Nursing in Northeast Ohio is in critical condition

Although health systems in Northeast Ohio are looking for skilled workers in nearly every position, the top priority for all of them is finding a nurse.

"Every RN is the golden goose," said Tony Montville, the Cleveland branch manager for Medical Staffing Network, a national health care staffing company. "The nirvana of recruiting success is being able to get a good, solid RN."

Northeast Ohio faces a projected shortage of 3,500 nurses by 2020 — a fate that hospital officials throughout the region are working to address.

While nurses are the No. 1 need, nurse practitioners, medical assistants and other health care extenders are all top of mind — as well as entry-level positions across the board.

Health care is facing the same challenge as many industries: The baby boomers are sunsetting into retirement, setting many employers up for a frantic search of experienced workers. But for health care, the hit is two fold: As their providers retire, the aging population of Northeast Ohio will continue to demand more care.

The problem becomes exponential, said Pat Cirillo, vice president of initiatives and analytics for the Center for Health Affairs, an advocacy group for Northeast Ohio hospitals. The average 75 or 80 year old uses five to six times more health care than an average 55 year old, she said.

"As we talk about shortages in workforce, you have to get beyond just, 'Oh, they're not out there' to 'How do you go find them?' and 'How do you partner with the right organizations?' and in some cases, 'How do you build your own?'" said Maria Miller, system director for talent acquisition for Summa Health.

A registered nurse is by far the most common job posting on OhioMeansJobs.com, a state-sponsored job posting portal, with roughly 4,200 annual job openings, according to a November 2016 report from the Ohio Department of Job and Family Services. Nationwide, registered nurses are projected to add the second highest number of jobs between 2014 and 2024, according to the U.S. Bureau of Labor Statistics. The annual mean wage for registered nurses in Ohio is $62,800, according to 2015 data from the U.S. Bureau of Labor Statistics.

"There's just not enough RNs, so we have to pull together as a region and tackle that," said Kim Shelnick, vice president of talent acquisition for University Hospitals. "And there's other areas where there's shortages too — it's just not in RNs. But the need is so large for RNs, that's where we put a lot of our effort."

In addition to nurses and other health care professionals heading into retirement, several hundred registered nurses in Northeast Ohio have shifted to roles as care navigators or care managers to help guide and assist patients, especially during the Medicaid expansion.

"Those are folks who were working in a traditional health care setting, (and) now suddenly, they're pulled into the community to work with a specific set of patients, chronically ill folks," Cirillo said.

The ongoing growth of a nurse's role is dynamic enough that "we're going to constantly have a need for new nurses in the future," said Chris Reardon, Cleveland Clinic's executive director of talent acquisition.

For example, MetroHealth has nurses in various non-clinical roles in departments where their direct clinical experience can help, including the quality, informatics, purchasing and research departments. While these other roles can help attract more people to nursing, it also pulls more nurses from bedside care.

Nurse staffing is "always a big risk for us," said Cheryl VanHorn, MetroHealth's director of talent acquisition.

Compounding the need for nurses, she said, is the system's recent growth and efforts to expand patient access.

Miller said that Summa's need for nurses — and any way the system addresses that need — must go hand-in-hand with the search for more medical assistants and other clinical roles that help physicians.

The shift toward population health, keeping patients well and preventing, rather than treating, illness means a need across the board for different skills and more employees, Miller said.

"I think for us, it really is about connecting the individuals out in the community with the opportunities that we have at Summa," she said. "And doing that in multiple ways that really position us to attract candidates."

Summa, and others, are doing this through various partnerships with educational and other organizations to create and support a pipeline to health care careers — from getting children interested to ensuring clinical opportunities for students to making sure there's awareness around the non-clinical careers in health care organizations.

Portraying the non-clinical career paths within health care is a big challenge the Clinic is working on, Reardon said

"I don't know that we've necessarily done that as well as we could have done recently," he said. "I think the challenge is helping people understand how these components of a corporate entity like marketing and finance and accounting, how those play a part in us being so good at the clinical services that we provide."

And once people are working in health care in any capacity, organizations look for ways to retain them and help them advance or even shift to other careers they're interested in within that system.

For instance, Summa is partnering with Stark State to help current Summa employees interested in pursuing a clinical career get that education. Other hospitals have similar programs to create a career ladder for those in entry-level positions.

The health care industry as a whole is excellent at career ladders, Cirillo said. Organizations often make additional training opportunities clear, accessible and possible, she said.

This could be key in addressing current shortages, as well as any that could be coming down the road, which officials are keeping a close eye on.

Many agree that data analytics and health information positions will be in high demand going forward and getting ahead of that will be important. The infrastructure for electronic medical records is built. Now, Cirillo said, everybody needs to figure out how to use it to their advantage – how to gain intelligence from it and sort out the information that can improve care and help patients.

Many of the shortages and challenges in Northeast Ohio reflect the same issues facing the entire country: aging populations, increasing retirements, fewer people entering the workforce and a shift toward population health and keeping communities well that takes a whole new skill set. However, the reputation and growth of Northeast Ohio's medical institutions presents some unique challenges and opportunities.

For one, the region is a good sell for someone who wants to enter health care — and Cleveland's rising national reputation boosts that draw. But as a major health care region, Northeast Ohio needs more high-skilled workers than other parts of the country, Cirillo said, noting that only a few other areas can claim a similar level of international attractiveness for health care services.

"A shortage in health care workers not only impacts our ability to take care of our own citizens; it also impacts our economy, because those are outside dollars coming in," she said.

In an effort to address the region's strong need for physicians, especially in rural and undeserved urban areas, Northeast Ohio Medical University partnered with Cleveland State University to create the Partnership for Urban Health, which recruits and trains medical students with an expressed interest in serving Northeast Ohio.

The community needs to supporting young adults pursue careers in health professions, said Dr. John M. Boltri, professor and chair of NEOMED's Department of Family and Community Medicine.

"Because these communities lack enough health care professionals, they therefore lack the role models for the students," he said. "And if students aren't exposed to a possibility, it's sometimes hard for them to imagine a possibility."

The number of health care employers in the region makes for a highly competitive market for talent, but it also means a lot of ideas and opportunities for collaboration. The collaboration and passion around workforce development makes the region stand out, Shelnick said.

"There's a really good foundation, a good bedrock and a good story here to draw people to the area," Montville said. "But you either have to grow them organically through school or you have to draw them to the area. One or the other, or both."

"Nursing in Northeast Ohio is in critical condition" originally appeared in Crain's Clevelang Business.