not receive adequate care as health care providers lack resources to properly train providers.
NATIONAL
Nationally, our economy suffers when workers don’t have access to preventative treatments that keep them healthy longer, when health care costs rise for families, and when we lack resources to combat major health care events such as the COVID-19 pandemic or even a bad flu season. Individuals and families—as well as local, national, and global communities—rely on nurses.
We are losing more nurses than we are replacing.
As of 2019, there were 182,951 registered nurses in Illinois. According to a 2018 study by the Illinois Nursing Workforce Center, 27% of that number is expected to retire within five years, meaning Illinois needs to replace 9,879 nurses each year in order to maintain current staffing levels.
What does this mean for Illinois?
Rising to the challenge
For years, nursing education has struggled to increase the number of graduating nurses. Often, the same two reasons are cited as to why: not enough clinical spaces for students and not enough nursing faculty.
Those are two very real barriers. Clinical sites, where students get their crucial hands-on practice required for licensure, are scarce and highly sought after, and the United States faces a nationwide shortage of nursing faculty.
However, the fact remains, we need more nurses than we are currently producing. Collectively, nursing education must find a way to rise to this challenge. We must, because if we don’t, the overall effect on the standard of care in this country—for our families, our children, our parents, and our communities—will diminish. For our part, Mennonite College of Nursing is working on putting targeted strategies into action.
“Now, don’t get me wrong; we know that MCN alone cannot solve the nursing shortage, and we are not claiming to have all the answers. But we are attempting to shift the conversation and approach toward a solutions-oriented framework. We are working systematically to address the nursing shortage here in central Illinois by making changes that impact our communities now while also preparing for the future,” explains Dr. Judy Neubrander, MCN’s Dean.
I: Increasing the number of graduating nurses
The most obvious way to solve the nursing shortage is also, perhaps, the most challenging: increasing the number of graduating nurses by expanding the capacity of our programs. This means that, as a profession, we must somehow eliminate the lack of clinical sites as a barrier. But—and this is critical—we must do so while maintaining high quality standards.
MCN is implementing a four-pillared approach. We plan to:
One way we can compensate for a lack of clinical sites is through simulation. The State of Illinois allows nursing educators to do up to 25% of a student’s clinical via simulation. In a normal, non-COVID-19 year, MCN students complete about 8% of their clinical experience through simulation.
In 2018, an MCN research team led by Dr. Melissa Jarvill studied the effect of increased simulation on students’ medication administration competence. Drs. Jarvill, Jenkins, Akman, Schafer Astroth, Pohl, and Jacobs found that increased simulation positively impacted competence, with the simulation experience group scoring significantly higher on the posttest than the control group.
Yet increasing simulation capacity means increasing simulation resources. This, like many other things, boils down to space and people.
“We are currently working with Illinois State University leadership to explore opportunities—such as a potential expansion of simulation capacity—that would facilitate the growth of the program. We are working thoughtfully and strategically to identify areas for potential investment, explore what that investment might look like, and understand how it would impact our students, the university, and our community,” explains Dean Neubrander.
Exploring new partnerships for clinical sites
Beyond simulation, the college is actively seeking opportunities to develop partnerships with organizations that have the potential to increase clinical capacity. Across higher education, institutions are turning their eye toward private-public partnerships; these partnerships leverage the resources of both organizations for the ultimate betterment of the student, often providing clear career pathways and financial incentives.
II: Developing pathways for nurses to advance their education
The next component of increasing the number of graduating nurses is addressing the national nursing faculty shortage. To do so, it is critical that we guide nurses to reach the top of their field so that they have the ability to teach at the highest level.
Building pathways through community college partnerships
Since nurses need a bachelor's degree to be preceptors—the nurses who take pre-licensure students under their wing at hospitals and other clinical spaces to show them the ropes—it's important to build a pathway to a bachelor's degree for the nurses who don't have one yet. We're partnering with community colleges to make it easier.
The American Association of Colleges of Nursing, the Institute of Medicine, and the Illinois Association of Colleges of Nursing have long maintained that academic progression programs are critical to elevating the overall educational level of the nursing workforce. These dual enrollment and pre-admission academic progression partnerships allow students to seamlessly progress from their associate’s degree to the bachelor’s degree in nursing—and then upward.
MCN piloted our first academic progression partnership—our Pathways Partnership—with Heartland Community College in 2015. Since then, we have continued to grow, forging 12 new partnerships with community colleges in the last year alone. These community colleges are located across the state, facilitating access for students (and improving health outcomes) in a wide range of communities.
BSN to DNP
MCN also launched a new BSN to DNP program in 2020. This program aims not only to elevate and empower nurses in their practice, but also to qualify them for faculty roles at colleges and universities.
Despite being the largest, most trusted profession in health care, currently only 13% of nurses in the United States hold a graduate degree. Less than 1% hold a doctorate. That means that just 13% of the nursing workforce is eligible to become nursing faculty at all, and less than 1% is eligible to teach at the highest level.
You can see how this is a problem.
III: Improving access to health care locally while building models that can be replicated nationally
When many think about the nursing shortage, they think in plain numbers: how many nurses are available to serve? But there is another face to the U.S.’s nursing shortage: access. Even if we have enough nurses, that does not necessarily solve issues relating to access. That’s where MCN’s grant-funded research steps in.
CAUSE: building a health care model based on collective action
Last year, MCN won a $2.6 million grant to fund Change Agents for the Underserved: Service Education (CAUSE). Through CAUSE, MCN is building a new model for health care that can be replicated nationally, focusing on holistic health and education that keeps patients out of the hospital. This model is effective because it involves collective action, bringing together students and professionals from across the ISU family—from social work, nutrition, audiology, exercise science, and a variety of other departments. Through collaboration, ISU students are touching the lives of people often neglected by the current health care system, transforming health care practices and creating a model that others can follow.
ANEW: improving health care in rural communities
Advanced practice nursing and Full Practice Authority can help provide better access to health care in rural communities.
In 2017, Illinois approved the use of Full Practice Authority, which gives advanced practice registered nurses the ability to practice health care without needing to be supervised by an attending physician. This allows nurses to bring health care to rural and underserved communities in which there might not otherwise be adequate access to health care. Some of MCN’s alumni are going on to pursue full-practice authority (FPA), allowing them to open up their own clinics in rural communities (read about one of them here).
America’s Promise: improving public health through the clinical experience
Each year, under MCN’S award-winning America’s Promise Schools Project, hundreds of MCN students work hands-on in area schools with children and their families. They model healthy practices, hold health interventions, advocate for children, and fill “gaps” such as oral health care.
There are currently more than 13,000 children on Medicaid in McLean County, and only five oral health providers accept Medicaid. In order to see each child once per year, each of those five providers would need to see over 50 children per day. This is simply not possible.
MCN’s students serve as a critical linkage in the health of our community. For some of those children, the work MCN students do in our area schools—teaching about healthy practices and holding interventions—is the closest thing they will get to oral health care.
Telehealth
In 2020, we saw COVID-19 disrupt the American health care system—along with almost every other facet of our lives. While telehealth has been an approved and reimbursable service through the Center for Medicare and Medicaid Service (CMS) since 1997, due to barriers, less than 10% of primary care providers had implemented telehealth technology prior to the pandemic.
In an article recently published in the Journal of Telemedicine and Telecare, Dr. Susan Watkins and Dr. Judy Neubrander discuss 2021 legislation aimed at reducing barriers to telehealth adoption, highlighting what they feel to be a critical oversight: the fact that neither the CARES Act nor the CONNECT Act legislation contains professional RNs as an eligible provider of telehealth services.
“Telehealth is a powerful tool that increases access to health care and support for patients, and it is associated with improved chronic disease management and population health improvement,” explains Dr. Watkins. “Professional RNs are key team members within team-based primary-care models—such as our CAUSE model—to support complex chronic disease management and care-coordination efforts. The research is clear and demonstrates that RNs are well prepared to care for patients with chronic illness—such as congestive heart failure, diabetes, and hypertension—utilizing telehealth modalities.”
One of the most effective ways to create change in health care is to make sure nurses have a voice. An Institute of Medicine committee on the future of nursing maintains that nurses at all levels need strong leadership skills in order to rise to the challenges our health care system currently faces. MCN agrees.
“It is our belief that nurses need to be a part of decision-making at every level of health care, which means that leadership development tmust be woven into every single layer of nursing education. If nurses do not take a seat at the decision-making table, we lose unique insight into the needs of our patients, into how staffing affects care, and into so many other critical issues,” explains Dean Neubrander.
IV: Elevating nurses to take on leadership roles
Preparing students to transform health care practices, even before holding their diploma
In MCN’s RN to BSN program, students complete a capstone Leadership course in their final term. During this course, nursing students create a final project proposing a change to improve health care practices in their current workplaces. Often, these proposals end up being implemented by their health care facility (read about some of the work our RN to BSN students are doing here).
MCN’s Traditional Prelicensure and Accelerated BSN programs also have leadership courses. The College’s new BSN to DNP program has an entire sequence devoted to nursing leadership and management. Capstone projects for this sequence focus on health care quality improvement, and they often have major community impacts.
Capstone Projects: Leadership & Management Sequence
Akouete Kouevigou
Kouevigou developed a project to implement a new nurse staffing model in anticipation of the surge of COVID-19 patients at the U.S. Naval Hospital in Okinawa, Japan. Upon completion of his project, Kouevigou’s preceptor said, “I have seen a phenomenal growth working with Lieutenant Kouevigou this semester. His efforts in implementing the COVID-19 staffing surge model plan with the critical care committee were acknowledged at the highest level of the command. Lt. Kouevigou is ready to take on greater responsibilities on the unit and across the hospital. We are so proud of him for his accomplishments!”
Lyn Carter
Lyn Carter’s project, titled “Improving School Nurse Involvement in the Planning and Implementation of Section 504 Plans,” was implemented in the Unit 5 school district. Section 504 plans serve as a blueprint for how schools will support students with disabilities such as depression, anxiety, ADHD, and allergies.
Karen Marquis
Karen Marquis explored how to decrease delirium in the intensive care unit at Carle BroMenn Medical Center. The project is not finished yet but is seeing positive results. Delirium has a negative impact on patient outcomes, such as cognitive decline and death. Typically, patients who develop delirium are transferred to nursing homes even if they have previously lived at home.
Renee Marshall
Renee Marshall facilitated a change in process to protect health care providers during patient resuscitation at OSF Saint Francis Medical Center. The goal was to improve safety during the pandemic; because COVID-19 secretions are aerosolized, it increases the risk for health care providers, especially during resuscitation. Marshall hopes to publish her work.
Preparing students for leadership roles
Tom Carroll, a former chief administrative officer who leads MCN’s Leadership Academy, stresses the importance of leadership development. He explains, “Nursing has earned a reputation as the most trusted profession in America. Trust is the bedrock of leadership, yet most nurses do not envision a career involving leadership. It is our job to change this.”
Looking forward
So where does this all leave us?
Within a 50-mile radius of Bloomington-Normal, there are, on any given day, about 1,124 open nursing jobs. At the time of writing, there were about 130 within the Bloomington-Normal city limits. These are good jobs that allow students to pay back student loans, build quality lives, and grow professionally in the future.
Nationally and globally, we are in a time of great uncertainty. But of this, we are certain: the world needs nurse leaders.
Mennonite College of Nursing is dreaming of a brighter future and taking the steps necessary to get there. Together with our partners, we are working systematically to change the face of health care—in Central Illinois and beyond.
We challenge you to join us.
Regardless of what happens with legislation in 2021, MCN is working to prepare students for telehealth now.
“At MCN, we are weaving telehealth throughout the curriculum and preparing our students to leverage this way of delivering care to patients in home health, primary care, public health nursing, and even in critical care. Our goal is that our students leave MCN prepared for a rapidly-changing health care environment—an environment that, increasingly, is relying on telehealth to connect with patients,” stresses Dean Neubrander.
“We have incorporated telehealth simulations into the work we do in both the nursing simulation lab, and through CAUSE,” explains MCN faculty Valerie Wright. “Telehealth gives nurses an incredible opportunity to interact with patients where they are: in their homes, at work, on the road. It opens the door to working with patients in a preventative way that was previously impossible."
Telehealth is the use of communication technology, such as the internet, to meet with patients remotely. Here, a patient is able to interact with a nursing student over a video call.
Who will the nursing shortage impact?
Simulation
Increase the number of graduating nurses
Develop pathways for nurses to advance their education
Elevate nurses to take on leadership roles
Improve access to health care locally while building models that can be replicated nationally
The Bureau of Labor Statistics predicts we will need to add an additional 221,900 new nurses each year for the next decade in order to make up for these retirements and meet America’s changing health care needs.
The issue is more complex than just an increase in the number of patients; these seniors will need specialized support services across the entire health care process, starting at the front desk—support which, in some cases, does not yet exist.
In 2019, an MCN research team including Dr. Brenda Johnson, Dr. Myoung Jin Kim, Emily McMahon, and Ali Mojadam explored the ease with which seniors could “shop” for services on hospital websites. The study compared the visibility of geriatric-specific services for older adults with the visibility of childbirth services for expectant mothers, looking at a variety of factors considered industry best-practices in web design.
“We found that, with the exception of images, identifiers of services related to childbirth were seen at nearly twice the rate compared to those of geriatric services across all areas of the websites explored in this study. In other words, information about geriatric services is more difficult to find, making it more difficult for older adults visiting theses websites to identify if a provider offers the kinds of specialized services they need and comparison shop.
Perhaps most surprising was the fact that this study was performed only on websites of hospitals known to have a nurse-led geriatric-specific program called NICHE (Nurses Improving Care for Healthsystem Elders). "It was clear to our research team that older adults and their caregivers are not going to have an easy time finding geriatric-specific care,” Johnson explains, “even when it exists!”
A 2016 study by the National Academy of Medicine shares Johnson’s worry. The study concludes, “Our health care system is unprepared to provide the medical and support services needed for previously unimagined numbers of sick older persons, and we are not investing in keeping people healthy into their highest ages.”
47.5% of RNs in the United States are 50 years old or older.
As the baby boomer generation ages,they're driving an increased need for nurses and health care. At the same time, many of our nurses are retiring.
HRSA projects that more than 1 million registered nurses will reach retirement age by 2030.
According to a national sample survey of registered nurses conducted by the Health Resources and Services Administration (HRSA), 47.5% of all RNs are 50 years old or older, and HRSA projects that more than 1 million registered nurses will reach retirement age by 2030. Meanwhile, the baby boomer generation is steadily growing older, and we are seeing an increased need for geriatric care and care for people with chronic diseases. By 2050, the number of U.S. residents aged 65 and over is projected to be 83.7 million—more than double the number from 2010.
27% of the 182,951 RNs in Illinois are expected to retire by 2023.
That means Illinois needs to replace 9,879 nurses each year to maintain current staffing levels.
Unfortunately, only about 7,000 newly licensed RNs graduate in Illinois each year. That means Illinois is short 2,879 nurses every year. By 2025, the state is looking at a 14,395 shortfall; that’s on top of the current shortage.
We are currently working with Illinois State University leadership to explore opportunities—such as a potential expansion of simulation capacity—that would facilitate the growth of the program.
JUDY NEUBRANDER, DEAN
The college is actively seeking partnerships with organizations that have the potential to increase clinical capacity.
Dr. Mary Dyck, MCN’s Associate Dean for Research, believes long-term care facilities present an opportunity, but she acknowledges that they also come with challenges. “Many long-term care facilities would like to work with us. However, in order for a nurse to precept students in a clinical setting, they must hold a bachelor’s degree. Currently, only about 30% of nurses working in long-term care have their bachelor’s degree in nursing. This means that the majority—70%—are currently unable to oversee students.”
She continues, “So we need to start by increasing the knowledge, skills, and abilities of RNs in the long-term care setting. MCN is beginning to work in that direction, both through our RN to BSN program and through the creation of specialized modules on gerontological (senior-specific) nursing. Developed by MCN’s gero research circle—including Drs. Brenda Johnson and Michelle Shropshire—the completion of these educational modules would prepare nurses to sit for certification exams that would demonstrate a greater knowledge in this specialty area.”
As a college, we are fiercely dedicated to building quality programs that eliminate barriers for working adult learners and make the journey to an advanced degree imaginable, actionable, and achievable.
JUDY NEUBRANDER, DEAN
Melissa Moody, Academic Advisor for the RN to BSN program as well as for MCN’s graduate programs, elaborates: “At both undergraduate and graduate nursing program levels, there are so many accessible paths to getting the next degree. There is no reason to stop.”
Moody, a pilot, likens advancing one’s degree to flying. “In aviation, the private pilot license is commonly called ‘the license to learn.’ Similarly, the RN license is just the beginning. It is the license that prepares a nurse to continue learning and to gain more and more knowledge in a continuously evolving field. MCN has designed programs specifically for the working nurse. With some planning and time management, anyone with the desire to grow and advance themselves is more than capable of doing it.”
Only 13% of the nursing workforce can teach at the college level.
Only 1% can teach graduate and doctoral programs.
“We know that ultimately, what stops nurses from pursuing a graduate degree is figuring out how to balance school with work, life, and family,” said MCN’s Associate Dean for Academic Support, Janeen Mollenhauer. “As a college, we are fiercely dedicated to building quality programs that eliminate barriers for working adult learners and make the journey to an advanced degree imaginable, actionable, and achievable.”
Carroll maintains that most traditional educational programs train nurses to be excellent clinical staff. “At MCN, we help our exceptional clinical nurses develop their voice as a leader—a leader of themselves, a leader of other people, and a leader of organizations. Stepping up to lead takes grit, resilience, and the courage to step away from the bedside to care, to nurture, and to strengthen the health of a system for our nation. We want our students to envision this as their potential career in nursing.”
Dr. Dyck agrees, reflecting, “A former student of mine—a triple MCN grad (BSN, MSN, DNP—shared with me that as a master’s student, I told her that she could have an opinion and lead on issues. Before that, she never considered leadership. Now, she’s working in Kentucky at a major medical center in a leadership role.”
Nursing has earned a reputation as the most trusted profession in America. Trust is the bedrock of leadership, yet most nurses do not envision a career involving leadership. It is our job to change this.
TOM CARROLL
Through CAUSE, MCN is building a new model for health care that can be replicated nationally.
In Fall 2020, MCN's first cohort of students attended primary care intensive clinicals at the Community Health Care Clinic, the McLean County Health Department, and the Chestnut Family Health Center, providing care to vulnerable populations.
“CAUSE is not only educating nurses and nursing students to function at the full scope of their license in primary care settings,” said Dean Neubrander. “It is also changing the way nurses think about caregiving. In the past, we saw ourselves primarily in the hospital caring for the sick. This model has the nurse out in front, educating, immunizing, and screening patients to prevent illness. We are also working as a team with other health care providers to provide holistic care to our most vulnerable patients. And we’re doing research to look at best practices, too. The students participating in CAUSE are excited to be just what the title says: ‘Change Agents’ to the underserved.”
Under ANEW, students are prepared as primary care advanced practice nurses to provide care for vulnerable populations in rural and underserved settings.
MCN has also mobilized a team under the Advanced Nursing Education Workforce (ANEW) grant to further respond to the needs of rural communities. Under ANEW, students are prepared as primary care advanced practice nurses to provide care for vulnerable populations in rural and underserved settings.
In partnership with local community organizations serving rural and vulnerable populations, MCN’s ANEW grant team strives to enhance clinical experiences for students in MCN’s Family Nurse Practitioner program. The ANEW grant supports those partnerships, allowing us to increase access, provide care to vulnerable populations, and offer funds to defray some of the cost of tuition and other school-related expenses for our students.
MCN students work hands-on in area schools with children and their families as part of the America's Promise program.
MCN graduate Terrah Cornell, FNP, earned full-practice authority (FPA) and opened her own clinic in a rural community.
From left: Chianitra Johnson, Benjamin Tucker, and Stephanie Adams, Mennonite College of
Nursing’s first group of Dual Enrollment students from Heartland Community College.
August, 2018.
Illinois is short 2,879 nurses every year.By 2025, the state is looking at a 14,395 shortfall,on top of the current shortage.
NEXT
Students work through a CAUSE disaster simulation in partnership with the Bloomington Fire Department.
Tom Carroll facilitates a socially distanced leadership session of MCN's leadership academy. October, 2020.