When Norton Healthcare announced earlier this year its plans to launch an innovative apprenticeship program to help train nurses, it became one of the first provider systems in the country to take up the task of helping to educate its own workforce, a function traditionally left to medical schools and universities.
The Student Nurse Apprenticeship Program, SNAP for short, is meant to supplement, not replace, an associate’s or bachelor’s degree in nursing, according to Program Manager Brittany Burke. The 12- to 18-month paid training program is a crash course in clinical procedures, Norton Healthcare-style.
It is designed to acquaint participants with “the culture of Norton Healthcare” as they gain additional hands-on experience and become more confident healthcare providers.
A three-tiered culture, clinical, confidence model, SNAP pays students to acquire an elevated educational and clinical experiences as they prepare for an RN role after graduation. It reinforces nursing education and patient safety, awareness of the professional nurse role, and an appreciation of organizational structures and operations within Norton’s first-rate healthcare setting.
The Louisville-based not-for-profit system includes five hospitals with 1,837 licensed beds; seven outpatient centers; 12 Norton Immediate Care Centers; over 13,000 employees; some 654 employed medical providers; and approximately 2,000 physicians on staff.
Upon its announcement last summer, SNAP earned accolades from Gov. Matt Bevin, who positioned it as part of his call for businesses to help the state’s workforce become more competitive.
“Innovative training programs, like this one at Norton Healthcare, deserve to be celebrated,” Bevin said in a Norton press release. “I have challenged Kentucky employers to think and act boldly, and Norton Healthcare has answered that challenge in an impressive way.”
While many SNAP participants are likely to become Norton staffers, there is an expectation that many will go elsewhere in the region also. There are 125 enrollees presently, with future cohort sizes dependent on the needs of the organization.
During an August interview published in The Lane Report, Norton Healthcare CEO Russ Cox explained the need for the program.
“We have always been very involved in training nurses, because that is the lifeblood of our workforce,” Cox said. “The nursing workforce is extremely important. One of the reasons we have weathered storms that others haven’t is because we’ve invested in training and apprenticeship programs for nurses.”
Norton, like all non-profit hospital systems, does not pay income tax on its earnings but files details of its community benefit services with the federal Internal Revenue Service.
While Norton lacks an outright shortage of nurses, its move to train more of them could be seen as a proactive step to avoid an issue affecting many hospitals across the country. According to an Oct. 20 article by Reuters, a nationwide shortage of nurses is threatening care. Hardest hit are rural communities, such as those in neighboring West Virginia, where the Charleston Area Medical Center in Morgantown spends $12 million annually on visiting nurses, a category the report says was unheard of until recently. The hospital, one of 20 Reuters surveyed to document the national shortage, incentivizes training for nurses by paying tuition in exchange for a two-year promise to work at the center.
Ron Moore, the Charlestown hospital’s retired vice president and chief nursing officer, explained in the report that incentives are necessary to combat a shortage he characterized as the worst he has seen in four decades.
Conditions in West Virginia mirror those in Kentucky, according to an Oct. 6 article published in The Courier-Journal, which quoted Galen College of Nursing CEO Mark Vogt as saying Kentucky was on the “front end” of the coming nationwide shortage.
National statistics back up this assertion. According to the federal Bureau of Labor Statistics (BLS), demand for nurses, who earn a median salary of nearly $33 an hour, is expected to jump 15 percent over the next decade, adding some 437,000 jobs to the current 2.9 million registered nurses currently working.
However, another metric is particularly troubling. The American Nursing Association reports that between 2000 and 2010, the average age of nurses increased by two years, suggesting that more nurses are retiring and leaving the workforce, without younger counterparts to replace them.
This is an issue also with educators training the next generation of nurses, notes Marcia Hern, dean of the University of Louisville’s School of Nursing.
“There is a nationwide shortage of nursing school faculty,” Hern said. “The average age of a nursing faculty member is in the low 60s. So what’s happening is many of them are starting to approach retirement, and even though nursing remains a popular career choice, we don’t have sufficient numbers (of faculty) to meet the needs as educators for the future.”
Seen in this light, Norton’s move to help train and incentivize nursing students can be seen as a proactive step to help build the pipeline of nurses for the next generation.
“One of the single biggest limiters in healthcare right now is a trained workforce,” Cox told The Lane Report. “There are a lot more people seeking care these days, so we need a whole lot more people to take care of them. So it’s not just designed to answer (Kentucky’s) needs; it’s designed to begin to answer some of the questions about the discipline of nursing and how we begin to replenish that workforce.”
The new primary care provider?
The employment situation of primary-care physicians, and doctors overall, parallels that of nurses, according to a recent study from the American Academy of Family Physicians. The association points to a 2012 article in the Annals of Family Medicine predicting a shortage of more than 50,000 primary-care physicians by 2025. With BLS data showing the median salary of a primary-care physician hovering around $200,810 annually versus just $68,940 for registered nurses, it’s easy to imagine some healthcare systems, especially in cash-strapped states with dense rural populations, could favor hiring more nurses to stem the physician shortage.
However, none of the sources interviewed for this story is suggesting a well-trained nurse could actually replace a primary-care physician. Instead, they advocate a paradigm shift in the way medical practices are structured, a way that could facilitate access to care during challenging financial times.
“The goal of the nurse is not to replace the physician,” assured Kim Tharp-Barrie, system vice president for Norton’s Institute for Nursing and Workforce Outreach, herself an R.N. “Nurses are part of a primary care team that provides a holistic approach to healthcare. As a member of the team, nurses play an important role in taking care of patients, focusing on patient safety, education and advocacy.”
UofL’s School of Nursing Dean Marcia Hern agrees that the goal is not replacement because doctors and nurses do not share overlapping functions.
“We are collaborative with physicians,” she said. “Physicians drop in and drop out – they’re not there for a whole shift unless they are doing a surgical case. Nurses are the ones, particularly in hospitals, who are present 24 hours. It’s up to an astute nurse in a situation where the patient is declining to make decisions and then call a physician.”
Hern describes a paradigm shift underway across the industry as it struggles to adjust to the shortages of both doctors and nurses, one that has prompted the industry to re-envision the structure of medical practices and delivery of care. Specifically, she points to the increased use of nurse practitioners or advanced practice registered nurses (APRN), who often have earned a master’s degree in nursing and typically have undergone additional training supervised by a physician.
“I think you’re going to see a significant increase in the utilization of nurse practitioners who can actually prescribe and diagnose and treat within their scope of practice, especially in primary care,” Hern said. “So pretty much, outpatient clinics across the United States (will be) staffed with two or three physicians with maybe four or five nurse practitioners … to do the initial screening. Then if there is a more complicated finding or something out of their realm of practice, they will refer on to a physician in a specialty area.”
Nurses usually outnumber doctors by a healthy margin in most healthcare settings.
It may be that in the future, healthcare facilities are staffed by registered nurses or APRNs, who typically receive either a master’s degree or doctorate in nursing from an accredited training program.
According to Kentucky’s Board of Nursing, APRNs provide care under the supervision of a licensed physician and after a minimum of one year of experience can prescribe medications.
Allowing registered nurses and APRNs to provide front-line care may be the industry’s next step as it adjusts to meeting the needs of both an aging baby boomer population as well as patients who can now afford healthcare given the recent changes in the Affordable Care Act. As mentioned previously, while family doctors earn around $200,000 a year, the median salary for specialists is nearly 50 percent more, reported at $284,000 by the American Academy of Family Physicians.
“Many residency programs in medicine have difficulty filling all their slots,” Hern said. “I think (primary care) is not as popular as it once was and many physicians are interested
in challenging specialty areas. Which
is good for us in nursing, as we’re in the right position to absorb some of that care.”
Robert Hadley is a correspondent for The Lane Report. He can be reached at [email protected].