The nursing pipeline in the United States has been affected by the COVID-19 pandemic. Nursing burnout increased, and nursing schools struggled to help students complete their practice experiences. The pandemic also highlighted problems in attracting more nurses to reproductive health practice.
- Nursing educational challenges make it difficult for student nurses to learn about various reproductive health positions.
- Most nursing students think about working for hospitals and inpatient settings and may know little about community nursing jobs.
- During the pandemic, some nursing schools resorted to virtual classes and simulated practice experiences.
The United States will soon need millions more nurses than are currently working in healthcare. But employers, including family planning centers and OB/GYN offices, likely will have a difficult time finding nurses. The American Nurses Association (ANA) predicts more registered nurse jobs will be available through 2022 than any other profession. A half-million nurses are expected to retire by the end of 2022.1
Nursing college educators and other experts say the COVID-19 pandemic has only made the nursing pipeline problems worse.2
To address ongoing nursing shortage issues, a three-pronged approach would include providing more opportunities for exposure to reproductive health nursing in nursing colleges, providing opportunities for nurses in other fields to learn more about reproductive healthcare, and preventing current and new reproductive health nurses from leaving the profession.
“The pandemic has highlighted the pipeline and issues with it,” says Anna Brown, BSN, RN, education program director with Nurses for Sexual & Reproductive Health (NSRH) in St. Paul, MN.
The nursing educational challenges make it difficult for student nurses to learn about the various reproductive health jobs in nursing. “You go to nursing school, and so much of the exposure is hospital-based nursing,” Brown says. “There is not a lot of information about what specialties look like.”
For example, Brown’s first exposure to sexual and reproductive health experience and knowledge was not in nursing school — but when she volunteered with a sexual assault health hotline while in college.
“If people needed access to a sexual assault nurse, the hotline was a linkage to those resources,” Brown says. “That was my first preview into what sexual and reproductive health means to people, outside of pregnancy planning.”
After that volunteer experience, Brown decided to seek reproductive health training. For instance, she worked as a volunteer for an abortion fund, providing practical support, such as transportation to an abortion clinic. However, her entry into the field was too self-directed and limited in scope to be a model for attracting new reproductive health nurses.
“This is something NSRH aims to address,” Brown notes. “If you’re in, you’re in, but there are not a lot of doors for entry into this kind of work. Coming at it from a multitude of angles is our focus.”
Specialty nursing areas like reproductive health will not draw as much interest compared to inpatient and more traditional nursing settings, partly because of student nurses’ personal interests and goals, notes Susan H. Lane, PhD, MSN, RN, associate professor in the department of nursing at Appalachian State University in Boone, NC.
“Undergraduate students often enter nursing programs with goals of becoming a hospital inpatient-based nurse or with long-term goals of becoming a nurse practitioner or CRNA [certified registered nurse anesthetist],” Lane explains. “Both of these educational tracks require experience in inpatient hospital critical care or emergency-type settings prior to admission to graduate programs, thereby contributing to the supply of nurses in these areas.”
Advanced practice roles — including community-based roles or nursing education — for RNs are not as well-known or advertised to incoming nursing students, she adds.
“The pandemic may be a positive influence on developing more interest in community-based nursing roles because of the increased news media focus related to community and population health,” Lane says.
The obstacles to familiarizing student nurses with reproductive health and other specialty areas include the role TV media plays in glamorizing hospital nurses and putting little focus on nurses working in community settings. Also, specialty-based nursing roles are not marketed to younger students during career planning sessions before entering nursing programs, she adds.
“For nursing programs, one avenue to support the interest in more specialty-based roles is exposure to these roles during clinical settings throughout the program vs. just in the community courses, which are typically only offered in baccalaureate programs,” Lane says. “Additionally, offering specialty-based nursing roles as optional experiences during capstone courses in the final semester of nursing programs may provide another opportunity to strengthen the interest of new graduates in these types of nursing settings.”
Part of NSRH’s advocacy work is to provide exposure to reproductive healthcare in nursing schools. “We offer topics of reproductive health to provide them with exposure to a variety of what this career could look like,” Brown explains. “The education we have in nursing schools is high-level labor and delivery. You come out and get a job, but there’s more to reproductive healthcare than those three issues.”
Nursing colleges handled disrupted education and limited nursing practice experiences as best they could since the pandemic shutdown of March 2020. Some resorted to virtual classes and simulated practice experiences for students.
“We were committed to progressing students on time and having them graduate on time, and had two major initiatives,” says Rhonda Maneval, EdD, RN, senior associate dean of the College of Health Professions and the Lienhard School of Nursing at Pace University in New York City. “We moved to remote and virtual reality clinical [education]. We invested heavily in new technology around virtual clinical simulation. That was a major lift on the part of our faculty.”
The college also provided telehealth for community and geriatric nursing. “Once we were able to have limited in-person presence on campus, we opened our simulation labs,” Maneval adds. “We mocked up the hospital environment.”
Other nursing colleges postponed practice experiences or found alternative, nonhospital sites for hands-on learning. “We experienced situations where clinical agencies were so strapped and overwhelmed with managing their patient population and the incredible influx of high-acuity patients with coronavirus that they suspended participation with nursing students because their staff couldn’t manage that with everything else,” says Julie A. Manz, PhD, RN, associate professor and assistant dean of the undergraduate program at the Omaha campus of Creighton University. “In some instances, here in Omaha, some of our practice partners were much quicker to allow our students to return. By June 2020, clinical partners welcomed us back because they recognized that if we want nurses, we need to help [the nursing college] with the learning.”
The college also created virtual grand rounds, in which each student is assigned a patient and virtual case studies. “We managed to be creative and innovate and found ways to not hinder their professional development,” Manz says.