Legislation provides incentives to address nursing shortage in NYS

New York State has been hard hit by a nursing shortage which has swept across the nation and was exacerbated by COVID-19. Gov. Kathy Hochul has proposed opting New York into the interstate licensure compact for nurses, which allows for the hiring of out-of-state nurses, working at a premium, to step in to help alleviate the shortages.

State Sen. Elijah Reichlin-Melnick and Assembly Member Aileen Gunther – who is the chair of the Assembly's Mental Health Committee and a former nurse – have co-sponsored legislation that also attempts to address the state’s nursing shortage, with incentives for New Yorkers to pursue nursing careers that includes loan forgiveness, and more stringent guidelines for the hiring and certification of out-of-state nurses.

City & State caught up with Reichlin-Melnick to discuss the shortage, Hochul’s plan and the legislation he and Gunther are proposing as an alternative.

This interview has been edited for length and clarity.

Please talk about what the nursing shortage was like prior to the pandemic and the way it is now after COVID-19.

What we saw is that the Department of Health in New York had done a study a couple of years ago before COVID hit that found that by 2030 we'd be facing a shortage of 39,000 nurses in New York State, which is an incredibly concerning number for a state of our size. Obviously, COVID has made that shortage worse, because we are seeing across New York and across the country, nurses, doctors and other people in the healthcare field – they're burned out and some of them have had enough and they're quitting. Whether they're retiring earlier, or they're finding other jobs that are less stressful and less draining after two years of basically running in crisis mode. There hasn't been a study conducted by the DOH to account for the impacts of COVID, but if we were going to be down 39,000 nurses by the end of the decade before COVID, there's no question that we're facing a significantly higher shortfall if we don't act soon.

What compelled you to propose this legislation? 

I saw these stories that were out there in the media and my aunt is a nurse out in Arizona. So, I heard from her about the strain that nurses are under. I talked to people. I talked to constituents. This was an issue, which when I first started working on this in the fall, none of my colleagues – that I was aware of – had any major legislation on. So, although I'm not on the Health Committee, I felt this was something where I could step in and really propose some solutions that I think are going to help with a major public policy problem that we're going to be hearing a lot more about over the next coming years as the effect of this “Great Resignation,” filters its way through the workforce. If a hospital is short staffed, you cannot just go out and get somebody off the street to become a nurse. It takes work. It takes training, and you need to make sure that the people who are doing it are equipped to do what they need to do to save lives. I just felt like if we don't start talking about this now we're going to come to a point where it is a literal life and death crisis and then it's going to be too late to deal with it because you can't get a nurse trained in three weeks.

How has the nursing shortage played into “The Great Resignation?”

What we're seeing is people that have been working essentially at 150% since March of 2001. And for anybody that does that, we all know that sometimes we’ve got to dig deep and give a little bit more. I think that the nurses and doctors and anybody in the medical profession knew that when COVID hit they were gonna have to buckle down, and they were really going to have to give it their all and they were willing to. They knew that we would flatten that curve two years ago, that we were going to try to get to vaccine development, and then hopefully, the worst would be behind us. Unfortunately, because of people resisting the vaccine and the spread of these variants, the worst has maybe only recently come behind us. With omicron, where we have more cases and more people in the hospitals in New York than at any time since early 2020. Thank God the death rate wasn't what it was. But people are burned out, and when you're working that hard in that level of stress, and you have nurses and doctors getting sick themselves, worried about their family, you're going to see people leaving. I personally have talked to people in the healthcare field that have called it quits. I've talked to the New York State Nurses Association, SEIU 1199, some of these other labor unions that represent thousands and thousands of nurses and healthcare workers around New York, and they're reporting the same thing. People, not everybody, but many people are realizing that although they may have loved this profession and still do, it's simply gotten too stressful. The pay can't keep up. And the work is getting so stressful and so nonstop, it's untenable in the long term.

Could you talk about the nurse licensure compact legislation proposed by Gov. Kathy Hochul?

That's the governor's proposal and it would opt New York into the interstate licensure compact for nurses. And I appreciate it. First of all, I have to say the fact that she made this part of her State of the State, and made this one of her initial things, shows that she recognizes the seriousness of this issue. This is an issue that is going to impact all of us in New York and the fact that the governor is on board and realizes we got to do something is incredibly significant. That said, I do think that her proposal doesn't quite go far enough, because it also has this downside that if you bring in people from out of state, working for nursing agencies, they may be working side-by-side in the same hospital with a nurse who's been working there for 20 years or more. And that nurse would be making less than somebody coming in from out of state, working for a nursing agency. That's incredibly demoralizing if you're in this job, and in fact, maybe will cause more people to say, “This just isn't the job for me.” So in our bill that I introduced, we would allow people to come in from out of state, and they would need to get an appointment with a New York state employer, and then within two years work. Of course, if you're working for a New York employer, they would be paid the same rate as any other New York employee. And within two years, they would need to get their certification in New York. So it is still an opportunity to bring people in, not as a sort of permanent class of important workers, but as people that we hope will be part of the state's economy and part of the state's labor force and certified as such going forward.

Please go into more detail about your bill.

Sure. So we identify two main barriers to getting more people into the nursing field. One of them is simply the high cost of becoming a nurse and the student loan debt that people have to take on. What the RN act proposes is a whole set of pathways to try to alleviate that. It's really an all of the above approach. So we add nursing into the types of fields that are eligible for the existing STEM scholarship programs for students in New York. This is something that will help people right off the bat. We create these new “nursing-in-shortage-area” scholarships, which will essentially pay the cost of attending a nursing program at a SUNY school or a private school that is similar in cost. Then they have to work in a nursing shortage area, which will be designated by the Department of Health for the next five years. Because we know that while there's a nursing shortage across New York, some areas are getting much worse than others. 

We've set up a “pathway to nursing scholarship” for healthcare workers, particularly people who are already in the field and want to get their nursing degree, so they're going to be working and going to school part time. These are people who are not captured by a lot of the traditional scholarship programs. We wanted to give them the opportunity to take advantage of the same sort of scholarships that are available to somebody going to school full time. 

And another couple other things on the loan forgiveness side. One of the challenges is there are not enough people going into nursing faculty. That's one of the other reasons for the shortage. Nursing programs turn away thousands of applicants every year, who would be qualified, because they don't have the faculty, they don't have the space to teach them. The problem is that faculty in nursing schools are usually paid less than if they went into clinical practice as nurses. You really have to want to be a teacher. You have to want to do that. For something as important as making sure we have enough nurses keeping us healthy, altruism is not enough. We need to incentivize people to be in the nursing faculty. By giving them additional loan forgiveness and student loan refinancing programs, those are among the things the RN Act does.

The other major piece of the shortage is the strain on health care facilities and colleges. So right now, some hospitals charge nursing students for their clinical placement. They have to complete a clinical placement in order to be certified, and they're getting charged to do that. So we would like to make it so that other than a nominal fee of up to $1,000, hospitals and nursing homes cannot charge nurses for getting the clinical training which they must get in order to complete their degree and frankly, also giving incentives to nurse faculty to continue working. One of the things we would do in this bill would be exempt nurses for the earning limitations if they are retired and want to keep working. If they're working as a nursing faculty at an accredited institution by the state, that would also allow them to have some tax exempt income.

What will this type of legislation cost if passed?

Obviously, the bill comes with costs, because scholarship programs and things like that have costs. While we're debating the budget, it's something that I'm going to be making a priority. Last year, the Senate's one house budget put $600 million in to raise pay for home care workers. That's a similar and related issue, because we have a workforce shortage there. We have to invest. This is a significant cost to the state, but this is one of these things that you can spend now on the upside, or you're going to be in crisis mode, if we run out of nurses, and who knows what would happen in that case.