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Prof. Ginny Bayes, left, plays the role of the next-of-kin from the control room of the CSU-Pueblo Simulation Lab. Bayes' students had just taken part in a Code Blue exercise in which the patient, JJ the mannequin, died. (Mike Sweeney, Special to The Colorado Sun)

Colorado needs thousands more nurses a year to keep up with growing demand amid staffing shortages and retirements in the health care workforce. But a $1.3 million grant to the Colorado State University Pueblo graduate school and nursing program as part of an $85 million state project is intended to keep adequate health care flowing through that pipeline.  

CSU Pueblo will use an Opportunity Now grant, administered through the Office of Economic Development and International Trade, to bolster the university’s nursing program, but not just by recruiting more entry-level students. The school says the only way to cure the state nursing shortage is with new nurses and nursing instructors alike. 

The Colorado Workforce Development Center this year reported Colorado faces a supply deficit of 526 registered nurses per year, due to a lagging workforce and early retirements. Equally troubling is a 32.2% growth rate in job openings for nurse educators by 2031 as compared to average job growth of 17%. This is due in part to nursing’s aging population: 35% of nurse educators are over age 55 with retirement in their near future. And the U.S. Bureau of Labor Statistics reports southern Colorado has one of the highest needs for nursing educators. 

The lack of nursing instructors has led to some of CSU Pueblo’s partner colleges and universities having to turn potential nursing students away, said Alexandra Hansen, CSU Pueblo’s regional development officer for operations and advancement. 

Fewer nurses overall also leads to patient safety issues, said Katie Edwards, who earned her master’s and doctoral degrees at the university and now is a professor in the nursing graduate program.

“The term used is ‘moral injury,’ where nurses know the correct thing to do to take care of people, but they’re limited by the state of the facilities they work in or lack of staff to give patients best care possible,” she added. “So there’s a constant state of feeling like you’re not performing well, or not it’s safe, or you’re not able to give the best care you should.”  

Sarah Trujillo-Webster, a student nurse at CSU-Pueblo, grabs a crash cart at the outset of a Code Blue training simulation. Approximately 60 students are enrolled in the school’s expedited nursing program. (Mike Sweeney, Special to The Colorado Sun)

The Opportunity Now program was created to alleviate critical problems like the nurse shortage by encouraging regional industry and education collaboration to create more in-demand jobs that pay living wages.

Colorado Gov. Jared Polis in June announced the first 46 recipients of the program. Three grant programs support projects and initiatives at various stages of development, including seed, planning and scale. Seed and planning had the most regionally diverse applicants, with nine programs in seed stage receiving between $944,000 and $1.5 million each. Thirty-three planning-stage applicants received $50,000 each. And five “scale” recipients — those with established, evidence-based practices  — will receive between $750,000 and $7 million apiece. 

Hansen said CSU Pueblo applied for a seed grant to continue tackling the nursing shortage in southern Colorado with various partners including Lamar Community College, Trinidad State College and Adams State University in Alamosa.    

The money will support graduate students in becoming nurse managers, nurse educators and nurse practitioners at the master’s and doctoral level, said Misty Sailors, the school’s dean of graduate studies. The university believes the funding will help address Colorado’s nursing crisis and give students in underserved communities better access to higher education.  

Nursing students need nursing teachers 

While the lack of instructors in recent years has forced Colorado colleges and universities to turn away nursing applicants, the cost and location of such programs were already barriers for some students in rural southern Colorado, Hansen said. 

About one-half of the residents in Adams County identify as “minoritized people,” and many live close to or in poverty, she said. Many also live far enough away from the university that getting there is a challenge. Obtaining a graduate-level degree “generally takes a couple of years of advanced coursework and hundreds of hours in clinical placement to receive,” Hansen said. So the school needed an innovative approach to building out pipelines not only for more nurses, but for nurse educators, nurse managers and leaders within these constraints.

Sailors said Opportunity Now money will allow the university to help students with tuition support, online classes and residential instruction courses as well as giving them “wraparound emergency funds” should they find themselves in circumstances that make in-person attendance difficult — a child needs unanticipated care or a car breaks down, for instance. Other rural students lack broadband access, despite state and federal efforts to alleviate the problem. Because of these and other circumstances, Hansen said rural students in the region “need to learn close to home. So the funding will support reliable hotspot access, to make sure students can log onto classes, for example.” 

“There’s a clear question of, ‘How can this program, reflecting the university’s mission of recognizing individual students’ needs, give our communities well-paying, essential health care jobs and create lanes to education that are accessible and affordable versus letting a first-generation student, whose family may have had little interaction with higher education before, think it’s unattainable?’” she added.

Hansen said CSU Pueblo’s grant application benefitted from the school receiving a positive designation in a recent study by Harvard University economist Dr. Raj Chetty that showed among four-year colleges and universities in Colorado, CSU Pueblo had the highest mobility rate, or percentage of students from low-income households who earn in the top 20% by midcareer. 

“When students in rural communities can get this kind of education, it impacts not just students but their whole families,” Hansen said. “Assisting students with higher education also helps (address) generational poverty. With adequate funding, CSU Pueblo and other schools can help grow opportunities for all Colorado students, not just those who have an awareness or resources to enter a traditional higher-learning institution.”  

Growing nurses where they’re planted  

CSU Pueblo’s grant will go toward expanding its Grow Where You’re Planted: Southern Colorado Partners Leading Advancement in Nursing Track program, known as PLANT. 

The university says PLANT will improve health equity in 15 southern Colorado counties by providing local access to nursing, nurse practitioners and nurse education programs. It’s meant to advance inclusivity, equity, diversity and accessibility practices and principles across training programs. It will serve as a sustainable model for regional and statewide worker-centered partnerships to address nursing shortages.

“It is an industry-driven, sectorwide approach in which everyone involved comes together to solve a problem higher education can’t fix by itself,” Sailor explained. “We have to partner with industry. We need area health education centers and workforce development centers. It’s important to all of us that we fix this problem.” 

CSU-Pueblo nursing student Adrianna Santillanes records data during a simulated Code Blue training exercise. (Mike Sweeney, Special to The Colorado Sun)

The PLANT program will unfold over a three-year period beginning with the start of classes in August. It will launch a “huge advanced nursing campaign involving immediately putting students into the program,” Sailors added. “Then, across the years, while continuing to recruit, we’ll support existing students in graduation and finding jobs.” 

Some of the focus will be in area high schools, with recruiters working with counselors and teachers to motivate students to consider nursing as a career, she said. The university will also “put in support systems targeted to its graduate students, with coaching, academic support and help navigating higher education,” she added. “We’ll also teach students how to present themselves to an employer, and how to leverage their degree to advance their career.” And they’ll connect students, many of whom are Hispanic, to resources such as the Colorado Nurses Association and the Colorado chapter of the National Association of Hispanic Nurses, with the aim of helping them “nestle into their communities,” she said. 

Hansen said broadening the nursing workforce also is crucial because the profession is such a physically and mentally taxing job. 

“It’s everything from nurses being on their feet for extended hours to the emotional toll of dealing with patients,” she said. “Obviously, COVID had such a huge impact everywhere. And rural nurses, even though they may be in a top-earning position in their region, are still experiencing burnout.” 

But nursing is considered an “opportunity,” “high need, high wage,” job, according to the Colorado Future Jobs report. And with the state needing nurses now more than ever, CSU Pueblo is hoping for more positive turnouts like that of Katie Edwards. 

A rural nursing success story

Edwards grew up on a ranch in Limon and discovered nursing in high school. Government funding — through the Western Graduate Exchange program — helped her attend college in Wyoming. When she returned, nursing degree in hand, she went to work at a hospital in Colorado Springs. She tried out different types of nursing: labor and delivery, school nurse, triage nurse — “but always gravitated toward students that would come in,” she says. 

That love grew into a passion for teaching, so when she returned to school, at CSU Pueblo, to get her advanced nursing degree, she started doing clinical instruction as an adjunct professor. 

Edwards’ bosses recognized her passion and drive, and they had some funding, she says. They asked if she wanted to get a masters in nursing education and she said yes. They helped pay for a hybrid program that met once a week on campus and the rest online. “So I was able to keep doing my nursing job and get the education,” she says. “But if it weren’t for all of those pieces aligning — the funding, the flexibility — there was no way I’d have been able to get my master’s degree.” 

In 2016, Edwards was able to obtain a full-time faculty position at CSU Pueblo and moved from the hospital side of nursing to full-time teaching. That led to her getting her doctorate through similar funding and flexible schedule. 

“The stars aligned,” she says. “I’m extremely grateful for everything CSU has done to advance my career and to see my worth in nursing education. They value my strengths coming from a rural background. They said, ‘You have a lot of grit.’ Well, yeah, I do. I woke up doing chores at 6 a.m. and then went to school. But the thing I see that’s the hardest in all of this is finding nurse educators who really want to do it.” The pay gap between practice in a hospital and education is very large, with hospitals paying more,” she says. “So unless someone has the passion, it’s hard to recruit.” 

Amber Williams, a nursing student at CSU-Pueblo, portraying a primary nurse opposite to JJ the mannequin, responds to JJ’s complaints of not feeling well out the outset of a Code Blue training exercise. (Mike Sweeney, Special to The Colorado Sun)

Thinking back to the “moral injury” concept in nursing, Edwards said, “as the crisis continues, that’s going to get more and more intense. And we as a profession rely on nurses currently practicing to assist in the education of future nurses. Well, I’m sure, as you can imagine, working a floor and taking on more patients than you should for safe care, and on top of that taking a student to work alongside you, it creates a lot of anxiety and fear. In that scenario, I don’t want to teach the students what I have to, because I know it’s not the safest.”  

CSU Pueblo is hoping to change that with its PLANT program. The university has an outreach team made up of rural Coloradans that have developed relationships “through boots-on-the-ground connecting with students and families,” Hansen said. 

But in the towns where they hope to foster a new, multilayered nursing workforce, “we don’t want to be an outside force dropping in on a potential solution,” Hansen said. “We’re going to first listen and learn from these communities,” letting people who know the needs and potential of their own residents help dictate how to deal with the situation best. 

Tracy Ross writes about the intersection of people and the natural world, industry, social justice and rural life from the perspective of someone who grew up in rural Idaho, lived in the Alaskan bush, reported in regions from Iran to Ecuador...