SC spending $30M to tackle nursing shortage predicted to be nation’s 7th worst

Nursing students walk out of Lexington Medical Center's new nurse training facility Monday, Aug. 26. 2024. The University of South Carolina and Lexington Medical cut the ribbon Aug. 12, 2024 on the new $20 million training center near the Lexington County-based hospital’s campus. (Jessica Holdman/SC Daily Gazette)

COLUMBIA – The Legislature has pumped $30 million into collegiate nursing programs in South Carolina over the past three years in an effort to stem a potential health care crisis.

By 2036, the Palmetto State could have the seventh-largest shortage of registered nurses in the nation — with a predicted 13,600 vacancies, leaving more than 1 in 5 positions unfilled — due to a retiring workforce and already low staffing levels, according to a March report by the federal Health Resources and Services Administration.

Shortages of registered nurses

A look at where the 10 worst shortages are expected by 2036, by percentage of vacancies:

1. Georgia: 29%
2. California: 26%
3. Washington: 26%
4. New Jersey: 25%
5. North Carolina: 23%
6. New Hampshire: 23%
7. South Carolina: 21%
8. Maryland: 20%
9. Michigan: 19%
10. Oregon: 16%

Source: U.S. Health Resources and Services Administration, March 2024

Meanwhile, South Carolina’s growing population of people 65 and older adds to the need for more nurses. By 2035, more than 1.5 million South Carolinians will be at least 65, according to the state Revenue and Fiscal Affairs Office.

In response, legislators have set aside $10 million annually in the last three state budgets, including the one that took effect last month: $5 million to boost the salaries of nursing professors and $5 million in loan forgiveness for nurses who go back to school to become nursing professors.

It’s all about building up the pool of instructors needed to educate the next generation of nurses at a higher rate.

“I think we’re starting to make a dent,” Jeannette Andrews, the dean for the University of South Carolina’s nursing program, recently told the SC Daily Gazette.

The state money, combined with several private partnerships, means USC’s Columbia campus is now admitting 300 nursing students in its bachelor’s degree program, up from 200 students previously. Within the next five years, the school hopes to train and graduate 400 nurses per year in the Midlands.

‘There’s momentum’

Graduates of the state’s largest university system account for more than 40% of registered nurses with a bachelor’s degree entering the workforce in South Carolina annually for the past five years. They include graduates of USC’s campuses in Aiken, Spartanburg and Beaufort, in addition to the flagship campus in Columbia, Andrews said.

To increase its enrollment in Columbia, Andrews said USC turned to Lexington Medical Center, which just cut the ribbon on a new $20 million training center near the Lexington County-based hospital’s campus. The building gives USC the extra classroom space and hospital placements for clinicals it needs to take on more students.

A grant from insurance company Blue Cross Blue Shield of South Carolina a few years back also allowed USC to create a pipeline for new faculty. Andrews said she now has eight doctoral students who have either completed or are in their final years of study. They are earning a full salary and will become professors upon completing their degrees. The first three started in their faculty positions this fall.

Home health workers, data scientists and cybersecurity projected to be SC’s fastest growing jobs

Those former students are now among 10 new faculty hired by the university for this school year, Andrews said. Those new hires include an oncology nursing professor, a family nurse practitioner and a midwife.

From the state, USC’s Columbia campus has received about $810,000 the last two years, allowing it to give professors an $8,000 to $10,000 salary boost.

“Nursing faculty, especially with doctoral degrees or master’s degrees, would make more in a practice setting than in an academic setting,” Andrews said, so the extra money makes those professorships more enticing.

For example, the average salary for a nurse practitioner in South Carolina is $117,000, according to the latest data from the federal Bureau of Labor Statistics . Assistant professors who have similar degrees within the nursing school make about $10,000 less, according to the state employee salary database.

In 2022, 670 nurses were working in academics specifically within nursing programs, which is similar to numbers in 2018 before the COVID-19 pandemic, according to data provided by the S.C. Office for Healthcare Workforce.

Legislators approved the spending using one-time surplus revenue, rather than as recurring funding that continues indefinitely, meaning those pay bumps aren’t guaranteed to continue.

Students that have pursued these advanced degrees since 2022 also will be able to apply for loan forgiveness in a couple years, up to $90,000 for each year of schooling. Those paybacks are available on a first-come-first-served basis until the $15 million set aside to date runs out, according to the state Commission on Higher Education.

“So, there’s momentum,” Andrews said “We are investing in our future, and I think that’s enticing to potential nursing faculty who want to join our colleges of nursing in the state.”

Funding split

USC had something of a head start thanks to its private partnerships. It may be a couple years before the state sees enrollment jumps at its other public nursing schools.

“Even if they can increase nurse faculty salary, it doesn’t automatically translate into the ability to accept more students,” said Katie Gaul, director of the S.C. Office for Healthcare Workforce. “Not only do they have to worry about faculty, they have to worry about facilities; they have to worry about clinical placements; they have all this stuff that is more than just being able to admit more students.”

The Legislature may also want to reconsider how it doles out the funding for salary stipends.

Both Gaul and Andrews said some of the smaller or rural nursing programs would likely benefit more from the assistance. But that’s not how the state calculates the funding. The Legislature instead directed it be based on enrollment, according to the Commission on Higher Education.

As a college system, USC has received about $1.6 million annually across four campuses, based on last year’s numbers. The technical college system has split $2 million across 13 campuses, with allocations ranging from about $46,000 at Spartanburg Technical College to $379,000 at Trident Technical College.

Programs at the Medical University of South Carolina, Lander University, Clemson University and Francis Marion each received between $280,000 and $394,000.

Gathering more data

Gaul said her office also is taking a closer look at the state’s forecasted nursing shortage and how it might be best addressed.

“We can always use more nurses, but I feel like sometimes the conversations may be a little one-sided,” Gauls said.

For one, Gaul said, data analyzed by her office shows a supply of nurses that’s actually growing faster than the state population.

“It’s just that maybe they don’t want to go work in the hospitals where they’re needed,” she said, choosing instead to work in clinics where schedules are less erratic.

About 54% of registered nurses in South Carolina work in hospital settings, Gaul said.

To address this, Gaul and her staff are working with several agencies and associations to try to get better answers on what is driving nurses’ career decisions.

For example, the National Academy of Medicine has encouraged states to consider nurses’ job satisfaction — such as their stress levels, mental health and ability to take time off — and how it might be contributing to turnover.

“We do have a lot who get licensed, but how long are they really staying? That’s a big question mark,” said Melissa Fluharty, a research associate on Gaul’s team.

Gaul and Fluharty said they’re working with the state Hospital Association to analyze what specialty areas may have the most demand in the future, which units have the highest rate of turnover and why nurses are choosing to leave their positions.