Hospitals in Arkansas are near or at capacity, and the number of nurses needed across the state is lacking. That is not news to the health care industry, of course. What started as a trickle before 2020 became a flood of nurses leaving the profession because of an already aging workforce retiring, leading to nurses taking on more and longer shifts. That led to burnout and more nurses leaving, either by retiring early or choosing to take another career with fewer demands and greater compensation.
Now, four years after the onset of the COVID-19 pandemic, the nursing shortage in Arkansas persists, leaving the state’s hospitals grappling for ways to address the shortage and turn its course. In addition to retiring nurses, other factors contributing to the issue include too few new nurses being trained to replace those leaving and an aging population that requires more health care services.
To address that need, Arkansas hospitals and other health care entities are employing several strategies to encourage more nurses to enter and stay in the field.
Those strategies include increasing funding for nursing education programs to expand capacity and enroll more students; offering incentives such as scholarships, loan repayment programs and tuition reimbursement to attract individuals to the nursing profession and facilitating partnerships between health care facilities and nursing schools to provide clinical training opportunities for students. Employers are doing their part through initiatives to improve the working conditions and job satisfaction of nurses to retain existing workforce and expanding the scope of practice for advanced practice nurses to allow them to provide more independent care, which may alleviate some of the workload on physicians and other health care professionals.
Even so, the nursing shortage is not going away quickly. According to the American Nurses Association, nurses represent the largest group of health care professionals in the country, and that is with a nationwide nursing shortage of 1.1 million. In Arkansas, health care providers are working with policymakers, creating partnerships with educational institutions and health care organizations, and developing new ways of working to provide patients with the care they need.
Despite these efforts, the nursing shortage remains a significant challenge in Arkansas and across the nation and is a complex issue that requires ongoing attention and collaboration to ensure an adequate supply of nurses to meet the health care needs of the population. Specialties such as telehealth, home health, long-term care, rehabilitation and outpatient care are in most need as the state’s population continues to age and deal with chronic disease.
Tammy King-Jones
Tammy King-Jones, chief nursing officer and associate vice chancellor for patient care services and clinical operations in the perioperative, interventional and imaging services division at the University of Arkansas for Medical Sciences in Little Rock, said the nursing specialties most in demand at UAMS are in the inpatient acute care nurses for medical-surgical and oncology units.
“We find that specialties such as [intensive care unit], emergency, women’s health and perioperative attract more nurses,” she said. “We have developed special incentives designed to draw experienced and new graduate registered nurses to these high-demand areas, and we are focusing our new graduate recruitment to these units.”
Other strategies UAMS is using to attract and keep nurses to fill these specialties include ensuring nurse-to-patient ratio is based on workload and acuity so nurses feel they are supported and equipped to render safe, quality care.
“Our ratios set us apart,” Jones said. “To do so, we have developed an in-house agency program and have also engaged outside contract labor to support these units while we are aggressively recruiting/onboarding. Like med-surg, those types of areas are where we need the specialties most. The thing about nursing is there are so many options that take you away from the hospital and the bedside, and while that is a draw for the profession, it does not meet the need at the place where it is most acute and critical, which is inpatient.”
Jones said the way care is delivered has changed since the COVID-19 pandemic. She has been a nurse for more than 30 years, and both her parents were nurses. She said there is a nursing faculty shortage, as well as a need for more nurses, and attributed that only partly to compensation issues.
“This generation still sees nursing as a pretty foolproof way to have a career with decent pay, but beyond that is their desire for a work-life balance,” she said. “The job is not first and foremost. While compensation matters, it is their schedule and ability to have a lot of flexibility that matters most.”
Jones said UAMS looks for innovative ways to schedule and avoid negative downstream impacts.
“Beyond how we run our schedules is how we set up our staffing strategies,” she said. “For instance, one of the things I immediately saw to make more robust was hiring full-time employee nurses into what we call float pools. We have one for ICU, one for med-surg, one for women, one for perioperative, and now we’re creating one for oncology. What happens is these groups of nurses with the competencies and skills to work on these diverse specialties provide coverage where needed on a set of units, and they’re paid more because of it. We call this our in-house agency, and while we still use travel nurses because we have to keep safe patient assignments and practice areas, if we don’t supplement vacancies with contract labor, our nurses will leave because they are taking care of too many patients.”
Jones said the ability to work in different specialties also is a draw for a new generation of incoming nurses who want variety.
“Float pool allows them that flexibility because they can work three 12-hour shifts, maximize their compensation and still receive full benefits, and it gives them four days off to be with their family or pursue more education or whatever they’d like,” Jones said. “Frankly, if I’m looking at a resume for a nurse who’s wanting to get into leadership and they’ve worked in a float pool, what that tells me about them is they can roll with the changes. They adapt, and they’re not this creature of habit.”
Jones added that in the industry, nurses more frequently must “roll with the punches, or you don’t survive.”
“When you talk about nurse specialties, med-surg is one no one really thinks of as a specialty, but it is one our most difficult to fill,” she said. “The reason is you don’t know what you’ll be dealing with from day to day. Our ratios of nurse-to-patients in med-surg could be five one day or seven the next, and each patient has something completely different. One could have a gallbladder removed, another is dealing with sickle cell, another dialysis. You must use everything in your training — assessment skills, ability to work with patients and families. In a med-surg unit, the social dynamics may include working with the homeless population. Med-surg is not glamorous, and while new RNs want to go to the NICU or labor and delivery, med-surg is where we need them. That’s our core, and they are on the front line.”
At the Arkansas State University College of Nursing & Health Professions in Jonesboro, nurse anesthetists are in demand. The program is currently accepting applications for the 2025 cohort, and the deadline to apply for the Doctor of Nursing Practice in nurse anesthesia is Oct. 1. A 36-month, 114-credit hour, full-time program, the DNP prepares registered nurses for entry into nurse anesthesia practice.
The nurse anesthesia program at ASU graduated its first class in 2005. Since then, the program has graduated less than 600 students. The most recent cohort, which completed the program in May 2022, had an attrition rate of zero percent. Every student that was scheduled for graduation that year successfully did so despite the effects of the COVID-19 pandemic. However, there was no graduating class in 2023 due to the transition of the program to the Doctor of Nursing Practice-Nurse Anesthesia in summer 2022. New administration of the nurse anesthesia program began in January 2023, and the first graduating cohort of the DNP nurse anesthesia will be in May 2024.
At Arkansas Children’s, the only hospital system in the state solely dedicated to caring for children, nursing specialties in emergency departments and intensive care units are most in demand. The Arkansas Children’s system is recruiting nurses for its hospitals in Little Rock and Springdale and is currently seeking almost 50 nurse positions in emergency and ICU alone. The system offers a variety of opportunities to learn and grow for new graduate nurses, and for experienced nurses, it offers an opportunity to grow professionally or continue their education to pursue leadership roles at the hospital, as well as in clinical settings.
Arkansas Children’s hosts an RN residency program for new graduate registered nurses, which is a formalized residency program that greatly benefits its participants, the hospitals and patients.
At CHI St. Vincent Health Care, working as a nurse provides a bounty of opportunities to advance a career. A part of CommonSpirit Health, the nation’s largest not-for-profit Catholic health care system, CHI has locations in Little Rock, Sherwood, Morrilton and Hot Springs and serves the central and southwest regions of Arkansas while caring for more than 2 million lives a year.
“Our ministry offers the most comprehensive cardiology network in the state, internationally recognized neurosurgery team and the most advanced network of employed and affiliated physicians,” said Angie Longing, CHI St. Vincent’s chief nurse executive. “These services provide a wide variety of opportunities for nurses, from clinics to the float pool, medical-surgical and specialty areas, several different intensive care areas, and procedural areas such as surgery, [the post-anesthesia care unit] and the [cardiac catheterization] lab.”
Angie Longing
St. Vincent seeks nurses who share the mission and core values of the ministry: compassion, inclusion, integrity, excellence and collaboration. The system can provide RNs and LPNs with all educational preparations, including diplomas, associate’s and bachelor’s degrees and more, while providing robust benefits to support nurses obtaining higher educational degrees.
While the nursing shortage is expected to continue, Arkansas hospitals are addressing it in innovative ways to make life more balanced for nurses while encouraging them to pursue more advanced education, take on leadership roles, and maintain an active life in their homes and communities. According to the Bureau of Labor Statistics, the registered nurse salary in Arkansas is $61,530 a year, and nurse specialties earn salaries from almost $130,00 for a hospital nurse practitioner up to more than $210,000 for a certified registered nurse anesthetist.
For those who can manage several tasks at once while working in an environment filled with adrenaline and the potential for lucrative compensation, nursing and nursing specialties represent viable career options in Arkansas, and positions are there for the taking.
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