August 2016 Feature Story: Nursing Shortage

Closing the workforce gap

CNA student Kasey Rivers practices for his clinical skills test at Samaritan Medical Center last month. Samaritan manages its own resident CNA training program. Photo by Justin Sorensen, NNY Business.

CNA student Kasey Rivers practices for his clinical skills test at Samaritan Medical Center last month. Samaritan manages its own resident CNA training program. Photo by Justin Sorensen, NNY Business.

Aging population drives demand for health workers

By Karee Magee, NNY Business

The U.S. health care industry has found itself in the midst of a dilemma. As baby boomers age and the need for health care grows, the nation is struggling to expand capacity, particularly in nursing.
The American Journal of Medical Quality projected in 2012 that a shortage of registered nurses would spread across the country between 2009 and 2030, and the north country has been feeling the strain.

While RNs generally are always needed, though, hospitals including Massena Memorial, Claxton-Hepburn and Carthage Area Hospital are more concerned with the shortage they’re seeing in specialty nursing areas, including obstetrics, intensive care, emergency room, and operating room nurses.

“They require more extensive training than out-of-college programs provide,” said Ralene M. North, a registered nurse and chief nursing executive at Massena Memorial Hospital.

New graduate RNs are required by New York state law to be on a med-surgical unit for one year, which is classified as any inpatient unit where they can use their basic nursing skills.

“When you graduate nursing school, you’re not necessarily ready to jump into the emergency room,” said Steve Olson, RN, the director of nursing and administrator of patient care services at Carthage Area Hospital. “You need those specialty skills, but they’re also the hardest to recruit.”

Recruiting has proven difficult for two other nursing areas at Samaritan Medical Center’s Summit Village and Samaritan Keep Home.

In the early 2010s, Samaritan began to notice a shortage of certified nursing assistants and home health aides in the area, which was exacerbated when the organization started recruiting for Summit Village in 2012, which is staffed half by CNAs and half by home health aides.

Both jobs are more difficult to recruit for than traditional nursing positions. Being a CNA is a tough job, said Christine Robinson, CNA training coordinator at Samaritan.

“The CNA role is the most difficult job in long-term care,” she said. “Long-term care doesn’t always lead to people going home. You’re dealing with not only residents, but family members. There is an emotional component.”

Home health aides can be harder to recruit because the state guidelines are very specific about who can teach a home health aide program, which didn’t exist in Jefferson County in 2012, said Michael Britt, manager of recruiting at Samaritan.

“It is more difficult to qualify as a home health aide instructor than a CNA instructor,” he said.

The shortage was causing a multitude of issues for area hospitals, including overwork, burnout and turnover.

“You cannot reduce the day-to-day requirements,” Mr. Britt said. “You have to do it with less people. It doesn’t help morale if you have short staffing.”

At Claxton-Hepburn Medical Center overtime was particularly difficult for nurses in department like OB because nurses cannot be substituted from other departments like they sometimes can for the ER.

“OB is so specialized you can’t just plug anyone in there,” said David Ferris, chief of nursing and vice president of patient services at Claxton-Hepburn. “I don’t have a lot of playroom.”

Adaptation, though, in the regions hospitals is helping efforts to recover the number of nurses needed in these areas, with a large focus on education.

Prior to the nursing shortage, few hospitals in the region hired RNs right out of college, but they have recently been giving special consideration to new graduates from regional colleges like Jefferson Community College and SUNY Canton to provide specialized training and to grow their own nursing staffs from the ground up.

Lisa Cooley, chair of the nursing department at JCC, said that hospitals are able to do that because of the quality of the nursing programs in the area.

“JCC grads have a reputation for being very strong when they graduate,” she said. “Our program has been the same since the beginning.”

JCC has a 100 percent pass rate for students taking their nursing boards and a 100 percent employment rate.

Massena Memorial began taking new graduates this year, including two to OB and ICU each, to go through specialty training that starts with a 12-week initial orientation and includes two weeks of classroom training, weekly evaluations and they go back to the classroom to work on skills as needed.

“They’re engaged,” Ms. North said. “They’re enthusiastic. The mentors describe them as sponges and we come out with a nurse who is specialty trained.”

The trainees have a guaranteed job at Massena Memorial when they’ve finished the program.

Carthage Area Hospital, Claxton-Hepburn and Samaritan Medical Center have also started similar practices of hiring new graduates and training them as well.

Ms. Cooley said a more formalized training program for specialty areas is better for the nurses and the patients than the old transition model.

“It’s beneficial to the patient population of that area because the nurses are getting that specialty training to provide that quality care,” she said.

Samaritan Medical Center also saw the benefits of training its own staff to solve the CNA and home health aide shortages by creating those training programs.

The CNA program began at Jefferson-Lewis BOCES in 2011, but Samaritan moved it to the hospital shortly after.

The CNA program lasts 10 weeks and includes an intensive interview process to be accepted, quizzes, a midterm and final, and 21 lab skills, three of which are picked randomly when students take the practical state exam.

Samaritan incurs all expenses including textbooks, workbooks, scrubs and testing fees.

The home health aid program is a three-week training program.

“It gives us that availability to fill those areas,” Ms. Robinson said. “We tailor the program to what we want to see in those CNAs and we reinforce those values throughout the program.”

The shortage has had an impact on nursing education across the board in the north country, including the programs at JCC and SUNY Canton.

When Cooley and others in the nursing department at JCC noticed a shortage starting around 2008 to 2009, they discussed how they could expand the associate degree program.

The solution was the Weekend Nursing Program that was started in 2010, where nursing students who couldn’t fit into the full weekday program or couldn’t attend weekday classes could take classes every other weekend on Friday, Saturday and Sunday.

“We always have more applicants than we have seats available,” Ms. Cooley said. “It has allowed us to increase our enrollment.”

In response to the shortage, SUNY Canton’s nursing program instituted a bachelor of science in nursing for RNs who want to continue their education, and Debra Backus, nursing director at SUNY Canton, said the school is preparing to include a dual degree program and a master’s in nursing.

The nursing shortage has also spurred on changes in the hospitals accommodate work-life balance and support their staff to improve retention.

Carthage Area Hospital renovated its medical-surgical unit by constructing a centralized nursing station after following up with staff about improvements that could be made.

Mr. Olson, said he’s receive help from the Studer Group, an organization that help with health care coaching, to provide a better, staff-driven environment by encouraging staff input.

“We talked to the staff, which is the most important thing,” he said. “I think they were a little surprised. It’s a novel concept.”

Mr. Britt said Samaritan is also concerned with making the hospital a better work environment, which is why it tracks turnover to determine if it’s a trend that can be fixed.

“We’ll do whatever we can to keep an employee,” he said. “We will work with the employee.”

That includes the CNA training program. Instructors follow-up and build relationships with their students to make sure they are happy in their new positions and to provide a feeling of security.

“It’s more personal because being new they don’t feel comfortable going to a manager,” said Kim Fleming, nurse aid instructor at Samaritan.

Ms. North said that Massena Memorial is also considering a relaxation room for the staff where they could de-stress.

A lot of changes have been made to nursing programs in the north country, but Ms. Cooley said that it’s just the beginning.

Jefferson Community College has been working on providing more clinical experience in community health care with organizations like Jefferson County Rehabilitation because there will be an increase in those jobs as well.

“I think you’re going to see nursing programs expand and offer more community experience, such as public health, hospice and JRCs because health care is switching more toward needs in the community,” she said. “The key is to be aware of the needs of the individual communities and then coordinate and collaborate with the communities.”

With the programs being established at the hospitals, though, Ms. Cooley said that the nursing shortage is on its way to recovery.

“They are on the right path,” she said. “They are staying on top of what the needs are. Now it’s just a matter of recouping.”

Karee Magee is a magazine associate for NNY Magazines. Contact her at or 661-2381.