The Nursing Crisis Knocking at USF’s Door

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Senior nursing students Sarah Vega (left) Caitlin Mayo (right). WILLIAM WIN/FOGHORN

The Bigger Picture

Sarah Vega is a senior nursing major. She is also the School of Nursing Senate Representative.

College nursing programs are on the brink of a crisis.

According to this year’s American Association of Colleges of Nursing report, 75,029 applicants from nursing schools across the United States were denied admission between 2018 and 2019. These applicants were not denied based on their qualifications, but rather due to a shortage of nursing educators, clinical sites and insufficient university budgets. This is a nationwide issue, and I see this on our own campus as exemplified by a growing frustration within the program.

As a senior nursing student, I felt this frustration when this spring semester, I woke up at 5 a.m., put on my scrubs, and took two buses to get to Oakland — only to spend my entire eight-hour clinical day in a makeshift classroom outside of the hospital because they were not ready to allow students to practice in the clinical setting with patients.

I felt exhausted from the early commute and disappointed that I was unable to get hands-on experience that day.

While sitting in Cowell Hall during office hours as Senate’s nursing representative, I hear a lot of similar stories from other students — some saying that they have not received any clinical experience for the entire semester. I realize now how many students are lacking in experience.

Sometimes, I hear about a clinical professor unexpectedly quitting their job at the beginning of the semester or the hospital not accepting a cohort of students on a unit they were assigned to. Associate Dean Scott R. Ziehm says that the shortage of nursing school faculty is a result of “nursing faculty retiring and there are not enough new faculty being hired to replace them. Faculty salaries are not as competitive with the salary nurses can earn in clinical practice.”

Despite these conditions, the USF nursing program actively recruits from their network of alumni and contributes to the solution through graduates of their Masters and Doctor of Nursing Practice program. USF’s School of Nursing is being impacted by a systemic issue much larger than itself.

From my perspective, the school is doing the best it can in these conditions and the main issue is not in the quality, but rather the quantity of their nursing faculty.  

In order to alleviate this issue, nursing schools must receive more funding from either the state or the institution they belong to, hospitals need to increase wages of nurse educators, and lastly, state leaders should keep track of these patterns of incoming retiring nurses so that they know what areas that can fit newly-graduated nurses. This would include tracking which specialties of nursing are projected to have a shortage, and indicating which positions newly-graduated nurses should fill in.

If nursing schools, hospitals and state leaders fail to act on this issue, there will not be enough nurses to replace those that are retiring and there will not be faculty to educate future nurses. Further, the shortage of nursing school faculty may cause a decline in the quality of nursing education. This could result in unforeseen ramifications in the quality of patient care across the country.

The Day-to-Day

Caitlin Mayo is a senior nursing major.

While doing research for my final project for USF nursing, it’s difficult not to think about the many things that I wish could have been improved about the overall experience. Transportation issues, limited academic support and a lack of consistently offered alternatives for missed clinical experiences are some of the many factors that, had I been aware of then, would have influenced my decision to attend this nursing school.

As I wrote in my op-ed “Nursing Student Transportation” in April 2017, transportation to clinical continues to be an issue that isn’t made clear before we decide to attend USF. Though it would be preferable to have a local clinical placement, the reality is that there are only so many students that hospitals are willing to take — in addition to the many nursing schools in the Bay Area that compete for these spots.

Having a vehicle can be much more costly and less comfortable in a city as busy as San Francisco. For students that aren’t local to the Bay Area, having clinical in places like San Jose and Oakland can be a stressor. For some, this may be a factor in choosing to attend a nursing school where owning a vehicle isn’t as much of a burden.

Our schedules as nursing students have always been busy. However, resources that our courses require us to access can be limited. The recent budget cuts to our program have proven to be detrimental, lessening the number of tutoring sessions and the amount of flexible academic support that nursing students can access.

The financial outlook will only get worse. Over half a million dollars will be slashed from the University’s nursing school budget for the next academic year.

A resource that has been inconvenient to access, yet necessary to our progression in the program, is the skills lab where we practice all our hands-on skills. Due to the limited amount of open lab hours and high demand from students, it has become almost impossible to be able to practice skills and collect the required number of signatures from the teaching assistants (TA)  that attest to proficiency.

Given the small pool of staff in the lab, the amount of time it takes to practice and the number of stations available to practice each skill, there just isn’t enough to keep up with the large number of students that need to access the lab. “I don’t like how limited the hours are,” junior nursing student Janelle Malonzo said. “It’s always difficult to find time to go in, and it takes long to get checked off. It’s always very helpful to get help from the TAs, but sometimes there aren’t enough TAs to help people.” Long lines of students waiting to stick an IV in a rubber arm or to place a Foley catheter into a mannequin aren’t uncommon sights.

Problems with providing nursing students clinical experience continue to persist into this semester. Some students in the current junior 2 cohort were unable to begin their clinical at Kaiser San Francisco on time due to understaffing in the hospital’s nursing education department, causing them to miss a whole month of clinical. Though the number of hours may be something to worry about, there is also the question of meeting the clinical course objectives — what is being done to replace the valuable experience that is being missed when someone misses clinical?

Our school of nursing’s response isn’t always very clear, nor has much been offered to every student who misses out on a clinical day. Addressing this issue, the program’s associate dean Scott R. Ziehm offered some alternatives to meet course objectives: virtual simulation and skills lab learning experiences, observational opportunities at a clinical agency and reviewing case studies with clinical instructors. Though these alternatives could never fully replace real-world experience, I would like to see them implemented, rather than not learning at all.

It all starts with clear communication and transparency: let us know what is being done, and let us know what we can do. Don’t keep us in the dark, and let us become part of the solution. I’ve always been proud of being a USF nursing student, and I have hope that we’ll be able to do better. Until then, let’s advocate for our success.

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