South Dakota is projected to have the seventh-highest nurse shortage in the U.S. by 2030, and is ranked as having the lowest median salary for registered nurses.
In a state with low pay and a high need for nurses even in pre-pandemic projections, the state’s nursing schools are working to combat the shortage by expanding program offerings and ramping up recruitment and retention efforts during the ongoing worldwide COVID-19 health crisis.
But some are reporting enrollment dips in their class sizes, while others have grown or stayed full.
Pre-pandemic reports from the Bureau of Labor Statistics show there were more than three million nurses in the nation in 2019, and an estimated 176,000 annual openings for registered nurses across the country.
While the U.S. produces about 170,000 nurses each year, the American Association of Colleges of Nursing reports 80,000 qualified applicants were turned away in 2019 because of a lack of teaching staff.
South Dakota needs 1,900 nurses, according to registerednursing.org, a California-based organization that works to provide resources to future nurses and helps nurses search for programs in the U.S.
But effects of the pandemic haven’t been factored into those projected nursing shortages because that data isn’t out yet, said Anne Krogh, dean of the South Dakota State University college of nursing.
“I think the pandemic probably will potentially make that a little bit more challenging,” she said, noting more than a third of registered nurses are 50 or older, a demographic of people who are getting closer to retirement age or are choosing to retire early because of the pandemic.
Krogh also said nurses are looking to travel companies to work and move around the country, and the companies pay pretty high salaries, making it a more competitive industry and more attractive for nurses to move.
In South Dakota, travel companies both import and export nurses.
The nursing shortage is “not a new thing,” Lake Area Technical College nursing department supervisor Amber Schleusner said. But it is an increasing problem in South Dakota. The college has worked to make nursing more accessible by offering in-person and online classes at a variety of locations, she said.
There’s been a “looming” nursing workforce shortage coming for several years, said Dr. Lynn White, the department of nursing chair and assistant professor of nursing at Augustana University.
Part of that may be because of the pandemic, but part of it is also the aging workforce. Augie uses recruitment strategies like events with the admissions department and discussion at local K-12 schools, and retention strategies like active learning and one-on-one time with faculty.
Nightingale College has also opened a new regional hub in Sioux Falls to provide the state another ability to train nurses who will stay nearby to serve local and rural communities, offering virtual clinical simulations and at-home skills practices to help students continue their education.
"Sioux Falls came on our radar several years ago," said Jonathan Tanner, executive vice president and chief opportunity & access officer for Nightingale College. "Sioux Falls was one of the areas we felt could really benefit from our type of nursing model of distance education, and one in which we wanted to help with the nursing shortage, not just in Sioux Falls but also within the state and the surrounding geographic area."
Leads are generated for the Utah-based college every week, Tanner said, as many as 12-15 leads each week.
Clinical partners for Nightingale include:
Shelby Boettner, nursing program director at Presentation College, said the Aberdeen college hosts a “nurse for a day” event for high school students to see nursing rotations and duties, like how IVs are drawn, for example. More exposure draws more people to the career path, she says.
“It might not be the easiest job to have, but it’s very rewarding at the end of it,” Boettner said.
But South Dakota has the lowest median yearly pay of all 50 states for nurses – $55,660 – and lowest median hourly pay for nurses – $26.76 – according to registerednursing.org.
However, nursing is about more than just salary, Schleusner says.
“It’s a calling," she said.
She became a nurse to provide care to people in crisis situations.
Rachel Nelson, a senior nursing student at Augustana University, got into the nursing profession because she grew up around her mother, who has 25 years experience as a nurse, and also had a good connection with nurses at the hospital when she was diagnosed with Crohn’s disease.
“Those nurses really took the time to not only get to know me as my diagnosis, but also as a person,” Nelson said. “They showed me that my disease would not define my life, and these are things I can do to control my disease, not let it control my life.”
Hewitt has a similar story — she chose nursing as a career after seeing the care and compassion of nurses who cared for her after she tore her ACL in high school.
“Even though they didn’t know what I was going through, they empathized with me so that they could help me through it,” Hewitt said. “When I started clinicals, I started seeing the care I was providing, and it was making a difference in people’s lives. That’s all I’ve ever wanted to do, is make a difference to different people and reach different people for different reasons.”
White said when she speaks to prospective students, “it’s usually not pay that’s part of the discussion,” she said, but rather students ask whether they’ll be employed when they’re done.
They’re guaranteed a position regardless, because of the workforce shortage, she explained.
Nursing program enrollment is increasing at Dakota Wesleyan University, Presentation College and Lake Area Technical College; full at Western Dakota Technical College; and shrinking at SDSU and the University of South Dakota.
At USD, as with many businesses and professions, there was a slight dip in enrollment during the height of the pandemic, nursing department chair Anne Pithan, said.
Students had “overwhelming challenges” during COVID-19, such as taking care of family members, illness, family demands or a difficult learning environment, Pithan said, noting this fall’s enrollment numbers are strong.
Enrollment numbers at SDSU show in fall 2012, 1,501 undergraduates were pursuing nursing. By fall 2020, undergraduate enrollment dropped by about 330 students.
University officials say this is because of the number of spots available, the fact that USD changed to a bachelor’s program, the associate programs at tech schools became more appealing to high school graduates and the availability of the dual credit program.
Dual credit isn’t a primary reason, but some students arrive with enough credits to go directly into the nursing program, SDSU spokesman Matt Schmidt said.
To combat the workforce shortage, SDSU offers student sites for nursing programs in Rapid City, Aberdeen, Sioux Falls and Brookings.
At Western Dakota Technical College, enrollment in the licensed practical nurse and registered nurse programs in Rapid City show cohorts each semester are full, and nursing program director Christi Keffeler says the programs have been full since 2017.
Enrollment has nearly doubled at Lake Area since 2012 when there were 88 nursing students, to 159 nursing students in 2021.
Presentation College has been on an “upward trend” since fall 2016, Boettner said. The college didn’t have enrollment numbers yet, but said fall 2020 enrollments including the graduate program were at 330 students.
DWU expanded enrollment by 25% this year, said Fredel Thomas, vice president of admissions and marketing at DWU, and still has a waiting list. DWU’s traditional four-year, on-campus nursing program remains one of the university’s largest programs.
At Augustana, the campus has one of the largest incoming freshmen classes it has had in years, and White said this also means a large number of nursing majors.
There was, however, a little dip in enrollment in the last couple years, White said, by as many as 10 students or so.
Still, there's one other existential element prospective students have to be wary of as they enter the workforce: The pandemic has strained those in the healthcare industry.
“My daughter’s a nurse; the cases are rising again,” Krogh said. “These are very sick patients nurses care for on a day in and day out basis.”
Burnout has four stages, said Rachel Hewitt, a May graduate of SDSU’s nursing program. She learned about burnout in nursing classes. Krogh said it’s important SDSU students learn about wellness and work-life balance.
Hewitt said the first stage of burnout is the honeymoon phase, when one leaves nursing school and is ready to get started, excited for the new job and ecstatic to help patients. This phase can last anywhere from six to nine months, usually, but now can last as little as a month, especially in critical care, Hewitt said.
From there, nurses may experience the “shock phase” of burnout in which new nurses are getting adapted to a new environment, Hewitt said, adding that COVID-19 accelerates this process.
Recovery and resolution are the subsequent phases where nurses start to feel reduced stress and then embrace their journeys, Hewitt said.
Burnout “really wears on nurses,” Krogh said. “It’s the sadness, it's being the substitute for the family because the family can’t be with the patient when they’re suffering from COVID-19, and those sorts of things.”
Talking to students about burnout and helping them find strategies for coping with the high-stress medical environments they work in is adding a whole new dimension to nursing care that Krogh hasn’t seen before the pandemic, she said.
Students in the programs at Presentation College are saying how “burnt out” and stressed they are, Boettner said, but they’re able to power through because they know that at the end of school, they’ll have their degree.
And despite the comparatively low pay, Nelson said she thinks nursing offers there are opportunities to move up in one’s career, go back to school or partake in opportunities fitting your passion.
Overall, it’s the aspect of caring for others that draws people into the nursing career, no matter the pay, Krogh said.
“Nurses really are the linchpin to safe care for patients,” she said. “They coordinate every aspect of a patient’s care, whether it’s outpatient or in the hospital. Without nursing, all of that sort of falls apart.”