Amidst a nursing shortage, legislators look to reduce licensing and training barriers. Photo from Getty Images.

By Whitney Downard
Indiana Capital Chronicle

INDIANA — Indiana doesn’t have enough nurses to meet growing demands, with thousands of openings across the health care industry. By the end of the decade an estimated one-in-four Hoosiers will be retirement age or older, a population that has more health needs and more complicated care.

Estimates predict that Indiana would need an additional 5,000 nurses by 2031, equal to graduating an additional 1,300 nurses each year until that time, according to the Indiana Hospital Association.

A nationwide nursing shortage has spurred states to take action, with some investing $125 million to lure students to the profession and other states providing a living allowance alongside child care benefits.

In Indiana, those types of add-ons are still in the hands of employers and legislator attention remains fixed on widening the pipeline of students and adding licensing flexibilities.

Building upon the passage of a 2022 nursing bill, House Bill 1259 seeks to continue expanding the nursing workforce by addressing foreign-educated nursing licensure requirements and on-the-ground training.

“We changed policy a couple of years ago … and then we found that these bottlenecks still existed,” said Rep. Brad Barrett, the author. “I think it’s great, legislatively, to put something in place, watch it in action, identify a couple of bottlenecks and then address those. (House Bill 1259) was just following up on this real intent to increase the nursing workforce.”

House Bill 1259 Details

While most of the bill received glowing support in testimony, one issue was a bit of a sticking point for nurses working in clinical settings: language striking minimums for preceptors, or licensed nurses supervising students during rotation. Previously, preceptors needed 18 months of experience before they could be drafted to teach and mentor the next generation.

The new law has no minimum requirement.

Rep. Cindy Ledbetter, a nurse practitioner with a doctorate, cautioned against the move, saying unprepared nurses would be given to students to address a shortage.

Barrett said that it was in hospitals’ and other employers’ best interest to identify and assign good preceptors, not just anyone with 18 months of experience.

On the other hand, foreign-born nurses help ease the shortages for some health care providers but recruitment can be lengthy and expensive, especially under a federal visa regression that delays processing and limits applications.

State barriers include requiring an English proficiency exam — even when an interview and clinical examination determine fluency — and using CGFNS International, Inc. as the sole entity to review visas when other states rely on multiple credentialing organizations.

The language on foreign-educated nurses has already been approved by the Senate in a separate omnibus health care bill.

Matilde S. Upano, a registered nurse and president of the Philippine Nurses Association of Indiana, said CGFNS reported that 60.8% of their nearly 27,000 visa screenings are Filipino. She testified in support of both the Senate and House bills addressing foreign-educated nurses.

Challenges For Nursing Homes

Nick Goodwin, the director of government affairs for the Indiana Health Care Association/Indiana Center for Assisted Living, said the domestic supply of nurses isn’t meeting the needs of long-term care. Because of that, providers might spend thousands of dollars recruiting foreign-educated nurses.

Working in long-term care comes with its own drawbacks. While nurses employed in the field can create lasting relationships with residents and their families — unlike temporary stays in hospitals or clinics — the reality is that patients age and die or can even decline mentally and become abusive.

COVID-19 also pushed an unprecedented number of nurses to seek other careers. Nearly every other industry — from hospitals to outpatient centers — have recovered from their pandemic losses when comparing their current labor force to February 2020. Nursing facilities, however, are still 7.4% lower (equal to roughly 3,500 employees) than their staffing levels from February of 2020, according to the Bureau of Labor Statistics.

Goodwin noted that while nursing jobs aren’t minimum wage, the $20-25 hourly wage isn’t as competitive as it used to be when some warehousing jobs offer similar pay.

As an added layer of difficulty for nursing homes in particular, the federal government is in the process of instituting staffing mandates for long-term care facilities. Goodwin observed that several roles were excluded from such counts despite their experience, including nursing directors.

Continuing Education For Nurses

At first blush, Senate Bill 45 appears to be a simple move to incorporate trauma-informed training into nursing education. Author Sen. Mike Crider passionately described how trauma-informed training had transformed his investigative approach during his law enforcement career and how he wanted other professions to have the same knowledge.

But unlike the majority of states, Indiana doesn’t have any continuing education requirements for nurses. Under Crider’s original bill, nurses would have to recertify every two years but the state’s Professional Licensing Agency doesn’t track continuing education for nurses like it does for doctors or other health care professions — nurse employers do that work.

Following pushback, senators amended the bill to say every nurse must certify within five years and there shall be a study about incorporating it into secondary education institution curricula.

Katie Feley, the chief executive director of the Indiana State Nurses Association, said most of Indiana’s school already had trauma-informed training in their curriculum. Her organization opposed the legislation, saying that PLA already struggles to meet its current workload.

Committee members still seemed incredulous that nurses didn’t have continuing education requirements in Indiana, meaning “a nurse that graduated 25 years ago is practicing what she was taught 25 years ago” in the words of Chair Sen. Ed Charbonneau.

Indiana does have continuing education requirements for one nursing profession: advanced practice nurses with prescriptive authority must get 30 hours between license renewals, eight of which must be in pharmacology. There is also a continuing education requirement for nurses with a controlled substance registration.