(August 11, 2021) – Even as North Carolina tries to catch up with its nursing shortage, it’s seeing changes in how nurses are trained, which nurses are most in demand and where they are needed.

For starters, the mannequins used to simulate real patients have transformed nursing education over the past 10 years. The mannequins talk, blink, bleed, vomit – some even give birth.

“I can’t imagine having to educate students without that now,” Dr. Heidi Krowchuk, an Associate Dean at UNC Greensboro’s School of Nursing, says in the accompanying video.

“Simulation has helped us out so much that we can really mimic what happens in a clinical setting,” Krowchuk says. “Students can figure out what to do and problem-solve in the lab, versus having to do that on the floor in a hospital…. I think it prepares our students so much better.”

But that technology doesn’t come cheap: The mannequins cost $100,000 apiece, Krowchuk says.

THERE’S ALSO A SHIFT underway in the types of nurses that hospitals – particularly large hospitals seeking “magnet” status – want to hire.

Dr. Erin Fraher, a health-workforce researcher at the Cecil G. Sheps Center at UNC-Chapel Hill, says Dr. Linda Aiken at the University of Pennsylvania has produced research that finds in-patient mortality rates are lower when patients are cared for by nurses with a four-year degree. 

Aiken’s work helped create incentives for hospitals to hire more nurses with bachelor’s degrees, Fraher says. And an organization called The Future of Nursing produced a report that asked the nation to move toward a workforce that consists of 80% nurses with bachelor’s degrees and 20% nurses with associate degrees.

Yet among the nurses North Carolina produces, Fraher says, 50% have two-year associate degrees and 33% have four-year degrees. “So we are still consistently producing about 50% of our new grads as associate degree, two-year nurses,” she says.

ANOTHER SHIFT is driven by efforts to limit health-care costs, Fraher says, and results in registered and licensed practical nurses working in settings where they aren’t traditionally trained to work.

Not surprisingly, nurses have shifted with their patients from more expensive, acute-care settings to less-expensive ambulatory care settings like doctors’ offices and outpatient surgery centers.

“So even though licensed practical nurses have traditionally been employed in long-term care and assisted living, now we’re seeing this large growth in licensed practical nurses moving to ambulatory care,” Fraher says.

“That’s almost what I would characterize as a seismic shift. Because licensed practical nurses and registered nurses don’t typically train in those settings – they train in in-patient settings.”