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Health workforce shortages at catastrophic levels

A Manchester Community College instructor and student in the Physician Assistant Certification Apprenticeship Program. Courtesy picture

MANCHESTER, NH – The acute shortage of healthcare workers in NH before the pandemic became a crisis following the Great Resignation. “We had seen a drop in the number of licensed practical nurses before the pandemic,” says Brendan Williams, president and CEO of the NH Healthcare Association, a membership organization that supports healthcare and long-term care organizations. “Before the pandemic, we had a crisis. Now we have a disaster when it comes to finding workers.

He, and others in the industry, say the greatest need is for licensed practical nurses – LNAs – and physician assistants. This is often the entry-level position for people entering the healthcare workforce, and they provide much of the hands-on care in hospitals or nursing homes.

While it was difficult for institutions to fill these positions before the pandemic, the added pressures of the last two and a half years – the challenge of securing protective equipment, watching patients die from the virus and the fear of exposing loved ones back home – has left many healthcare workers wondering if they really want their jobs.

Meanwhile, those left behind are forced to work longer hours or come on scheduled days off because there is simply no one else to attend to patients. “We saw a lot of burnout,” Williams says. “I’ve had baffled members say, ‘Where did everyone go?'”

Wage increases can help stem the losses, but they don’t solve the problem. Williams says he knows of facilities that have given three raises this year alone and are still struggling to hire. Wages for nurses rose 24% between 2019 and 2021, he says, and continuing to pursue upward wage trends could threaten financial stability.

“It feels like an existential crisis,” Williams says. “It is sometimes difficult to see how we could get out of this. For many of our members, this looks like an extinction event.

Measure the gap

Between the number of workers available and the number needed, there is clearly a gap. The magnitude of this gap, however, remains an open question.

“We don’t know, we’re trying to quantify it,” says Roxie Severance, a former long-term care facility manager who has worked as a consultant since 2017. She helps lead the Sector Partnership Initiative, bringing together employers, educators and state community health organizations, by region, to address health worker shortages.

Severance and the initiative are in the process of surveying all suppliers, by region, to determine how many workers are needed, what type and where.

“How can the state, or anyone else, fix it when we don’t know the extent of the problem? Severance estimates the state is short of at least 1,000 LNAs, though the final number could end up being closer to 1,500. “Then you look at community colleges and LNA programs. If enough people wanted to be LNAs, could we train 1,000? »

For someone who is unemployed or underemployed, or who wants to start a career in healthcare, an LNA position offers good pay, guaranteed employment, and opportunity for professional development. But there is a barrier. The cost to get certified is around $2,000, which is prohibitive for someone of limited means. It’s important, says Severance, to make grant programs available to remove this barrier.

Then there is the need for capacity in these certification programs. This capacity is often limited by the availability of teachers. State and federal regulations establish requirements for LNA instructors that include at least two years of experience working in a nursing facility. Anyone who meets these standards should take a pay cut to become an instructor.

“The pay is usually so low that you could work in a hospital and make more money, so there’s no incentive to teach,” Severance says. It’s important to keep the pipeline full of new LNAs, she says, because many of these new workers will seek higher certification, such as a registered nurse or nurse practitioner, leaving another LNA vacancy behind.

Until the need is fully quantified, Severance says she fears the situation will only get worse. “I have the impression that there is nothing big to do. I don’t sense the urgency of others to improve the situation,” Severance says. “I know people are trying to do things, but because we don’t have the data, [we] don’t feel the urgency.

Learn and earn

A solution already in the works takes an old idea, the learnings, and applies it to healthcare, an industry that didn’t offer one before. Kristen Miller, vice president of academic affairs at White Mountains Community College in Berlin, says her school helped develop a learning program in partnership with a hospital.

“One of our partners, Memorial Hospital, came to us in the middle of COVID and said, ‘We need medical assistants, what can we do?’, so they started a learning program.

“We have created sections for a cohort of our students. They were hired as medical assistants in North Conway; they were paid full time to go to work, but for 28 hours they went to school,” says Miller. The rest of the time was spent working in the hospital on tasks they covered in class. “It was a very active learning environment,” says Miller.

At Manchester Community College, Kristine Dudley, director of workforce development, says she’s committed to a statewide effort, ApprenticeshipNH, to provide programs that enable students to become physician assistants, LNAs, or patient services administrators. “The best part is, it’s earning while you’re learning for the participant,” says Dudley.

She says student demand for apprenticeships has been encouraging, but the effort is running up against some internal limitations such as the capacity of instructors.

Another innovation in Manchester taps into the population of recent immigrants and refugees. Many are interested in becoming LNAs, Dudley says, but need help paying for training as well as English skills. This program, called LNA for Success, has already graduated two classes and will begin its third this fall.

“All of these partnerships that we have are really helping to move forward and solve the pipeline problem, but it takes multiple paths to move forward. We have to be open to trying different things and being open to change,” says Dudley.

Endowment for Health outlines strategic plan to address pipeline issues

New Hampshire has a big problem on its hands, and it needs to do something — in fact, 107 something — and fast. This is the message contained in the report “Giving Care: A Strategic Plan” published earlier this year by the Endowment for Health.

The report notes that the labor shortage in NH’s healthcare sector, already apparent before the pandemic, has only worsened and that projections predict an even more troubling future if nothing changes.

“While more than half of the state’s physician assistants are under 40, 24% of its nurse practitioners and 27% of its primary care providers are over 60. Additionally, New Hampshire is expected to be the 10th most serious US state. nursing shortages,” the report said.

“Giving Care,” a two-year effort involving stakeholders from public and private sectors, education and industry, and from all corners of the state, was designed to be a call for action – 107 actions divided into four sections: Pipeline, Policy, Data and Governance.

Among the strategies recommended in the report are: creating a statewide financial support system for new and existing workers for education development, including student stipends and payment initial tuition for professional development; encourage schools to launch an introduction to health professions from the 5th year; launch a summer jobs program hiring teens (16 and older) for jobs in health care facilities to influence their entry into health care careers; and implementing strategies to overcome barriers to licensing.

Kim Firth, program director at Endowment for Health, says the plan has already gained traction, with committees meeting in August to begin “unbundling” the recommendations and setting a timeline for action, with an eye particularly on the next state budget and legislative cycles.

“It was really intended not to be a pie-in-the-sky 10-year plan,” she says.

The full report is available at

Firth says anyone considering a career change should look to health care. “It’s a great career to get into,” she says. “If you are a healthcare worker, we appreciate you. The pandemic has been very difficult for our healthcare staff. It’s really important for us to tell them that we appreciate them and all they have done to keep people safe during a really difficult time in our state. »

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