In the face of a severe nursing shortage exacerbated by the pandemic, an Indiana House committee unanimously passed a sweeping bill on Wednesday that would allow nursing schools to increase enrollment and hire more part-time instructors.
The House Public Health Committee voted 12-0, in a rare bipartisan move, to approve the bill and send it to the full House for a vote. The bill is widely supported by Indiana hospital systems, nursing schools and the long-term-care industry.
Across Indiana, hospitals are straining to deal with a rising level of COVID-19 patients, as nurses retire, quit, reduce hours to part-time status or take administrative jobs. Thousands of nursing jobs remain open, limiting the number of beds some hospitals can staff.
Indiana will need an additional 5,000 nurses by 2031, and currently needs to increase the number of nursing students graduating each year by 1,350, said Rep. Ethan Manning, R-Denver, the bill’s author.
“We are currently facing a severe shortage of nurses,” he said. “It’s a problem that existed before, but the pandemic has made the problem worse, like many other things.”
The bill, HB 1003, would allow nursing programs that have been operating for five years or longer and have a student passing rate of 80% or higher on the state licensing exam to increase enrollment at any rate they deem appropriate, rather than current limit of 25% a year.
The bill would also allow nurses with a bachelor’s degree to teach associate-level nursing courses if they are enrolled and making progress in a master’s degree program. It also lowers the level of experience required that a nurse must have to work as a clinical supervisor for nursing students, from three years to 18 months.
Another provision would allow nursing programs to use more part-time or adjunct faculty if they choose. Currently, nursing programs are required to have at least 50% of their faculty to be full-time. Nursing programs could also replace up to half of a student’s clinic training hours with simulation training, using mannikins and role-playing.
In addition, the bill would allow foreign-educated nurses to get licenses through a credentials evaluation service professional report or through a visa-screened verification letter, something several other states allow.
Community Health Network, with a staff of 5,000 nurses, is trying to fill about 600 nursing positions, said Jean Putnam, the system’s chief nursing officer. She said there are 4,000 openings in hospitals and nursing homes across the state.
“I have never seen this type of vacancy rate in my career,” she said.
Indiana University Health, the state’s largest hospital system, currently has openings for 1,900 nurses, said Jason Gilbert, chief nursing executive. He said the system, with more than 9,000 nursses, is turning to all possible avenues to staff the nursing units, and is paying up to $200 an hour for temporary, traveling nurses.
“We are in a crisis,” he said.
Ivy Tech Community College, which graduates about 1,300 nurses a year, said it had to turn down 300 qualified students last year because it didn’t have enough spots open. The bill would let Ivy Tech increase nursing spots by 600 a year by allowing it to hire more adjunct faculty that could teach courses and oversee clinical simulation training, said Mary Jane Michalak, the college’s vice president of public affairs.
The bill is supported by the Indiana Nursing Association, the Indiana Hospital Association and the Indiana Health Care Association, which represents long-term-care facilities.
The only voice of dissent among nine witnesses was from Norma Hall, dean of the School of Nursing at the University of Indianapolis. She said she opposed allowing nursing schools to provide up to 50% of clinical training through simulation, rather than on real patients.
“This violates our national accreditation standard, which allows for simulation to be used as a supplement to, but not a replacement for, actual contact hours with patients,” she said.
She also said that allowing nursing programs to drop the full-time faculty ration below 50% would hurt the continuity of education with students.
The bill’s supporters said nursing programs would not be forced to take actions that would violate their accreditation standards.