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A nursing problem: ND hospitals use all available tools to fill high demand for caregivers; need expected to grow

FNS Photo by Dave Wallis Kelly Robinson, right, a registered nurse who works on a medical-surgical floor at Sanford Medical Center in Fargo, gives a nursing report to Hannah Oswald, clinical care supervisor. Robinson joined Sanford from Hawaii because she was able to work in a hospital setting after graduating. Sanford is actively recruiting nurses, offering sign-up bonuses for some positions and experience levels, in the midst of an ongoing nursing shortage.

FARGO — Kelly Robinson found that the shortcut to launching her nursing career involved moving 3,800 miles from Honolulu to here.

She learned of opportunities for registered nurses at Sanford Health in Fargo. Because she could work immediately as a nurse, without a year’s stint as a nursing assistant, a common requirement on the West Coast, she uprooted after graduation.

“I was at a computer screen the whole time I was there,” she said of her job at a hospital in Honolulu, where she placed incoming patients in appropriate rooms. When she started in January as a nurse on a medical-surgical floor at Sanford Medical Center, she was immediately giving hands-on care.

The move was eased by a relocation assistance grant from Sanford, which is aggressively recruiting registered nurses from around the country to meet a high demand.

As an added inducement, Sanford is offering sign-up bonuses of up to $15,000 for certain nursing positions, experience and commitment levels — one more recruiting tool in an ongoing nursing shortage that is expected to become even more acute in the years ahead.

“We have attracted some people into the organization” with the bonuses, said Karin Tobin, Sanford’s chief operating officer in Fargo.

“We certainly haven’t filled all the positions yet,” she said, adding that the bonuses have been extended. “We still have a lot of openings.”

Smaller bonuses also are available for employees who help recruit nurses.

North Dakota now has about 12,810 licensed registered nurses and 3,744 licensed practical nurses, figures from the North Dakota Board of Nursing show.

By 2021, if marked growth trends continue, the need for registered nurses will rise to 18,000.

“What we’re experiencing now is just going to become more of an issue,” said Carla Gross, who heads the nursing program at North Dakota State University.

A mix of factors combine to heighten the continued need for nurses:

- As the wave of baby boomers enters retirement, the population is graying, and requires more health care. North Dakota has the highest proportion of residents ages 85 and older. The oil boom also is increasing the state’s overall population.

- Another demographic challenge looms from the aging nursing workforce. As experienced nurses reach retirement, they require replacements.

- Expansion of medical services. In Fargo-Moorhead, the new $494 million Sanford Medical Center, expected to open in late 2016, will require about 2,200 employees.

Although some will transfer from downtown, many will be new nursing positions. Essentia Health is adding a new wing and 28 beds, which also will increase local demand for nurses. The expansion will create 150 new jobs, with many of the 100 clinical jobs involving nurses.

- There is a push in health care for more registered nurses with a four-year degree, increasing the demand for more highly trained nurses. There’s also a rising role for advanced practice nursing, with master’s or doctoral training.

Growth in western North Dakota from the oil boom has strained the ability of hospitals and clinics to attract and keep nurses. In Minot, Trinity Health recently recruited 86 nurses from the Philippines.

Recruiting nurses from foreign countries is not a step local hospitals have taken. But as Robinson’s decision to uproot and move from Hawaii illustrates, they are seeing a growing number of out-of-state nurses as word of North Dakota’s job opportunities spreads.

Sanford also now offers loan forgiveness for nurses who make a commitment to stay more than a year, said Carla Hansen, Sanford’s chief nurse executive in Fargo.

With college graduations coming in May, recruiting efforts are in high gear, she said: “This is a very high time of recruitment for us.”

Last year, Sanford hired 732 nurses — LPNs and RNs — in the Fargo region, where it averages 129 nursing openings, a figure Hansen called “high but not unusually high.”

Nurse retention also is a growing challenge. Nurses now have an increasing number of career paths, with nontraditional or growing options including roles in electronic health records, health insurance and consulting.

The demands on nurses, especially in hospital settings — with the need to provide care around the clock, including weekends and holidays — also take their toll, and some leave the profession.

“The younger generation is not as willing to work overnight shift work week after week,” said Patricia Moulton, executive director of the North Dakota Center for Nursing, based in Fargo. “That’s what they’re seeing nationally.”

In fact, some nursing advocates argue that hospitals would be well-advised to focus more on keeping nurses, which would help alleviate the need for recruiting.

Nationally, the annual turnover rate among hospital nurses is about one in five, and Sanford is close to that average, Hansen said.

Essentia also mirrors the national turnover rate in the area of medical-surgical nurses, although turnover is lower for some other areas, said Doug Vang, senior vice president of North Dakota operations for Essentia.

“We’re holding our own right now,” he said. Essentia has not used sign-up bonuses for nurses, but tries to make its work environment attractive, Vang said.

“Our focus, No. 1, is on our culture,” he said, adding that nursing is “demanding both physically and mentally.”

Keeping experienced nurses is a big challenge, he added. Hospitals in the Twin Cities like to lure experienced nurses from Fargo-Moorhead, Vang said.

To help meet the growing demand for nurses, programs at area campuses have expanded.

As of June, NDSU will absorb the nurse-training program at Sanford Medical Center in Bismarck. That program has 174 students and is expected to reach 240 by 2015.

In Fargo, NDSU has 64 slots each year for its baccalaureate nursing program. Starting next fall, that will increase to 96. NDSU receives many more applications to its nursing program than it can accept, allowing it to accept the best candidates, Gross said.

“It’s one of the really sought-after degrees,” she said, given the high demand for graduates.

The nursing program at Concordia College, which traditionally accepts about 32 students each year, recently added an accelerated track for students who already have a baccalaureate degree, but want to add a nursing degree, with room for about 10 students a year.

Concordia also is working on a collaboration with North Dakota State College of Science that would provide a track for nurses with two-year training to advance to a bachelor’s degree in nursing, an option expected to become available in fall 2015 with 10 slots, said Jack Rydell, a professor of nursing and interim chairman of the program at Concordia.

“Nursing has great job security, plus there’s a great market for it out there right now,” he said.

The North Dakota Center of Nursing also is working on programs to create awareness for opportunities in nursing among students in grades K-12, Moulton said.

As for Robinson, she expects to stay at Sanford for at least two years. Eventually, she wants to return to her native California.

“A few months ago, I never expected to be in North Dakota,” she said.

Patrick Springer

Patrick Springer first joined the reporting staff of The Forum in 1985. He can be reached by calling 701-241-5522. Have a comment to share about a story? Letters to the editor should include author’s name, address and phone number. Generally, letters should be no longer than 250 words. All letters are subject to editing. Send to