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Just when more nurses are needed, it's more difficult to get into nursing school


Health care workers are burnt out. Across the country, hospitals are so desperate for nurses that they are hiring students before they even graduate. And this shortage of nurses is especially dire when it comes to acute care. Meanwhile, becoming a nurse has become more difficult.

NPR's Yuki Noguchi joins us now to talk about this. Good morning.


DETROW: So given this desperate need, it really feels like we should be making it easier to become a nurse. Why is that not happening?

NOGUCHI: Well, a main reason is that there just aren't enough people to teach nursing. There are lots of applicants, but students - but schools can't take all of them. There's often 800 people applying to community college nursing programs offering 50 slots.

DETROW: I can't do that percentage math on the fly, but that feels like it's, like, Ivy League-school level percentages of admittance.

NOGUCHI: Exactly. And that's just community colleges. At four-year colleges and universities, 80,000 prospective nursing students didn't get accepted last year.

DETROW: Why can't they find more nursing teachers?

NOGUCHI: Well, one of the chronic issues is that teaching only pays about half what a typical hospital nurse makes. But it also requires a master's or a Ph.D. And, you know, people can't afford to pay for those degrees and - only to earn less. Or very few people can. So add to that the financial pressures of a pandemic, like a spouse losing a job, and that's driving more faculty to seek higher-paying work, which alarms people like Sharon Goldfarb. She teaches nursing at several schools near San Francisco. And she surveyed 91 community colleges in California and found faculty declined by 30% during the pandemic.

SHARON GOLDFARB: To lose an additional 30% has been devastating. There is not a school I know of that isn't desperately looking for nursing faculty.

NOGUCHI: And that desperation is disrupting classes.

GOLDFARB: Some schools went on hiatus. Some schools reduced their enrollment so they took even fewer students. You know, some schools, they scramble so much they actually have to extend semesters.

NOGUCHI: And to make matters worse, Scott, many teachers are in their late 50s or 60s. So another third of the nation's nursing faculty will retire within about four years.

DETROW: Well, what does that mean for people who still really want to become nurses?

NOGUCHI: Well, it's a big bottleneck. It's so narrow that it's like only the hardiest can survive. And Foxx Whitford is one of them. You know, to me he typifies the ideal nurse. But he also typifies the struggle it takes to become a nurse. He describes life as a nursing student as one of the hardest things he's tackled, which is saying a lot, given what he's been through. He grew up in Fairfield, Calif., which is a small freeway town best known for its Jelly Belly factory. At age 10, he got his first job to supplement his dad's truck-driving income.

FOXX WHITFORD: We've had to, like, struggle a lot when I was growing up, in terms of just, like, getting food on the table. You know, we were, like, evicted before.

NOGUCHI: As a teenager, he joined the Marines and did a tour in Afghanistan.

WHITFORD: I like being in, like, tents outside, like, [expletive] conditions. Terrible stuff that people don't want to do, like, I like doing it. You know, that's how it was in the Marine Corps.

NOGUCHI: And after that, he was studying at community college to become a physical therapist and waiting tables on the side when a group of nurses, who were his regulars at the restaurant, told him, you'd make a great nurse. And that endorsement stuck with him. It became his mission. But the road to nursing school was bumpy. He'd been a C student in high school. So in college he had to teach himself how to learn.

WHITFORD: Pursuing nursing was my ticket to doing everything that I want to do.

NOGUCHI: Meaning a life out of poverty and into meaningful work he loved - and he nearly failed a class but eventually labored his way onto the dean's list. And yet, the first time he tried to transfer into a nursing program, he was rejected. There were - some 800 others applied for 64 slots. Whitford had to wait another year to reapply. And he finally got in. But then the pandemic hit. So instead of training in a hospital, Whitford had to learn using computer simulation. And when clinical training slots finally did reopen, competition for those were fierce, but, you know, so was his desire to join the front lines. His childhood, he says, made him feel at home in such chaos.

WHITFORD: That stuff just gives me, like, the fuel to do everything. Every time things get hard, I always think about all those, like, losses and all those hard times.

DETROW: So did he make it?

NOGUCHI: He did.


NOGUCHI: He's about to graduate as a nurse and is training in an ER, which is where he wants to make his mark. But, you know, it obviously took a lot to get there.

DETROW: And even if you get to the finish line and make it, I imagine there is still a cost to this. These degrees probably aren't cheap, are they?

NOGUCHI: Yeah. That's right. And that's a factor that was true before the pandemic. Many complained of the financial sacrifice it takes just to get through the schooling and training. I talked with a guy named Nathan Ballenger. He's 46 and lives in the Denver area with his wife and three kids. He's a salesman but has always dreamed of working in medicine. And over the last 15 years, he told me, he's tried three times, including during the pandemic.

NATHAN BALLENGER: I went and got certified as an EMT just to get my foot in the door because I'm so hungry to get into the nursing field or into the medical field.

NOGUCHI: But the cost of schooling and training were just too much. So his dream of becoming a nurse is just languishing.

BALLENGER: It's hard for me to say that I see a path towards it, regardless of the fact that I hold it in my mind and in my heart as something that I sure wish I could have done in this lifetime.

DETROW: So we've been talking about what schools are doing. What are hospitals doing to deal with this bottleneck?

NOGUCHI: Yeah, the American Hospital Association says hospitals recently upped their compensation and recruitment to attract people like Ballenger in a number of ways. Some are offering full scholarships or loan repayment. Some are hiring students before they even graduate, as you mentioned, or training new graduates in specialties where they're most needed. Hospitals are also working with nursing schools to lend them their nurses, who can then teach. You know, opening this bottleneck is critical because health care worker burnout is a major concern globally. So it's not just that we need to keep graduating nurses, Scott. We need to graduate more nurses.

DETROW: That's NPR health correspondent Yuki Noguchi. Thank you so much.

NOGUCHI: Thank you. Transcript provided by NPR, Copyright NPR.

Scott Detrow is a White House correspondent for NPR and co-hosts the NPR Politics Podcast.
Yuki Noguchi is a correspondent on the Science Desk based out of NPR's headquarters in Washington, D.C. She started covering consumer health in the midst of the pandemic, reporting on everything from vaccination and racial inequities in access to health, to cancer care, obesity and mental health.