To meet Indiana’s future nursing demand, it is estimated the state will need an additional 5,000 nurses by 2031, according to the Indiana Hospital Association. To reach that number, about an additional 1,300 nurses will need to graduate each year up until 2030. A state senate bill aims to loosen requirements to enter the field, as a start to fix the “cyclical” issue.
Sen. Shelli Yoder’s Senate Bill 176 would allow high school students to begin training for and earning credits toward becoming licensed practical nurses before graduation.
Indiana Senate’s Health and Provider Services Committee passed the bill unanimously last month, and it will now move to the Indiana House of Representatives for further consideration and approval.
The state currently requires students to graduate high school before earning credit toward a nursing license, an obstacle SB 176 would remove. Individuals would still be required to provide proof of their high school degree or equivalent when applying for a practical nursing license.
However, SB 176 would make it possible for prospective nurses to begin their path toward licensure earlier, and in turn, enter the workforce sooner.
Currently, Indiana has less than 10 nurses per every 1,000 people. Though the number of nurses in Indiana has increased in recent years, it is not enough to account for the growing and aging population of Hoosiers. According to the American Association of Colleges of Nursing, enrollment in nursing bachelor's degree programs declined 1.4% from 2021 to 2022, a small but relevant decrease.
Yoder, who represents much of Monroe County, said the concept for the bill came about as she visited long-term nursing facilities in Monroe County. An administrator told her about the current language written in law that does not allow students to move toward acquiring a practical nursing license until they are 18 and have a high school diploma or equivalent.
Under the proposed bill, Yoder said, students could take all but one class toward licensure before graduation. As soon as the summer after graduation, prospective nurses will be able to take a final eight-week capstone course to finalize their license, allowing them to enter the workforce soon after graduating.
“As someone who worked full-time through college, I really appreciated that,” Yoder said. “I really appreciated this opportunity for both students but also to address nursing shortage in Indiana, so it was a win-win.”
She noted the overwhelming and unanimous support for this bill shows its importance, especially among licensed practical nurses and registered nurses.
“Not one person was against this bill, whether it was young people who wanted to work towards an LPN or an RN license, our health care providers, our state-approved programs,” she said.
Gregory Carter, associate professor and assistant dean of research at the IU School of Nursing, began his first job in health care in 1993. In that time, he has witnessed firsthand major changes within the healthcare system. He said the nursing shortage issue is “cyclical.”
“This isn’t something that’s new, we’re just experiencing it, I feel, in a more intense way than we did before,” Carter said.
The issue on the education side, Carter said, is not the number of students looking to become nurses or the schools not admitting them, but limits on how many students can be in the clinical space at a time. He added that there is a nursing faculty shortage, working hand in hand with the limited clinic size to worsen the nurse shortage.
Additionally, Carter cited the aging population as another contributor.
Estimates show that 1 in 4 Hoosiers will be of retirement age or beyond by 2030, making the population older than in the past. Older people tend to have increased health issues and require more complicated treatment, and Indiana does not have enough nurses to supplement this rising demand. Carter added that due to the aging population, the need for extended care staff is growing.
He said the aging population includes nurses who are soon to retire and will be leaving the workforce, furthering the shortage.
Mary Drewes is the vice president and associate chief nurse executive for system nursing operations at IU Health. She said she saw the workforce shortage peak during the COVID-19 pandemic — specifically when its spread lessened in 2021 and more nurses took on traveling positions.
She said there had been forewarnings of an impending nursing shortage even before the pandemic, noting the aging workforce, high burnout rates and the competitive job market.
“The aging population, the aging workforce, it’s just creating almost this perfect storm where the needs are outpacing the supply,” Drewes said.
The effects of the shortage hurt current working nurses, too. Carter said burnout is at the top of the list of issues nurses are facing. He added burnout, driven by nurses having to work more and more to alleviate the effects of the shortage, causes some nurses to reduce their hours or quit, worsening the issue.
Similarly, Drewes said the well-being of all healthcare workers has surfaced as a priority within IU Health.
Carter said SB 176 could help the issue.
He noted that vocational programs for high school students could also help with nurse retention by providing real-world experience and letting them know what they are getting into before they officially enter the workforce.
Drewes also mentioned the importance of ongoing scholarship and nursing expansion programs for student nursing implemented specifically by Ivy Tech and the IU School of Nursing that help with enrollment and retention of nursing students.
Carter said hospitals provided childcare for nurses when he began working in 1993, but that has become less common since then. In Indiana, there is currently a shortage of affordable childcare.
Reimplementing these systems for nurses and other healthcare providers could change the game, Carter said, calling childcare “another epidemic” in America.
“When you have a high-stress job where it’s really hard to find care and you have a place that says, ‘Here’s a place where you can drop your child off,’ that changes things,” Carter said. “That led to, I think, a more secure work environment and caused a lot of turmoil and emotional pain when they ended that.”
To facilitate nurses’ well-being, Drewes said making sure their schedules are flexible and having wellness programs in place is important. She added that she has been focused on helping improve nurses’ work-life balance and creating an environment where everyone feels supported.
“It takes a village,” Carter said. “If you want people to be mentally there at work, you’ve got to take care of these larger things so the smaller things take care of themselves.”
