Better Access to Education for Working Adults Will Help Meet the Nursing Shortage - Dr. Michelle Cummings, Senior Director of Healthcare and Nursing at Academic Partnerships

SHIV GAGLANI: Hi, I'm Shiv Gaglani. The nursing profession in the U.S. is experiencing a challenging moment. Burnout from COVID and other factors are spurring an exodus of nurses at a time when they are needed most. In addition, long-standing problems in nursing education and retention are hampering efforts to meet the current and future shortage of nurses. Our guest today is in a great position to get into the details of some of these challenges and discuss the role online education can have in addressing these. 

Dr. Shelly Cummings is Senior Director of Healthcare and Nursing at Academic Partnerships, which helps not-for-profit universities expand and change students' lives through education. She has worked at the intersection of healthcare and education for over 20 years and brings BS and MS degrees in nursing, a Doctorate in Education, and both clinical and teaching experience to her work. Dr. Cummings, thanks so much for taking the time to be with us today.

DR. SHELLY CUMMINGS: Thank you so much for having me.

GAGLANI: Let's start by getting to know your background a bit more. What led you to become a nurse?

DR. CUMMINGS: Well, the truth is, I probably worked every job in the hospital except clinical jobs throughout my high school and college. I worked housekeeping, laundry, nutrition services, the mailroom, switchboard operator, and insurance and billing. Honestly, I did not consider a career in nursing until my late 20s. I was divorced with two small children, and I honestly went into nursing as a quick solution to support my family. I planned to use my nursing degree to extend my career in healthcare insurance billing. Funny thing, though, as I was completing my associate degree I worked in neonatal intensive care, and just fell in love with nursing. So, I decided to go on to do my RN to BSN. I had great faculty and mentors and made very deep connections with my fellow students, and the program just shifted my thinking completely. It was a very eye-opening educational experience for me, and it really exposed me to the intersection of nursing and clinical care and healthcare as a business. The course content was focused on healthcare finance and quality and safety, and leadership and management, and I was hooked.

GAGLANI: That's pretty incredible. We haven't had that many guests who've worked all the jobs in the hospital, and I think that's given you a lot of empathy and perspective. That's one of the things I've noticed about a lot of people who are beginning or switching careers into nursing, is they come from very diverse adult learning kind of backgrounds, as opposed to when I was in med school where there's some diversity there, but it's less. 

You have an accomplished career in nursing education. Can you tell us a bit more about how you got into the actual education and career pathway and the different roles that you've had over the years?

DR. CUMMINGS: Sure. I was truly inspired by the quality of my RN to BSN program and the learning experience, and I was greatly influenced by amazing faculty and mentors. I saw the importance of strong, enthusiastic, and supportive faculty who treated students with respect, and the learning partnership and the process that supports positive student outcomes. I really wanted to contribute to that. I went on to complete my Masters in Nursing Education through an online program. Then I just fell in love with the online learning environment, and the opportunities it affords. I eventually became a faculty member at my alma mater, and became intent on learning how to educate and how to integrate adult learning principles, instructional design, and educational technology into my teaching practice. When I was faced with the choice of a doctoral program, I chose an EdD in adult education with a focus in technology and leadership. That just supported my interests and passion and helped me to further my skills and help drive nursing education improvements. The integration of adult learning principles into our program methods and student support strategies was just paramount to my role and where I wanted to focus my attention. 

I remained in a faculty role for several years and earned tenure, and then I decided I wanted to have a greater impact on clinical nursing and workforce education. So, I left a tenured position and moved into nursing executive leadership and I held several positions overseeing clinical education, interprofessional practice, patient safety, surveillance and mitigation and magnet program oversight with various health systems including the University of Virginia, Johns Hopkins, and Memorial Hermann Health System. 

Alongside of that career progression, I have continued to teach as adjunct nursing faculty with several universities, in both traditional on-campus programs and online program delivery. So, for the past 20 years, I've sort of straddled clinical nursing and the nursing academic world. My career has come full circle. I am now delighted to be with Academic Partnerships in Dallas, Texas. My role with them is Senior Director of Healthcare and Nursing Initiatives, and I get to lead our academic services and products healthcare and nursing team. 

GAGLANI: That's quite an impressive career. For our audience that doesn't know what Academic Partnerships is, can you tell us a bit more about the organization and the mission?

DR. CUMMINGS: Sure, I'd love to. Academic Partnerships supports not for-profit universities in their efforts to increase access to their top-quality, affordable programs. They do this by offering excellent online program offerings. Our mission is to expand access to top-quality, affordable, and relevant education in the high-demand workforce areas, such as education, business, technology, health care, and nursing. We work with over 50 universities and have supported more than 650 education programs serving working adults who are pursuing additional education to advance their careers and improve their future. To date, we have supported over 300,000 students since 2007. 

I'm really proud to work with Academic Partnerships and support improved access to affordable, high-quality nursing education. AP's goal is to serve the students where they are. Adults have busy lives. They're taking care of their family. They're working full time. They may be taking care of their parents. In the midst of this, they're looking to advance their education. We do this by partnering with regional universities to provide affordable, asynchronous quality programs and increased access. 

We recognize that for many people, cost is a primary concern. Accessibility to asynchronous learning that allows one to study and learn when it fits into their schedule is critical. So, our mission and our partnership with more than 30 universities offering healthcare and nursing programs allows me to live my personal mission each and every day -- to have a significant lasting impact on nursing education and improve the student learning experience to be the best possible.

In my current role, I lead our academic services and products health care in nursing team, which is composed of four subject matter experts. We provide academic program planning consultation to our university partners during program development in an effort to support their transition and optimization of their programs for accelerated asynchronous online delivery, with the end goal of ensuring a positive quality learning experience for their students. We work with university partners on full programs, certificate programs, and short course offerings with a focus on upskilling and preparing for additional important roles across the healthcare system and in our communities.

I don't, in my role, get to see the students' faces as I do when I'm actually teaching, but I know from personal experience the importance of access to quality online education and how it changes your life. It changed my life, and I love being part of Academic Partnerships and working with my colleagues and our amazing university partners to support our mission to increase access. 

Our partner programs support nursing career transition. By their nature, that helps to extend careers and directly impacts the longevity of a nurse's career. This is incredibly important given the current state of the nursing workforce and the serious mounting challenges facing both clinical nursing and nursing education. My various experiences as a clinical nurse, nurse executive, and nurse educator have provided me a front-line view of the challenges from different viewpoints, and the impacts on the health care delivery both today and in the future. I know firsthand the challenges of various roles from my own nursing career pathway. From that, I can see this from several different angles.

GAGLANI: Yes. We began the intro of this episode with talking about the mounting challenges that we're facing, both in clinical nursing and nursing education. Can you give us a couple of specific examples of that, and then go into the impact that COVID-19, specifically, had?

DR. CUMMINGS: Sure. Well, to truly understand the challenges, we need to explore the demographics of our current nursing workforce here in the United States. The National Council of State Boards of Nursing's 2020 National Nurse Workforce Survey reported that there are currently approximately 4.2 million actively licensed registered nurses, and approximately 945,000 LPNs or LVNs within the U.S. Many people don't realize that there are four times as many nurses as there are doctors. The nursing workforce is truly the backbone of the healthcare delivery system, and it provides direct patient care in various settings across the health systems and communities. That's outside of the hospital system. I think oftentimes when we think of nursing, we think hospital. But our nurses are in multiple locations. So, the challenge of the nursing workforce is an inadequate number for the last 10 years or more. That is only going to get worse. It's predicted that by 2030, we will need more than 1.3 million new nurses to address the current shortage. 

There are multiple factors at play: a huge baby boomer population with increased medical needs, limited ability of nursing schools to expand capacity to meet the workforce demand, and an aging workforce. Burning Glass -- an analytic software company that provides real-time job market data, analytics, and labor market trends -- reported in late 2018 that the demand for healthcare workers, including nurses, exceeded the pipeline of available talent by 144%, with almost 1.2 million vacancies. You compound that with the fact that the median age of a nurse is 52, and 20% of our RNs and 18% of our LPNs are 65 years or older. That creates a bit of a crisis. At the time of the NCSBN survey, which was February to June of 2020, that was really prior to the surge of the COVID pandemic. One fifth of respondents to the survey reported that they planned to retire within five years.

Since then, the impacts of the COVID-19 pandemic on our workforce have resulted in extreme fatigue, burnout, and early retirements, and the full-term impacts of the pandemic have not yet been truly realized. Another important factor when thinking about nursing workforce is that wages of clinical nurses have remained flat for several years. They have not risen to meet inflation. We add to that the reality that nurses who choose employment in non-clinical settings, such as faculty, or instructors in schools of nursing, or teaching and clinical roles to support nursing education programs, are paid far less than the nurses who work in clinical roles. These various factors pose significant challenges for our nursing workforce across the country. As we think about the statistics and what they mean, we need to understand that nurses are truly the core of our health care system, and we need to really find some solutions.

GAGLANI: Totally. Those are some really compelling statistics, and thanks for sharing that. Touching upon the topic of diversity, I wanted to go right into that because I know sometimes they talk about lack of diversity in the nursing workforce. What do you see as the biggest current concern facing the healthcare industry given all that you've shared already?

DR. CUMMINGS: Well, when we think about the impacts on COVID, too, it's a two-pronged thing. We have multiple implications for our healthcare delivery system resulting from the COVID-19 pandemic. Nurses have suffered greatly from the demands of the pandemic, and many may now not view nursing as an attractive career. There is additional data that supports that people are looking to change jobs, they're looking to move out of nursing. 

One of the challenges, as you mentioned, was the diversity issue. The nursing workforce does not represent our population's diversity, and so the need to diversify our nursing workforce can't be overlooked. There's a hugely disproportionate lack of diversity. When you look at the United States, we're 60% Caucasian, 18.5% Hispanic and Latino, and 13.4% African-American, 5.9% Asian. Nearly 81% of our nurses self-report as Caucasian. I think only 9.4% of our nurses are male. So we really have to focus on how do we ensure accessibility in the pipeline for diverse candidates that can reflect the diversity of our country. Right now, it's not where it needs to be.

GAGLANI: Yes. Within nursing, but also certainly other industries, we're seeing the same sort of thing. The surveys are showing that trends of nurses leaving the profession are likely to continue. What do you think can be done to address the shortages and retain the nursing workforce?

DR. CUMMINGS: There are several things that I think could give us some advantages. Nursing is a very physical job, with a high risk of on-the-job injury. We've seen an increase in the prevalence of violence toward nurses and care providers. Many nurses are simply are not physically able to continue to practice at the bedside and sustain the physical demands of the job through their entire career. So as our nursing population ages, the potential losses are formidable. The loss of senior nurses with strong clinical skills and experience is a huge blow. These senior nurses have expertise and knowledge that cannot be readily replaced, and they are critical to the training and onboarding of new staff. We really need to ensure that we're doing everything possible to retain every nurse that we can, with particular focus on our experienced senior nurses. 

Every nurse is a valuable investment. They should be supported across the lifespan of their career. Employers need to partner with nurses to identify their individual career goals and provide career pathways that support nurses as they grow throughout their careers. Many nurses will opt to stay at the bedside for their entire career, that's their preference. But there are so many nurses that struggle to transition from the bedside to other roles where they can optimize their knowledge and expertise. 

There are so many opportunities to capitalize on the robust nursing workforce skillset. There are so many other roles in management, quality, patient safety, informatics, clinical education and academics. Many health systems are focusing as much effort on retention of their nurses as they are on attracting new nurses. Many are collaborating with local academic partners to identify strategies that benefit both the health system and the school of nursing. Some of these strategies include affiliation agreements, preferred clinical placements, preceptor stipends and credentialing, tuition reduction, and student pipeline agreements for early employment of nursing students prior to graduation. There are additional opportunities for healthcare systems to partner with local colleges.

One avenue is to share resources and offset costs to support the education of nurses. This is to be achieved through grants and monetary support. However, the most effective strategies are shared human resources, such as employment agreements with healthcare systems, employees being paid by their employer to support the clinical training needs, possible reciprocated faculty appointments for clinical educators and preceptors, and then access to clinical training facilities and simulation training labs. Hospitals and healthcare systems have been fighting this nursing shortage battle for a very long time, so this is not new for them. Many employers offer some type of tuition assistance program for nurses, but many nurses don't feel supported by their employer to return to school and manage the rigors of academic study while working a very demanding clinical job and meeting personal demands such as raising a family or caring for aging parents. 

Another opportunity that employers could adopt is additional retention strategies, such as career pathways and career planning services to help nurses identify the opportunities for different roles, and help them determine any needed up-training or skill development or academic degree requirements to position themselves into those new roles. Employers can support nurses pursuing additional education by helping the academic program selection and providing a framework of support for nurses while they are completing their degree program.

There are also many nurses who don't want another academic degree, but they're interested in possible short courses or certificate programs that provide upskilling and will open additional opportunities for upward mobility. Short courses in leadership, management, healthcare finance, and general business concepts are all great options to upskill nurse managers. As healthcare continues to drive towards zero harm, it moves towards a more quality-based reimbursement model. Training in quality, data analytics, project management, and patient safety risk management can complement a nurse's clinical expertise and skill and help provide additional up-training that they need to be more effective in senior clinical roles. There are also, of course, additional opportunities in telemedicine and health and medical insurance. There are so many things that can be done to retain that talent and repurpose that skillset.

GAGLANI: Certainly. That's definitely something I know we're passionate about at Osmosis, is lifelong learning. Many nurses will be listening to this podcast. We have over 2.3 million YouTube subscribers, for example, hundreds of thousands of whom are nurses, nursing students, and nursing professionals. We offer continuing nursing education as well. I'm curious, you mentioned ways that employers can offer career training and pathways for these nurses. Can you share any advice you'd give to nurses listening to this podcast right now on what they should be doing to manage their career in this really dynamic and challenging COVID environment?

DR. CUMMINGS: Sure. There are two things I would strongly suggest. The first is to find a mentor or mentors and make a plan. Let me explain what I mean. I was fortunate enough to be surrounded by great colleagues and mentors throughout my career, and they pushed me and encouraged me. I have been so richly blessed to have great mentors who pushed me to do more. I wouldn't be where I am now if I hadn't sought out people who were willing to invest their time and expertise to share their insights and help me figure out my plan. 

The second part is just that: make a plan. Your career plan will change and will need to be adjusted from time to time. But make a commitment to yourself to make a plan, and work your plan. You've got to revisit the plan on a regular basis and seek out mentors who are sincerely interested in helping you achieve your goals and will provide guidance and even help you identify the flaws in your plan. I started out with an associate's degree, and at every step of my education and career, I had someone nudging me to keep going. I eventually earned a doctoral degree in adult education and became tenured faculty. After about a year in that role, after I had received tenure, I felt that I wasn't where I needed to be to fulfill God's purpose in my life. After prayerful consideration, I left tenured faculty -- something that's practically unheard of. When I came to the conclusion that it was time to leave that role and pursue clinical nursing leadership, it was quite a surprise to those around me. However, I was very fortunate that I had strong mentors who encouraged me to be true to my purpose and my passion. Those mentors have been a source of strength for me across my career. 

The best gift you can give yourself is to surround yourself with mentors who encourage you and push you toward being the best version of yourself. I would encourage those listening to consider that the best mentors often are not in the same line of work. A good mentor is one that challenges you, your ideas and your thought processes, and encourages you to grow. The push-pull relationship of a good mentor—or mentors, because one is typically not enough—is the true value of the relationship. Find someone that you can have a frank conversation with. Ask for actionable feedback, and then listen to that feedback. Take it to heart and address any needed corrections or skills gaps. Then work the plan. Don't get sidelined. My plan changed. I would not be where I am if I had stayed on my original plan, because working at Academic Partnerships is like a dream job. It wasn't on my list. But if you work your plan, just keep going back to it and make those adjustments for opportunities and things that come your way.

Seeking out a mentor who will push you and help you take control of your career is one of the best pieces of advice. No one owns your career but you. So, own it and take full control by putting together a plan and then working it. I believe in the Pac-Man approach…one bite at a time. Move yourself forward in the direction that you want to go. Sometimes you'll hit those little power pills and you'll get a little speed, and then sometimes you'll just drop back to that one bite at a time. So, start with a career pathway, discuss it with your manager to determine what opportunities exist, and identify any skills gaps. If your desired career pathway requires an additional academic degree, then check that out. All of these factors need to be vetted and explored, but unfortunately, your employer may not have a pathway that supports your passion in your career field, so you may have to be willing to leave your current employer or even move to another area of the country, which I have done, to work your career plan. That can be scary, but sometimes you must change your garden if you want to continue to grow. So, take some risks, but first and foremost, get a mentor and second, get a plan.

GAGLANI: I like that. I've never heard that, the Pac-Man approach, one bite at a time; it's good. I wholeheartedly agree with you on the importance of mentors. I certainly would not be where I am with Osmosis without many, many mentors from medical school, business school, and other places. I know we're coming up on time. Do you have any final words of advice for our listeners as we conclude our time together?

DR. CUMMINGS: Yes. I just really encourage your listeners that when you start to think about selecting a program, or selecting a short course, be discriminating about what you're selecting, and be sure that it aligns with where you want to go. You want to be sure that the training or academic program that you select aligns with workforce needs. What are the program's outcomes, and how do those outcomes support your future aspirations? So be sure any additional training or education you complete will advance you appropriately. When selecting an academic program, make sure the program resonates with you. Explore the program's learning outcomes, try to get a sense of the culture. The level of faculty engagement is important, as is peer-to-peer contact.

Today's adult learners need affordable, quality academic programs that respect that they are working adults with additional demands. So, look for a program that verbalizes and demonstrates a love of students, eagerness to support students throughout the academic journey, and always look for a program that's academically robust, but also truly embraces diversity. Cost and convenience and length of program are always factors, but most importantly, take the time to review many programs. Don't just hit on one and go, "Okay, that works." Check out many programs to determine the best fit for your personality and your career goals. We often get distracted by the length of a program, and see an extra semester in one program as off-putting because we really want to be done. But don't undercut yourself. That extra term or semester may pay dividends downstream and in the long run, it's an investment in yourself and your career.

Lastly, just make sure your program of study truly matches your passion and your goals, and reach out and talk to your wellness specialist or advisor. Take the time to have those conversations. Training or academic misalignment is always a risk, but it could be mitigated by really digging in and reviewing everything you can and comparing different programs. Take your time and truly consider the value proposition with the degree that you're seeking. Is it a stepping stone to your next role? Will it ultimately get you where you want to go? You're making an investment in yourself. You need to do your research, and you need to take the time in selecting the best program to support your career path. Those are my takeaways. I hope that they'll land with somebody and that they serve somebody's needs, and that somebody heard something that gave them pause today.

GAGLANI: Totally. That's some great comprehensive advice to end on. Dr. Cummings, thanks so much for taking the time to be with us today. 

DR. CUMMINGS: Thank you so much. I'm so grateful to have had the opportunity to share my insights with you and the audience. Thank you so much for inviting me to talk with you today. It's been a true pleasure.

GAGLANI: Of course. With that, I'm Shiv Gaglani. Thank you to our audience for checking out today's show, and remember to do your part to flatten the curve and raise line. We're all in this together. Take care.