Maryland nursing schools aim to diversify students, update curriculums amid shortage

Racing to help fill a national shortage of nurses, nursing schools in Maryland are working to improve their curriculums and increase diversity to enable better health outcomes for all communities.

Health care and the role of nurses has changed dramatically since Robert “Bob” Atkins entered the field in 1994. It’s no longer just a bedside role in hospitals, but a community one in which nurses help people manage their health before they need treatment, said Atkins, executive vice dean of the Johns Hopkins School of Nursing.

And health is viewed in a broader sense, too, he said, with nurses looking at social determinants that can affect well-being — such as whether a patient graduated high school and what ZIP code they live in. This wider knowledge base, which expands with a more diverse candidate pool, allows nurses to better meet the health care needs of the 21st century, Atkins said.

But nurse burnout is real, especially in the wake of the coronavirus pandemic that pushed many to their breaking points. Even as the federal COVID-19 emergency ends next Thursday and honors nurses with National Nurses Week starting Sunday, the need for more nurses continues to grow more severe.

In Maryland, nursing schools are working to meet that demand while also diversifying and modernizing nursing practices by updating curriculums, offering free tuition or building pipeline programs and partnerships.

“One of our goals in school is really to change the narrative,” Atkins said. “To do that, we really have to make sure that we are changing the narrators, that we’re bringing more diverse voices into the conversation and preparing nurses who are going to be able to represent a perspective and the voices of those who are underrepresented in nursing.”

A national shortage

The nursing shortage is expected to escalate as older generations require more health care, according to the American Association of Colleges of Nursing. More than 275,000 additional nurses are needed from by 2030, the U.S. Bureau of Labor Statistics projects.

Maryland mirrors these national trends, according to the Maryland Hospital Association. As of 2021, Maryland had a shortage of 5,000 registered nurses and 4,000 licensed practical nurses; by 2035, shortfalls could increase to 13,800 and 9,200, respectively.

As a result, Maryland would only have enough nurses to meet 80% of demand for registered nurses and 44% for licensed practical nurses. (LPNs can perform basic nursing functions but have a more limited role than RNs.) The shortage is worse in rural areas, the association said.

But as Maryland looks to bolster its nursing workforce, enrollment in nursing degree programs has declined by about 2,000 students from 2018 to 2021, according to the Maryland Higher Education Commission.

However, the decrease is not for a lack of interested students, Atkins said. Rather, a nursing educator shortage limits how many students a program can accept.

“We have plenty of students that want to get into nursing school,” Atkins said. “We don’t have enough nursing faculty teach them. Those things contribute to the bottleneck.”

Shawn P. McNamara, dean of the School of Health Professions at the Community College of Baltimore County, said part of why there’s a nursing faculty shortage is salary, as professionals can make more money in the field than in the classroom.

Maryland Board of Nursing rules require nursing faculty to have a master’s degree, as well as some field experience.

And those with more specialized skills, like nurse anesthetists, can make a couple of hundred dollars per hour, Atkins said.

“There’s a shortage of nurse anesthetists; it’s hard, even here at Hopkins, for us to compete to hold onto nurse anesthetist faculty because they can make so much if they’re working in the health care system,” Atkins said.

Some area colleges are making do despite the faculty shortage.

Morgan State University Director of Nursing Maija Anderson said a lot of the school’s faculty practice nursing at the same time so they don’t experience the pay gap.

Notre Dame of Maryland and Mount St. Mary’s universities joined forces last month to help students enter the field quicker and are sharing faculty resources, as Mount St. Mary’s pre-nursing track feeds students into Notre Dame’s fast-track bachelor of science in nursing program.

At the University of Maryland School of Nursing in Baltimore, the faculty shortage inspired a teaching innovation — the Academy of Clinical Essentials, said Maeve Howett, the associate dean for baccalaureate education. The school partners with the University of Maryland Medical System and identifies experienced nurses to help teach nursing students. The school also offers the Practicum to Practice Partnership, or P3 program, in which students can work for a medical unit until they graduate and immediately return there for work.

“We’re practicing everything they’ve learned in nursing school, and they go immediately to work on that unit,” Howett said. “We think it’s going to shorten their need for orientation time ... so it’s a win-win for the school and for the hospital.”

Diversifying the pool

As Maryland nursing schools find ways to ease the faculty shortage, they’re also working to attract more diverse nursing students to ensure health care is distributed more equitably.

“[When] people who come from poorer communities [get] to be a part of the conversation and be trained in health care, they take that back to their communities, and they can improve health outcomes,” Anderson said. “It’s important to have people who look like you and think like you taking care of you because the studies have shown that health outcomes are better.”

Morgan State, a historically Black university, benefits from having a diverse student population already, Anderson said, though the school tries to bring in role models, such as representatives from the armed services, to recruit more male nurse candidates.

The University of Maryland School of Nursing also works to recruit more men and trans men into the field, Howett said. The school recently received a $7 million gift that will go to scholarships to help remove barriers to entry for more nursing students, especially immigrant and first-generation students.

Hopkins recently implemented the Pathway to PhD Nursing Scholars program, which aims to increase diversity of Ph.D.-prepared nurses who can then either bring further expertise to the field or educate the next generation of nurses. The $5 million investment will serve 10 scholars each year for five years.

The community college student population is already fairly diverse, McNamara said. He said he hopes that free tuition for Baltimore County residents — announced as part of County Executive Johnny Olszewski Jr.’s budget plan for fiscal year 2024 — will entice more students into CCBC’s nursing program.

Updating curriculums

Diversity in nursing is “crucial” to eliminating health disparities in nursing education and practice, Anderson said.

For example, Anderson, who sits on a committee for the International Association of Forensic Nurses, helped work on a project looking at eliminating bias in forensic nursing following the 2020 murder of George Floyd. At Morgan State, Anderson said a faculty project recently found biased language in nursing textbooks and identified areas for improvement to the publisher.

“If we’re going to mitigate the disparities in health outcomes for minority populations or poor populations, then we have to eliminate this bias,” Anderson said. “A few years ago, people were using a term ‘noncompliant’ for patients for different reasons, like they weren’t taking their medications, but the real issue is they have to choose between whether they’re going to eat or pay for this medication.”

Across institutions, nursing students are taught now to look at “social determinants of health” to help understand that health issues do not exist in isolation.

For example, Howett said, University of Maryland nursing students are prompted by scenarios like how they can help a Baltimore community in a food desert manage high blood pressure.

“It’s no good for me to test a nurse on how to manage blood sugar in a patient and not take into account their availability of healthy food,” Howett said. “Take into account their understanding, their health literacy around their care; patients live in the complexity of all these different factors. So we’re teaching more about social determinants, about racism and the effect of race on people’s health status and access to get health care.”