Abstract

Long-term models show a growing challenge in meeting the demand for nursing workforce in North Carolina. Baseline projections from NC Nursecast, a nurse workforce model developed by the Cecil G. Sheps Center for Health Services Research in partnership with the North Carolina Board of Nursing, show a 27% shortfall in LPN supply by 2033, with the largest shortfall of 49% appearing in long-term care settings like nursing homes and assisted living facilities. Without any changes in trends from baseline projections, there will be an 11% shortfall in RN supply by 2033.

With the clear challenges facing the nursing workforce and the anticipation of future challenges with meeting the demand for nurses in our state, the North Carolina Institute of Medicine (NCIOM) launched the Task Force on the Future of the Nursing Workforce in February 2023 to develop recommendations to support the development and retention of the LPN and RN workforce into the future.

The task force was supported by funding from The Duke Endowment, the North Carolina Pandemic Recovery Office, and AARP North Carolina. The task force was co-chaired by Dr. Ernest Grant, PhD, RN, FAAN, Immediate Past President, American Nurses Association, Interim Vice Dean for Diversity, Equity and Inclusion, Duke University School of Nursing; Dr. Catherine Sevier, DrPH, MSN, RN, President Emerita, AARP NC; and Hugh Tilson, Jr., JD, MPH, Director, NC AHEC. They helped guide 11 steering committee members, over 50 task force members, and over 120 work group members through insightful conversations that led to the creation of the recommendations in this report.

The final report presents the 8 overarching recommendations, 25 supporting strategies, and a variety of actionable sub-strategies from the Task Force on the Future of the Nursing Workforce. Recommendations and strategies are organized by the following overarching topics:

• Preparing future nurses
• Developing, sustaining, and retaining nurses in their careers
• Valuing the work of nurses

Links to sections of the report:

Executive Summary

Key Points

Table of Responsible Parties and Partners

Chapter 1 – Background on North Carolina’s Nursing Workforce

Chapter 2 – Preparing Future Nurses

Chapter 3 – Developing, Sustaining, and Retaining Nurses in their Careers

Chapter 4 – Valuing the Work of Nurses

Conclusion

Appendix – List of Recommendations and Strategies

Links to recommendations and strategies in the report:

Recommendation #1 – Develop a strong and diverse nursing workforce that is representative of the communities served and is prepared to meet the growing health care needs of North Carolinians

• Strategy 1 – Expand early pathways to develop a nursing workforce that is representative of the population of North Carolina
  • Strategy 1.1
  • Strategy 1.2
  • Strategy 1.3
• Strategy 2 – Increase nursing program collaboration, sharing of best practices, and connections with employers
  • Strategy 2.1 and 2.2
• Strategy 3 – Increase the number of North Carolinians graduating with nursing degrees by addressing faculty shortages
  • Strategy 3.1
  • Strategy 3.2
• Strategy 4 – Improve retention and graduation rates of nursing students by supporting economic and material needs and enhancing academic supports
  • Strategy 4.1
  • Strategy 4.2
  • Strategy 4.3
• Strategy 5 – Enhance the preparation of nursing students through more inclusive educational environments and curriculum
  • Strategy 5.1
  • Strategy 5.2
  • Strategy 5.3
  • Strategy 5.4

Recommendation #2 – Enhance the educational and career advancement of nurses through all stages of their careers, particularly those serving in practice environments experiencing persistent shortage (e.g., hospital, long-term care, underserved, and rural settings)

• Strategy 6 – Strengthen transition to practice and early career development for nursing students and new graduates across all care delivery settings
  • Strategy 6.1
• Strategy 7 – Identify opportunities for nurses to participate in educational advancement, leadership, mentoring, and preceptorship
  • Strategy 7.1
• Strategy 8 – Strengthen opportunities and incentives for later-career nurses to participate in mentor and preceptor roles
  • Strategy 8.1
  • Strategy 8.2

Recommendation #3: Ensure a workplace culture that values the physical and psychological safety and well-being of nurses

• Strategy 9 – Create and promote a supportive and inclusive workplace culture
  • Strategy 9.1
  • Strategy 9.2
• Strategy 10 – Protect nurses from violence in the workplace
  • Strategy 10.1
  • Strategy 10.2
  • Strategy 10.3
• Strategy 11 – Increase awareness and support for the mental health of nurses
  • Strategy 11.1
• Strategy 12 – Evaluate the current state of efforts to address equity in the nursing workforce
  • Strategy 12.1
  • Strategy 12.2

Recommendation #4: Expand the role of nurses in leadership, shared decision-making, and team communication

• Strategy 13 – Create robust systems that involve nurses as leaders in decision-making that impacts their work environment, patients, and the interprofessional team
  • Strategy 13.1
  • Strategy 13.2
• Strategy 14 – Improve communication and understanding within interprofessional care teams
  • Strategy 14.1
  • Strategy 14.2
  • Strategy 14.3

Recommendation #5: Improve retention of nurses in practice environments with high rates of turnover or vacancies by addressing work environment issues such as workloads and offering flexibility in scheduling

• Strategy 15 – Expand opportunities for non-traditional employment schedules and settings and increase family-friendly workplace policies
  • Strategy 15.1
  • Strategy 15.2
• Strategy 16 – Decrease the experience of high workload and documentation burden for nurses
  • Strategy 16.1
  • Strategy 16.2
• Strategy 17 – Retain nurses in North Carolina and incentivize practice in needed roles and rural areas
  • Strategy 17.1

Recommendation #6 – Equip nurses and the public to be strong advocates for nursing and health care improvement

• Strategy 18 – Enhance the ability of nurses to advocate for themselves and their profession
  • Strategy 18.1
  • Strategy 18.2
  • Strategy 18.3
• Strategy 19 – Enhance the ability of the public to advocate for nurses
  • Strategy 19.1

Recommendation #7: Quantify the value of nursing care

• Strategy 20 – Use value-based payment and develop mechanisms to quantify the importance of nursing in quality care
  • Strategy 20.1
  • Strategy 20.2
• Strategy 21 – Explore opportunities for nurses related to National Provider Identifier (NPI) numbers
  • Strategy 21.1

Recommendation #8: Optimize payment for health care services to support nursing care

• Strategy 22 – Increase funding to support school nursing
  • Strategy 22.1
  • Strategy 22.2
• Strategy 23 – Use funding mechanisms to support the long-term care nursing workforce
  • Strategy 23.1
• Strategy 24 – Promote RN billing in primary care
  • Strategy 24.1
  • Strategy 24.2
• Strategy 25 – Expand the state budget in key shortage areas for nursing care
  • Strategy 25.1