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The Bergen Community College simulation lab is revolutionizing the hands-on training that medical students receive.
In an innovative simulation lab setting, Bergen Community College medical students collaborate in a highly practical environment, diagnosing and treating lifelike mannequins, which enhances their clinical skills and readiness for real-world situations.
Under the dim lights of Bergen New Bridge Medical Center in Paramus, nurse Kadesha Bryan finds herself immersed in the demanding environment of the intensive care unit at 3 a.m. Even though she isn’t a regular staff member and only picks up a shift or two each month while she diligently pursues a full-time advanced nursing degree, her presence makes a significant impact.
As a dedicated per-diem nurse, Bryan plays a crucial role in reinforcing the staff at Bergen New Bridge Medical Center and other local hospitals, addressing a pressing need as New Jersey and the nation face ongoing staffing shortages stemming from the aftermath of the COVID-19 pandemic.
“Every nurse knows the feeling of being short-staffed,” Bryan reflected, emphasizing the gratitude felt among per-diem nurses when they come on shift, bringing much-needed support to their overwhelmed colleagues.
“The increased number of patients requires heightened focus and care,” she stated. “Every extra hand makes a big difference in the quality of care provided.”
Nearly five years post-pandemic, a significant number of healthcare professionals have opted for early retirement or transitioned to less demanding career paths, leading to persistent staffing challenges at hospitals, nursing homes, and various medical facilities across New Jersey and beyond.
And projections indicate that this issue is poised to escalate dramatically.
A 25% shortage of nurses in NJ by 2036
According to a recent analysis published by the federal Health Resources and Services Administration, New Jersey is set to experience a staggering 25% shortage in registered nurses needed to care for its rapidly aging population by 2036. This deficit translates to a need for 24,450 additional nurses, positioning New Jersey among the top states facing critical nursing shortages.
This timing couldn’t be worse; the combined effect of an exodus of healthcare workers and an aging population is straining the system to its limits.
The demographic shift is alarming, with projections showing the state’s population aged over 60 soaring to 3 million by the end of the decade—a remarkable increase of 1 million within just ten years as the baby boomer generation reaches retirement, further complicating the already tense care dynamic with fewer providers available for each patient.
A staggering nearly one-third of nurses exited bedside care within the three years following the pandemic, as reported by New Jersey’s largest nurses and healthcare workers union. Among those remaining, a concerning 70% of union members are contemplating leaving their positions due to inadequate staffing levels and overwhelming stress.
Nursing unions are making mandatory staffing ratios a focal point in ongoing contract negotiations, aiming to ensure adequate care. This has been particularly evident during recent disputes at hospitals such as Robert Wood Johnson University Hospital in New Brunswick, where nurses organized a four-month strike to advocate for better conditions.
A component of the staffing issue lies in the insufficient number of qualified nurses to mitigate the exodus from the field, let alone to expand the workforce. While interest in healthcare careers is surging, adding more available slots for nursing students has proven to be a complex challenge across community colleges and major research universities.
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Edna Cadmus, executive director of the New Jersey Collaborating Center for Nursing, emphasized, “The supply can’t meet the demand unless we take some action,” stressing the urgent need to expand nursing programs as a vital first step.
Reinforcement bottleneck leads to signing bonuses
With healthcare workers in such high demand, recent graduates now find themselves in a unique position to choose from various job opportunities, wielding newfound negotiating power to obtain benefits like signing bonuses and flexible work hours. This marks a significant departure from the traditional practices that previously forced new employees into the least desirable shifts.
A vivid example of this trend can be seen at the CityMD urgent care center in Edgewater, where a prominent flyer lures potential employees with a $2,000 signing bonus for an X-ray technician position.
“Unless they do not want to work, they will have a job,” noted Susan Barnard, dean of health professions at Bergen Community College, emphasizing how graduates are now able to negotiate better working conditions, such as more flexible schedules—options that were once scarce. The demand for healthcare professionals has prompted industries to offer substantial incentives.
This surge in opportunities hasn’t gone unnoticed by aspiring healthcare workers, resulting in a notable increase in enrollment for healthcare-related majors.
Angela Starkweather, dean of the Rutgers University School of Nursing, expressed enthusiasm, stating, “We have no shortage of interest these days,” highlighting the demand that could potentially allow for a substantial increase in program size.
Rutgers faces the challenge of turning away approximately 1,000 applicants each year for its 800-student nursing program, illustrating the fierce competition for slots. With a visionary plan to triple enrollment within five years, the university now faces the critical task of acquiring additional funding to enhance facilities and hire additional faculty. A bill currently under consideration in Trenton proposes to allocate $26.7 million specifically targeting the expansion of nursing programs.
Hurdles to expanding nursing programs
However, even if funding becomes available, entrenched issues present significant obstacles to expansion.
Currently, nursing programs are grappling with a faculty vacancy rate of around 10%, according to Cadmus. While many experienced nurses are eager to exit bedside roles, transitioning to teaching roles can be challenging. Teaching requires at least a master’s degree—only 11% of registered nurses in New Jersey possess advanced degrees—and many nursing professionals face the prospect of a pay cut if they choose to teach.
Another major obstacle to growth is the scarcity of clinical training opportunities for nursing students. As Barnard explained, for instance, a radiography student is required to amass 1,700 hours of hands-on experience in hospitals, clinics, or imaging centers to qualify for graduation, but such training spots are increasingly hard to secure.
This limitation results in a bottleneck, capping the number of students who can be admitted. For instance, Bergen Community College’s two-year health professions program routinely turns away many applicants—its radiography program alone sees 160 applications each year for only 40 available slots.
“It’s not merely a situation of constructing more classrooms and hiring more staff,” Barnard explained. “We depend immensely on our clinical partners to offer students the essential real-world experience they need for graduation and subsequent careers. An increase in clinical training spots is vital to creating more classroom openings.”
Nursing home shortage
The most severe and persistent staffing challenges are being experienced not in hospitals, but in nursing homes.
A significant shortage of certified nursing assistants has emerged, jeopardizing the quality of care provided in these essential facilities. CNAs play a critical role, handling personal care tasks that range from assisting patients with bathing to transferring them from beds to wheelchairs.
The majority of CNAs hail from immigrant communities—predominantly women from the West Indies—seeking immediate entry into the healthcare sector. They complete a rigorous 90-hour training program to achieve certification and can typically secure employment right away.
However, the financial compensation is often lackluster compared to industry standards, with average hourly wages hovering around $20, according to several job market analyses. The demanding nature of the work contributes to high rates of burnout among these essential workers.
A recent survey conducted by the New Jersey Collaborating Center for Nursing revealed that the intensified workload prompted by staffing shortages, coupled with low pay, has created an untenable situation for nursing assistants. Among the feedback were comments highlighting the impossibility of delivering quality care under current conditions:
- “CNAs work short every day/night; sometimes, I get assigned 15 patients or more. You tell me how you can give good care to 15 patients without falls.”
- “Some aides work 16-hour shifts seven days a week just to make a living off a $20.00/hour rate.”
- “It’s like no one cares about what is happening in these nursing homes. No one cares about the strenuous workload on the CNAs and no one cares about the residents’ overall well-being.”
At Bergen New Bridge Medical Center, the vacancy rate for registered nurses during the summer fluctuated between 12% and 14%, while the nursing assistant vacancy rate at its extensive nursing home reached a concerning 28%.
“We definitely saw an acceleration of people leaving the workforce, and it’s been a struggle,” said Deborah Visconi, CEO of the hospital. “But we feel we still have safe staffing levels.”
To address the staffing deficit, Visconi has partnered with CareRev, a company specializing in providing per-diem healthcare workers. This partnership offers a solution to the workforce shortage while granting nurses, CNAs, technical staff, and others interested in per-diem work the flexibility they crave in today’s gig economy, where traditional schedules are increasingly unwelcome.
Open shifts at New Bridge are listed monthly, with registered nurses being offered hourly rates between $66 and $83 depending on their specializations, a significant increase from the typical $45 to $50 that many staff receive—albeit without benefits.
‘Muscle memory’ on an ICU shift
Among the many health professionals seizing these newfound opportunities is Kadesha Bryan. Following her graduation from William Paterson University’s nursing program four years ago, she has accumulated diverse experiences working in various nursing roles, from a staff nurse in the intensive care unit at St. Joseph’s Wayne Medical Center to a traveling nurse in upstate New York.
In June, Bryan decided to shift her career trajectory by enrolling full-time at Columbia University to become a nurse anesthetist. To supplement her income, she now picks up shifts at New Bridge, committing to just one or two each month.
“Once I’m back, it’s muscle memory,” Bryan said, expressing how instinctive it feels to care for patients, regardless of the time that has elapsed between her shifts.
Despite facing a learning curve with different charting software at New Bridge, Bryan has adapted quickly, prioritizing getting patient care procedures right, even if it means asking for repeated explanations.
“If I have to ask five times how to do something, I’ll do it because it’s important to get it right,” she remarked. “Now, I’m the one showing the new nurses how to do it.”
The flexible arrangement allows Bryan to choose her work schedule in harmony with her academic commitments and even enables her to visit her family back in Jamaica during holidays—an opportunity that working as a full-time nurse had previously denied her.
“It’s exactly what nursing needs right now,” Bryan stated. “When your personal life gets dictated by your professional life, it creates an environment ripe for burnout among staff nurses, and addressing this is critical.”
What are the key strategies being proposed to address the nursing shortage in New Jersey?
Ss=”presto-h2 wp-block-heading”>Path Forward
As New Jersey grapples with this acute nursing shortage, stakeholders across the healthcare spectrum are recognizing the need for comprehensive solutions that address both immediate staffing challenges and long-term sustainability. Innovations in recruitment, retention, and education are critical in bridging the ever-widening gap in healthcare provision. State officials, educational institutions, and healthcare providers must collaborate to enhance pathways into nursing education. Initiatives could include scholarships for nursing students, partnerships with high schools to promote healthcare careers, and streamlined processes for international nurses looking to work in the U.S. Additionally, improving working conditions for existing healthcare staff is essential in retaining talent. This includes enhancing compensation packages, offering mental health support, and implementing policies that promote a better work-life balance. Regular feedback mechanisms can help institutions recognize and address staff concerns before they escalate into full-blown attrition. With the healthcare landscape shifting rapidly, fostering a culture that values and prioritizes the contributions of all healthcare workers is imperative. By adopting a proactive, multifaceted approach, New Jersey can begin to reverse the trends of burnout and dissatisfaction while positioning itself favorably to meet the burgeoning needs of its aging population. The time for action is now, as the challenges faced today will dictate the quality and accessibility of healthcare services for the years to come. Only through decisive measures can New Jersey hope to build a resilient healthcare system capable of withstanding future pressures and ensuring that every patient receives the care they deserve.