Karli McGuiness had just accepted her spot in a demanding masters program at the Johns Hopkins School of Nursing when the catastrophe that has rocked the world hit the United States.
She was “amazed and inspired" to see how members of her future profession flocked to battle the lethal coronavirus, but the dangers they faced were enough to give her pause about her newly chosen career path.
It was after “a lot of long and very honest conversations” with mentors in the health care field that McGuiness, 33, realized her determination to pursue that path was stronger than ever.
“I don’t necessarily want to risk my health or the health of my loved ones, but the situation is horrific, and it’s affecting every single person across the globe,” says McGuiness, a California resident and onetime event manager for rock music tours. “My determination to become a nurse hasn’t faltered. I’m anxious and chomping at the bit to help.”
Health care officials in Maryland and beyond are hoping that others come to the same conclusion.
A shortage of nurses has been a concern for years in the United States, in part because of the growing demand for their skills in health care delivery even as Baby Boomers in the field have been retiring.
Studies and federal estimates show that nursing schools have not been graduating enough professionals — and often don’t have the capacity to accept more students.
Now there are worries that fear about the virus could diminish the supply of new nurses at the exact moment it should be growing.
Patricia Davidson, dean of the nursing school at Johns Hopkins University, says applications for the fall 2020 semester were plentiful, and the entering class for the school year is set.
But applicants made their decisions before the coronavirus outbreak was declared a pandemic, rendering acceptances a less reliable gauge of commitment than usual.
Fears around the contagion could prevent some students from showing up in the fall, Davidson says, and could weaken applicant interest for 2020-21 and beyond.
“I’m hoping that people who feel they want to be part of a profession that has a long history of doing wonderful work will stay with it,” she says. "But we’re holding our breath. I don’t think anyone knows what will be awaiting us in the next few years.”
Classes are also set for the fall semester at the University of Maryland School of Nursing in Baltimore, but officials at the highly rated 132-year-old school are keeping an eye on “melt,” according to Dean Jane M. Kirschling.
The term is admissions-speak for that group of applicants, usually comparatively small, who commit to attending but for one reason or another decide not to come.
Kirschling says that while it’s unrealistic to surmise that no applicants or students are fearful of facing virus-related health risks, she expects the school’s biggest challenges will center on financial uncertainty.
“Let’s say I’ve paid my admission deposit, and I plan to be at the University of Maryland in August, but as the time draws closer, I’m not sure,” Kirschling says.
“Part of it could be explained by a student thinking, ‘Maybe I don’t want to be on the front lines when people are that sick,’" she says. “But what if I’m a member of a traditional family and both my parents are suddenly unemployed? Are people going to have the wherewithal to come forward and continue their education?
"What’s likely to hit us harder is the economic downturn.”
Among the considerations: Nursing school is expensive, with tuition ranging from upward of $10,000 per year for state schools to about $50,000 for private institutions such as Johns Hopkins.
Meanwhile, the Journal of Nursing Regulation has projected that 1 million nurses will retire by 2030, leaving continuing shortages in patient-care settings.
Maryland is generally expected to fare better than most states. Thirty of its colleges and universities offer registered nursing degrees, and about 75 percent of graduates typically have gone on to become employed in the state. The National Center for Health Workforce Analysis in 2017 center even projected a surplus of 12,000 nurses in Maryland by 2030.
But that’s far from enough to allay concerns, with the pandemic and its effects expected to escalate demand well into the future.
“We might well have a shortage crisis in the offing,” Davidson says.
One source of optimism, experts say, is that the coronavirus crisis has shone a fresh spotlight on the profession, offering the public a clear view of the talents and determination of health care practitioners who may receive less acclaim than doctors.
Gene Ransom, CEO of MedChi, Maryland’s physicians’ association, said even though doctors and nurses rely on one another in the best and worst of times, Americans are seeing that nurses are often first to a patient’s side and stay there longer.
During a pandemic, that means “they are taking a lot of risks,” he says. “Everyone appreciates what they do.”
At present, that includes such potentially lethal duties as taking the vital signs of infected patients, caring for arriving patients whose status is unknown, operating technologically sophisticated diagnostic equipment in clinical settings, and conducting screenings and contact tracing in the community at large.
Davidson says at Hopkins, students, faculty and alumni have answered the call with “amazing creativity” during the crisis, working to transform hospital recovery rooms into intensive-care units, devising models for providing telephone support for older people at home, and making strides in “telehealth," a method of care in which “we’ve advanced 20 years in four weeks.”
“I’m so proud to be the dean of this school at this time," she says. "What I’m hearing people say is, ‘This is what I was called to do. This is what I was trained to do. I just don’t want to bring [the virus] home to my children and family.’”
Count Matthew Padgett among them.
The Hopkins nursing student is an Oklahoma native who majored in nutrition and economics in college, and taught school in China for six years. He chose Hopkins for its focus on both hands-on nursing and public health.
The 33-year-old puts his finger on what he believes sets nurses apart.
“We do a lot of medical intervention, but we also understand the importance of the whole person, where they live, who they are, what their goals are,” says Padgett, who has been placing phone calls to elderly Baltimoreans to offer moral and logistical support.
“At this time it’s likely that people feel very isolated, and nurses have a very developed ability to be present with individuals," he says.
At the University of Maryland School of Nursing, undergraduate Chika Okusogu has taken advantage of an unusual arrangement the school has made with the state nursing board to allow some soon-to-graduate students to enter the workforce amid the crisis.
The 22-year-old used the opportunity to increase the clinical hours he was already spending in the adult emergency department at the University of Maryland Medical Center, where he dons protective gear to work directly with COVID-19 patients.
As part of his studies, the Perry Hall native has worked as a volunteer for public health nonprofits, explored the effects of poverty on health, and focused on critical and emergency care, and he believes such breadth of experience is essential at the front lines.
“It can be hard on the patients being isolated in their rooms," he says. “But we treat them all with respect, kindness and empathy, and that’s an important part of promoting health. It’s an honor to be part of a profession that can truly affect the course of the pandemic.”
Still, Padgett, Okusogu, and other nursing students in Maryland have gotten a close look at what could be challenging times ahead.
All of the nursing programs in the state moved academic classes online in early March, and each had to find ways of teaching hands-on clinical skills via the internet.
Towson University has turned to vSim, a visual simulation platform, to conduct its clinical training.
Department chair Hayley Marks says it’s far from ideal, but for the time being, the priority in nursing education is “focusing on how we can get students the skills they need under the circumstances.”
Marks says it’s anyone’s guess whether Towson will be able to offer normal clinical work in the fall, when a record 97 new students are scheduled to enroll.
“What if we can offer some clinicals and not others? What if we can’t offer clinical at all?" she says. "If that’s the case, we’re not sure we’ll even be able to progress students” through the program.
That, in turn, would shrink the pipeline into professional settings, Marks says.
Aspiring nurses must weigh another ongoing issue: The job picture is cloudier than it has been in years.
Health systems are focusing so intensely on the coronavirus that they’ve cut back on other services, ironically leading to widespread layoffs and furloughs.
That diminishes one of the profession’s usual appeals — a plenitude of employment opportunities.
Davidson and Kirschling guess the problem will abate once the coronavirus crisis does, though no one knows when that might happen.
Such uncertainty has not deterred Padgett, who is set to finish his master’s program at Hopkins in August, or Okusogu, who is to graduate from the University of Maryland next week.
“Am I regretting going into nursing?" Okusogu says. "Not at all. This has not intimidated me into considering another profession.”
McGuiness, the California applicant, says she’ll be in Baltimore this fall to enroll at Hopkins, currently ranked the top nursing school in America by U.S. News and World Report.
A longtime yoga instructor as well as entertainment industry veteran, she says it was while helping to spearhead tours for the likes of John Legend and Pharrell Williams that she came to marry a fascination with human anatomy to a newfound passion for improving global health.
The COVID-19 crisis has only boosted her sense of mission.
“I can’t speak to how others are feeling, but I’ve realized something interesting," McGuiness says. "It’s my personal ambition to dive into global health in the middle of a global health pandemic.”
Baltimore Sun reporter Meredith Cohn contributed to this article.