Throughout the pandemic, Emily Jones has been working with COVID-19 patients as a medical assistant at Lahey Hospital in Burlington, Massachusetts, an experience that she says has only heightened her interest in more schooling to become a nurse.
"It really felt good helping those people, and they'd say 'thank you' to you, with all this oxygen hooked up to them,” said Jones, 22, who is also a nursing student at Mount Wachusett Community College in Gardner. “This is what I'm meant to do."
While the prolonged battle against COVID is leading more nurses to retire and exacerbating the existing shortage, nursing schools in Massachusetts are maintaining their overall enrollment amid the challenges of fewer nursing instructors and internships. But it's a different story at most of the state's community colleges, which are struggling to keep pace with schools that offer four-year bachelor degree programs.
A GBH News survey found that overall enrollment this fall is up about 4 percent from 2019 levels, based on responses from 39 of the state's 41 nursing programs. Northeastern University in Boston and Merrimack College in North Andover declined to participate in the survey. That enrollment pattern is a hopeful sign considering that even before COVID, economists forecast that Massachusetts would be short 14,000 nurses by 2024.
“You would think, ‘Oh, geez, you know, big, scary pandemic, we want to stay away from that.’ That is actually not the case," said Dr. Kim Shea, dean of nursing at Mount Wachusett.
In fact, there appears to be more student interest in nursing programs than there is capacity.
One reason for that gap between demand and availability is that most of the state's community colleges had to cut or limit their nursing programs, partly because of a shortage of instructors. The American Association of Colleges of Nurses reports the national vacancy rate for nursing faculty jobs was 8 percent this year, up from 6 percent last year. Schools also face the obstacle of tighter limits on the number of student nurses allowed to do internships — which are necessary to become licensed — as hospitals operate under restricted access to their facilities to curb the spread of COVID.
As a result of those two factors, the survey found nursing enrollment has declined at eight of the state's 15 community colleges: Mount Wachusett, Massasoit in Brockton, Roxbury, Middlesex in Lowell and Bedford, North Shore in Danvers and Lynn, Northern Essex in Haverhill, Springfield Technical and Berkshire in Pittsfield.
Massasoit's enrollment is down 19 percent because a lot of students deferred attendance as classes were postponed. Mount Wachusett, where enrollment is down 14 percent, has nine full-time nursing professors and four openings.
"There's a shortage of faculty, and we're all working on that," said Diane Welsh, president of the Massachusetts Association of Nursing Colleges.
Mount Wachusett sits on an old farm on the edge of Gardner, a highway pit-stop city 60 miles northwest of Boston. The hitch is that it can't compete with private hospital and university salaries to attract enough faculty and administrators. Because of that shortage, the school postponed its licensed practical nursing program for a year because not enough internships were available for incoming students.
"This was a very difficult decision to make, but it's really important that students have hands-on clinical experience,” Shea said.
John Mburo, who’s worked as a nurses aide for the past five years at Nashoba Valley Medical Center in Groton, was supposed to begin that program earlier this year.
“Because of COVID, they didn't know how it was going to go down,” Mburo said. “It was very frustrating because I had everything mapped out."
The 25-year-old Kenyan immigrant said the pandemic made working in healthcare stressful, but smiling from his apartment in Fitchburg via Zoom, he didn't look scared. "It was a little bit tough at first, but I got used to it," he said, shrugging. He is eager to join his licensed practical nursing class at Mount Wachusett in January.
Baystate Health in Springfield, which partners with Mount Wachusett and other nursing programs in western Massachusetts, has limited the number of student nurses in its facilities. “I think the pandemic put a stress test on the system,” said Dr. Mark Keroack, Baystate's president and CEO.
But Keroack said he doesn't lose sleep over whether the state's nursing schools fill their classes.
"That's not the kink in the hose,” he said. “A number of different kinds of roles want to train in the big teaching hospitals like Baystate Medical Center, and there are only so many physical spots.”
Emily Jones, driven to become a nurse, hopes to land one of those spots.
“It is who I am,” she said. “Nothing really is going to stop me from pursuing that — even a pandemic.”
Filling the gaps
Massachusetts needs Jones and other nursing students to fulfill licensing requirements and join the workforce. Even in a state with many nursing programs, Keroack said, the pipeline is not robust enough to keep up with COVID-related burnout. He said many older nurses who were near retirement decided to leave the profession. That's on top of the nurses who were burned out because public health issues became so politicized during the pandemic.
“Right now, we have 1,500 open positions for a workforce of 13,000, which is a quite a huge gap,” he said. “We're hiring about 100 to 150 new people every single week, but it's going to take several months for us to get back.”
Nationally, enrollment in two-year associate degrees in nursing was declining before the pandemic, according to Davis Jenkins, who researches community colleges at Columbia University.
In contrast to community colleges, Jenkins said enrollment in bachelor degree nursing programs at four-year colleges was increasing steadily in the decade before COVID — and has since surged. At Regis College in Weston, enrollment is up 14 percent. The increase is 8 percent at Simmons University in Boston.
"One reason for this is the trend among hospitals, in particular, to increase the share of their nurses who have bachelor's degrees,” Jenkins said. “And nurses with bachelor’s degrees can advance into better paying, specialized roles or nursing management."
That's why Jenkins predicts community colleges will continue to face stiff competition for students, but they will remain the most accessible option for low-income, first-generation students like Mburo.
As the pandemic recedes, advocates are urging states to reform nurse licensing requirements by allowing more community colleges to offer bachelor degrees in nursing, which are often required by hospitals.
"We have to be more cognizant of building those pathways,” said John Cardova, program director of allied health at the San Diego-based nonprofit Futuro Health. “It's a safety patient issue at the end of the day."
The idea of allowing more community colleges to offer bachelor degrees in nursing is gaining ground in some states. In the past year, California and Arizona passed laws designed to expand the number of bachelor degree programs at community colleges, but in many states like Massachusetts, such efforts are still opposed by four-year colleges concerned about quality education and lower-cost competition.
A hands-on opportunity for new nurse practitioners
While the state's nursing colleges struggle to get their students necessary hands-on experience, Regis College in Weston is taking a new approach to training. It launched a nursing residency program this fall with the Greater Lawrence Family Health Center, which recently converted an old Dollar Store located in a Haverhill strip mall into a bright new clinic. The one year of practice is similar to the training novice doctors undergo in hospitals affiliated with medical schools.
Few programs of this kind exist in the country. Residents are licensed, paid nurse practitioners, unlike standard clinical nursing interns, who are unlicensed and unpaid.
Greater Lawrence Family Health Center has been trying to expand into Haverhill for more than 15 years, said Rich Napolitano, the center's chief strategy officer. During the pandemic, Napolitano says the health center has been backfilling many jobs. “We're always looking to recruit and hire new nurses,” he said.
Regis aims to give new nurse practitioners like Elsa Acosta Sullivan, the first nursing resident at the clinic, the chance to provide hands-on care to patients.
Acosta Sullivan, who is in her 40s, said she delayed going to nursing school until her teenage son was old enough to take care of himself. The stay-at-home mom graduated from Regis last spring during the pandemic — which had a big impact on her chances of getting practical experience. “My last clinicals for nurse practitioner were during COVID, so a lot of things got shut down,” she said.
At the Haverhill clinic, Acosta Sullivan receives guidance and mentorship from experienced professors like Lesly Harris.
“They shadow for a while and then they have the time to go with a patient under supervision to practice directly their skills and gain it progressively,” Harris said. “It’s a great opportunity to send them out into field feeling more confident.”
Harris, a Honduran immigrant, said the Regis residency is also providing greater access to quality care to patients who are mostly low-income, Latino immigrants.
“It's a little challenging because a lot of the patients recently [emigrated] from another country and they come up with a lot of things,” she said. “It's diabetes and hypertension. It's depression. It's obesity.”
To care for immigrant patients, the center needs more bilingual nurses like Acosta Sullivan, who grew up in rural New Mexico and identifies as Hispanic. She acknowledges she thought twice about her decision to go into nursing after talking to friends who were longtime nurses. But on the other hand, the pandemic heightened her interest in the field. She appreciates having a mentor looking over her shoulder as she begins her career.
“I can present my care plan, but it's not going to necessarily go anywhere until she pushes the button and says, 'OK, yes, that's good' or 'No, you probably want to change it to this,' and then we move forward,” said Acosta Sullivan, who hopes the health care center hires her after she completes her residency next year.
At scale, healthcare experts say, this model could help newly minted nurses prepare to fully enter the workforce just as they’re so desperately needed.
GBH News' Diane Adame contributed to this article.
