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Where are all the nurses going?

Wayne County Nursing Home, like other health care institutions, has a problem filling the ranks of nurses

Wayne County Nursing Home Director, Denis Vinnik, has a problem. On Tuesday he voiced his concerns, once again, to the Health and Medical Services Committee of the Board of Supervisors. Filling nursing positions at the Home is becoming more difficult.

The Wayne County Home is not in a unique position. The problem of all classifications in the nursing profession has the whole industry struggling, according to Vinnik.

In both positions as a Registered Nurse (RN), or as a Licensed Practical Nurse (LPN), the Wayne County Nursing Home currently has numerous openings. Currently, the Wayne County Nursing Home is short 8 RN positions, 2 RN substitutes, 8 full-time LPNs and 1 part-time LPN.

So, what is causing the nursing shortage problems?

With a growing aging population and growing need, nursing homes simply cannot afford the wages being paid out by regional hospitals. Currently, the Wayne County Nursing Home/County have a starting salary for a new nursing LPN graduates at $19.58 per hour, with hospitals starting at $30, or more and RNs at $25.39, well below the $45-$50 paid by hospitals. This does not include signing incentives, tuition  stipends, shift differential pay and bonuses that independent nursing homes cannot compete with.

According to Denis, the Wayne County Nursing home is currently paying out about 1/2 million dollars this year in overtime.

According to Vinnik, the new entries into the nursing field gravitate towards the more fast paced, adrenaline rush work at hospitals, over the more laid back task of serving the elderly. He added that many of his long term nurses tend to be older, with less need for the adrenaline rush and job jumping and in mind.

Another advantage hospitals offer  over salaries is the flexibility of 12 hour shifts, with three days on and four days off. Larger hospitals and associated nursing facilities also offer far more advancement opportunities.

According to Lenore Friend, spokesperson for Finger Lakes Community College (FLCC), they currently have 80 competitive slots open for students in their nursing class. The college would love to expand the number of slots, but part of their curriculum is comprised of clinical, hands-on experience for students. Unfortunately, rural hospitals do not have the spaces available for students needing clinical/hands-on training. FLCC does connect with the larger medical facilities and once a student is exposed to the larger institutions, they tend to stay within those systems after graduation. The FLCC program has a 98% placement for its grads.

Currently, FLCC offers 3 levels of health-care training: Certified Nurse Assistant, Licensed Practical Nurse and Registered Nurse.

A certified Nurse Assistant training program is five and a half weeks of training Monday through Friday 8 am to 4 pm. 16 hours of Essential Workplace Skills added to Nurse Assistant Curriculum (15 days), four days of clinical experience, and qualifying students to take NYS exam. Topics include: Patient care (clinical and classroom), Patient safety, Infection control procedures, Moving, feeding and caring for patients, Nutrition and diet therapy, Assisting with admissions and exams, Communication with the patient, Patient self-care, Pre and postoperative care, Anatomy and physiology, Circulation and respiratory care, Elimination procedures, Human sexuality, Job seeking and retention skill.

Tuition is $2000, class minimum is 12, maximum is 24.  In 2017: 25 classes, 4 Instructors, 317 students with 310 students completed, passed NYS exam and employed in the field.

In July of 2017, FLCC launched a program that allows certified nurse assistants (CNAs) to take classes to become licensed practical nurses (LPNs) while maintaining an income to support themselves and their families.

Marcia Lynch, FLCC’s director of workforce development, explained that the CNA to LPN class is different from other training programs in that students will go to school part-time and work part-time.

“If you have to work full-time to make ends meet, you cannot afford to reduce work hours to take the classes you need for advancement. It’s a catch-22,” added FLCC President Robert Nye. “This program provides financial help and case management so these dedicated CNAs have a supported transition to a higher-paying job.”

According to the New York State Department of Labor, the median wage for a certified nurse assistant is $35,580 while the median wage for a licensed practical nurse is $47,420.

The Rochester General Health (RGH) network, that includes Newark-Wayne Hospital and the Demay Living Center, has also established and expanded its own CNA to LPN classes and facility to meet the demands. According to Mark Klyczek, Long Term care Division at RGH, his health group purchased an entire building and expanded it to double the number CNA to LPN graduates.

As for the nursing home functions of RGH, Mark  admits it is a competitive market, with a big issue convincing nursing graduates that there are complex tasks in the everyday life of a nursing facility. Still, a high turnover rate exists.

New York State offers scholarships which encourages nurses to continue their education. Awards are made on a competitive basis to RNs enrolling in a graduate program that will qualify them as nursing faculty or adjunct clinical faculty. Successful applicants will be required to fulfill a four-year agreement to provide teaching service at an institution in New York State.

Williamson resident, Danielle DiSalvo, was originally a drop-out from Williamson High School. She obtained her GED (General Education Degree), received her Associates degree from FLCC, then went on to graduate from Nazareth College with her BSN Bachelors in Science and Nursing. She will soon be taking her State Boards in Nursing and has already lined up a job at Highland Hospital as a specialist nurse in Labor and Delivering as a RN in Obstetrics.

As a nurse in a specialty field, she will have a starting salary well above even the standard pay for a non-specialized nurse. With overtime and shift deferential,  Denis Vinnik stated that the hoops a county nursing home has to jump through to utilize state dollars makes them all but unattainable.

To complicate things even more in the nursing field, as of December 19, 2017, the legislation for “BSN in 10” has been signed by Governor Andrew M. Cuomo. Future licensed nurses will now be required to earn their BSN degree within 10 years of their initial licensure.

This came about after years of lobbying and promotion by national and regional nursing organizations, including the American Nurses’ Association and many nursing programs in higher education.

“Nurses will now be better prepared to meet the multiple challenges within the rapidly changing healthcare system,” said Cheryle G. Levitt, PhD, RN, Professor, School of Nursing.

Current RNs and nursing students already enrolled in associate or diploma programs will be grandfathered into the law, meaning it does not apply, however employment conditions will continue to advance to require the BSN degree as the entry level for basic positions.

Vinnik, at last week’s Health and Medical Services Committee, proposed a Board Resolution to increase the hourly rate for Substitute RN positions. These positions, hired   as per diem employees, would increase the per diem rate to $25-$31 per hour to  assist in nursing coverage.

Wayne County Administrator, Rick House, said he did not know what effect the Proposition would have. He added that with the current CSEA Union contracts coming up for negotiations, many facets come into play. “The bottom line is that our nursing home may be a nicer place to work, but you still have to put food on the table.”