Recently, The Baltimore Sun described how emergency rooms in Baltimore are struggling to care for severely wounded gunshot victims. These same emergency rooms are also providing care to people who have experienced other serious health threats (e.g., heart attacks, strokes, car accidents) and to those who have limited access to or no other point of entry for health care. Orchestrating care for this wide variety of patients requires teams of health care providers who together address medical and psychosocial needs. Every health care team in the emergency room includes at least one registered nurse (RN), and the care that nurse provides has a direct impact on patients' health outcomes.
RNs make up the single largest segment of the health care workforce, with more than 3 million in the United States and more than 79,000 in Maryland. The demand for nurses will continue to increase along with demands on the nation's health care system as America's population ages and as we strive to address inequities in the care that racial and ethnic minorities experience. To have a substantive impact on health outcomes given these emerging challenges, nurses must continue to advance their education.
The Institute of Medicine's 2010 report, The Future of Nursing: Leading Change, Advancing Health, recognized the importance of having a well-educated RN workforce and consequently recommended that 80 percent of RNs hold at least a baccalaureate degree by 2020. But in 2014, only slightly more than half of RNs had completed their baccalaureate degree. We still have a ways to go.
The U.S. Department of Labor predicts that between 2014 and 2024, the number of RN positions nationwide will grow by 16 percent — or 439,300 jobs. If job replacement needs are considered, an additional 649,000 positions will be required, making the total need more than 1 million. This growth bodes well for individuals interested in pursuing their nursing education, but we need to educate more nurses to meet the projected demand for RNs in Maryland, one of 16 states in the country and the only state in this geographic region projected to have a nursing shortage in 2025, according to the U.S. Health Resources and Services Administration.
This poses a significant challenge given current resources unless creative solutions can be found to ensure nursing students have access to the breadth of clinical experiences necessary to: (1) prepare them to practice in today's complex health care environment, (2) provide sufficient numbers of qualified nursing faculty to teach in Maryland's nursing programs, and (3) address the real costs of providing nursing education.
We are working to develop solutions. Maryland's associate and baccalaureate degree nursing programs are collaborating to prepare a well-educated nursing workforce. Through dual-admission and other agreements, students in associate degree nursing programs can streamline their coursework to seamlessly matriculate into a baccalaureate nursing program. These Bachelor of Science in Nursing programs are providing RNs the option of completing their coursework in traditional face-to-face formats and through online learning. In addition, the University of Maryland School of Nursing is offering scholarships that cover in-state tuition, books and fees to 125 RNs through its Conway Scholars program. These initiatives are intended to reduce barriers that in the past may have prevented associate degree-prepared nurses from pursuing further education. Additionally, the state's Health Services Cost Review Commission and the Maryland Higher Education Commission have worked diligently to respond to the nursing faculty shortage and to improve nursing educational capacity. For our part, we're undertaking continued efforts to ensure the affordability of nursing education despite the associated increasing costs.
The residents of Baltimore and of Maryland deserve to have access to quality health care, whether it is provided in their homes, in ambulatory care settings, in emergency rooms or in other areas of hospitals. Nurses have always made and will continue to make a difference in the lives they touch and will continue to work with other providers to optimize the outcomes of care.
Having a well-educated nursing workforce is critical for our future, and Maryland nursing programs' collaborative efforts are an important step in addressing not only the challenges seen in today's emergency rooms but those that will come tomorrow as our health care system rapidly evolves and as the population becomes increasingly diverse. We may not know precisely what challenges lie ahead or how they will need to be addressed, but you can be sure there will be a nurse there, ready to serve.
Jane M. Kirschling is a professor and dean of the University of Maryland School of Nursing; her email is firstname.lastname@example.org.