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By Liv Osby
Signing bonuses, help with tuition, and flexible work schedules are just a few of the strategies being waged in South Carolina to combat the years-long nursing shortage.
And from the Upstate to the Lowcountry, stakeholders continue to brainstorm ways to recruit and retain these essential health care providers as the shortage is expected to continue for the foreseeable future.
“We have the perfect storm,” said Dr. John Whitcomb, chief academic nursing officer at Clemson University.
“There are a projected number of retirements … (and) after Covid, there were a lot of nurses who decided to leave the profession,” he added. “By 2036, we could be missing one in five positions if we’re not replacing those who are leaving.”
“Nurses are retiring and aging out,” agrees Jeannette Andrews, dean of the University of South Carolina College of Nursing. “And there’s not only a nursing shortage, there’s a faculty shortage. We had four retirements this past year.”
“I don’t think we have enough, and I don’t think we’ll ever have close to enough,” said Lara Hewitt, vice president of workforce with the South Carolina Hospital Association.
“Historically, nurses can work in doctors’ offices or at the bedside,” she added, “but now with their skill set, they can go everywhere, and everyone is looking to hire them.”
Nurses represent the largest component of the health care workforce, are the primary providers of hospital-based care, deliver most long-term care, and increasingly provide urgent care as well, said Robert Rosseter, spokesman for the American Association of Colleges of Nursing.
Having too few nurses can impact access to care and the quality of care provided, he said, adding that a robust supply throughout the system is essential to ensuring that all patients, including those in rural and underserved areas, have access to care.
“For more than 20 years, the U.S. health care system has struggled to find enough registered nurses to meet patient care needs, given the aging population and the growing demand for primary, chronic, and preventative care services,” he said. “We continue to hear from practice leaders that finding enough nurses to fill open positions is an ongoing challenge. The high demand for nurses is expected to continue into the foreseeable future.”
The Bureau of Labor Statistics projects 189,100 openings for registered nurses each year through 2034, Rosseter said, adding that employment is projected to grow by 5 percent a year over the next decade with expanding opportunities for nurses to practice, teach, conduct research, and lead.
The AACN is advocating for federal legislation and increased funding to help students afford nursing school and to hire, Rosseter said. It also collaborates with other national nursing organizations to introduce new legislation to expand nursing school capacity and address the faculty shortage, he said.
The Palmetto State had 45,164 RNs, 6,696 advanced practice registered nurses, and 8,892 licensed practical nurses as of 2022, according to the most recent data available from the South Carolina Office for Healthcare Workforce.
But many initiatives are underway statewide to increase the number of nurses and faculty as well.
McLeod Health, for example, established a Department of Workforce Development after the pandemic to find ways to attract and retain more nurses, said Director Charity Gerald.
To start with, she said, they asked nurses what they needed to stay.
This led to changes that included the freedom to choose uniform colors and shoes among other changes, she said. It also led to flexible scheduling so nurses have better work-life balance, she added.
“We are not holding to three days a week, 12 hours a day, and every other weekend on any more,” she said.
McLeod also offered incentives, including benefits that nurses wanted, such as enhanced paid time off policies and stable insurance premiums for the last three years, Gerald said.
“We as an organization have taken on that cost,” she said. “We also have pet insurance and benefits with the health and fitness center. We listened and acted.”
And annual pay adjustments make the hospital competitive, she said.
“The first year, which was 2023, we hired 919 nurses,” she said. “We were in the double-digit percentages when it came to vacancies. Now, we’re single-digit vacancy.”
The following year, 511 were hired, Gerald said, adding the turnover rate is less than 5 percent.
During the pandemic, McLeod employed a lot of contract nurses – up to 200 full-time equivalents, she said. That’s down to six now, she said, which saves millions of dollars.
And in June, McLeod Health contributed $75,000 to Florence-Darlington Technical College to help maintain their nursing program.
McLeod also has dedicated coordinators who go into local schools in an 18-county area to talk up nursing as a profession and offer shadow tours to encourage students to think about nursing, Gerald said.
There’s also a nursing liaison, who acts as a combination mentor and adviser, she said.
McLeod is also offering hiring bonuses in high-need areas, she said.
“Times have changed. We’re not as stuck in the status quo,” Gerald said. “We want them to be happy.”
Experts agree that the shortage is most keenly felt at the hospital bedside, and in rural areas.
“The state has been very wise to invest in nursing and cultivating faculty,” said Hewitt, pointing to funding from the Legislature to boost the number of nurses and faculty. “That’s what’s gotten us to where we are now.”
But many new hospitals are being built, and others are adding services, she said.
“There is so much growth in the health care space now, we have to continue to produce nurses,” she said. “This is a concern for hospitals, and they’re working on the problem.”
Hewitt said she recently spoke with one chief nursing officer who’s strategically hiring more nurses than needed because she knows some will leave.
Hospitals are also investing in technologies that can make nursing more efficient, such as AI programs that help with bedside documentation, and virtual nursing in rural areas, Hewitt said.
Efforts also are underway to address the desire for better work-life balance to reduce burnout, she said.
Though South Carolina is feeling the pinch, many efforts have been very helpful, such as the state’s investment in technical schools to get associate’s degree nurses prepared in two years and the $10 million to support nursing educators, said T.K. Curtis-Pugh, executive director of the South Carolina Nurses Association.
And nursing schools, many of which have waiting lists, are being innovative as well, she said.
Clemson’s Whitcomb, who sits on the state Board of Nursing and sets the number of RNs today at 73,000, said there’s been a slight uptick recently.
“Overall, since May, when you count RNs, LPNs, and APNs, we’ve seen an increase of about 1,700 licensees,” he said.
Nonetheless, by 2035 South Carolina is projected to rank 10th on the list of states with the largest shortages, down 11 to 15 percent, he added.
Clemson expanded its nursing program from 76 freshmen in 2018 to 176 in 2021, Whitcomb said, with the addition of a second teaching site in Greenville.
The board of trustees also approved an expansion of up to 100 students to begin in the fall of 2027, he said.
Clemson also has a variety of endowments, scholarships and gifts – including $2 million from the Bedford Falls Foundation – to support tuition for about 114 undergraduates in addition to the Prisma Health Nursing Scholars Program, he said.
And Clemson’s accelerated program allows students to graduate in 3½ years instead of four, though that program only seats 144 students, he said.
But like elsewhere in the state, adequate faculty is also an issue, Whitcomb said, citing retirements and faculty pay lower than what hospitals pay.
“We’re in the process of hiring again,” he said. “We are receiving money from the state Commission on Higher Education to help with that this year for the fourth year. It has made a difference.”
But while Clemson is down at least 10 full-time faculty, they have funds to hire only three or four, he said.
Still, interest is high. Whitcomb notes that Clemson had 4,000 applicants for 176 seats last fall.
“The demand is out there,” he said. “Our nursing students already have jobs lined up in their last semester. They’re just waiting to graduate and pass their boards.”
USC’s Andrews agrees, noting she had 5,000 applications for nursing slots this year, double what it was five years ago.
“You can go anywhere around the globe and get work,” she said. “My students have jobs six months before they graduate.”
Nationwide, about 100,000 nurses left the profession during the Covid crisis, Andrews said. The numbers are back to pre-pandemic levels, but South Carolina still has too few, she said, adding that besides a growing and aging population, more nursing roles are being created in other settings, such as home health care, increasing demand.
The major gaps, she said, are typically in the specialty services like the ICU, the ER, and the OR – slots not usually filled by new graduates, she said.
So like other schools, USC has tapped into the $10 million the state provided for faculty pay and for loans to those getting a master’s degree at a state school and repays $30,000 for every two years of faculty work, Andrews said, noting there’s been a lot of interest.
“Hopefully they stay at least 6 years to pay off loan,” she said.
There are some loan repayments opportunities for nurses to work in rural communities, too, she said.
Experts say that between 65 percent and 70 percent of graduates stay and practice in the state. So more nursing students means more will stay, Andrews said, noting that the USC system has nursing on every campus now.
Meanwhile, she said, Lexington Medical Center in Columbia built a 52,000-square-foot building that doubled the classroom space.
“Five years ago, we graduated 200 nurses a year in the Bachelor of Science nursing program,” Andrews said. “This past year, we accepted 300 nursing students into that program.”
Accelerated training programs also are available at USC, along with programs that allow working nurses to study to become faculty, she said, noting USC also got a grant from BlueCross BlueShield of South Carolina to add six new faculty members.
“I have about 250 full-time and part-time faculty and six vacancies for full-time positions,” she said. “We’ve been strategically and measurably able to overcome some challenges to increase our nurses.”
By 2036, South Carolina is projected to have more than 1.5 million residents over 65, said Catherine Durham, dean of the Medical University of South Carolina’s College of Nursing. And many rural areas of the state have small hospitals or no hospitals at all, she said.
While there’s been an increase in students applying to nursing school, the faculty shortage has been an impediment, she said. So MUSC has also taken advantage of the state’s $10 million to boost faculty salaries and forgive loans for nurses willing to teach, she said.
“That’s been critically important to me here at the College of Nursing to provide financial incentive to faculty to stay,” she said, “as well as faculty who’ve gone back to get advanced degrees.”
MUSC graduates about 100 nurses twice a year, Durham said, adding that the strategic plan is to double that over next five years.
One initiative calls for increasing the number of bachelor’s-level nurses by offering a 20 percent tuition discount for nurses who complete their degrees at technical colleges in the state.
“Partnering with another institution is a means for us to double our enrollment,” Durham said.
MUSC also is seeking approval for a new degree program that allows students who’ve completed their required courses elsewhere to finish their bachelor’s degree at MUSC, adding another 100 nurses per year, she said.
And MUSC offers nurses seeking advanced degrees the ability to continue working while studying online to earn their master’s or doctoral degrees, she said.
And in addition to more flexible work schedules, MUSC sometimes offers signing bonuses driven by the highest shortages areas, Durham said.
“This year, we’ve done a deep dive in increasing salaries,” she said. “And being an MUSC state employee has a phenomenal retirement plan.”
Tuition reimbursement is an important component of the strategy, she said, noting MUSC works to attract donations and other funding to help offset the cost of education. The school received $1 million from Bedford Falls to fund a quarter of tuition for 33 students per year – or $3,300 a semester, she said.
And MUSC Health supported nearly $500,000 in scholarships as well, Durham said.
In fact, last year’s $2 million scholarship goal was exceeded, and officials expect to blow past this year’s goal of $4 million as well, she said.
MUSC also has efforts to encourage high school students to consider health care careers, including spending time over the summer with faculty in simulation labs and a student recruiter who attends high school job fairs, she said.
Nursing schools are always looking to philanthropy to help fund efforts such as new building and scholarships, experts said.
“We are always looking for a big donor,” Whitcomb said. “We will always need nurses. And it takes resources.”
Andrews said that people around the state are working together to address the shortage.
“It takes a village to do what we do,” she said. “I hope we can catch up to where we need to be. We’re strategically attempting to do so.”
“It’s a great opportunity,” added Durham. “We’re supportive of each other and see this as our mission to address this shortage.”
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