NORTHERN HILLS — “Nursing is something that is needed everywhere. There is not a single country, city, town on the planet that is exempt from the need for health care,” said Nicole Kerkenbush, Monument Health chief nursing and performance officer.

Right now, there are “pockets” across the United States where the demand for nurses far outweighs supply.

South Dakota is one of those pockets.

“There definitely is a shortage of nursing staff and when I say ‘nursing,’ I include all kinds of nurses, so, RNs (registered nurses), LPNs (licensed practical nurses, nurse’s aides, certified nursing, medical assistants,” Kerkenbush said. “We really are not finding that we have enough workforce in the Black Hills area.”

Kerkenbush said that at any given time within the Monument Health Care system, for example, there are anywhere from 100 to 150 openings of nursing support staff and another 75 to 100 RN openings.

“And that fluctuates all the time,” she said. “Overall, that’s probably around 250 openings … at a given time.”

There are currently between 1,300-1,500 nursing and nursing support staff members employed bu Monument Health.

“It would be the largest part of our organization, if you look at nursing, as a whole,” Kerkenbush said.

Overall, there are 4,500 caregivers and physicians in the Monument Health Care System.

Kerkenbush said that the greatest area of nursing need is inpatient in the hospital medical/surgical area.

“That’s where we have our greatest group of openings right now,” she said. “It’s true of every organization that I’ve ever worked in. That’s where the shortages are.”

Due to the fact that hospitals never close, nursing jobs in a clinical or other setting are sometimes more appealing, as they are more family and lifestyle friendly.

Scott Engel owner/administrator of Golden Ridge Senior Living in Lead, Key City Assisted Living in Sturgis, and Kelley’s Retirement in Pierre, said he has not experienced a nursing shortage at his assisted living facilities, but that he does not require the number of nurses of other facilities.

“Day to day, I’m not having any significant challenges, but I truly believe, in the marketplace, that there are some shortages,” he said. “All of us, no matter what business we’re in, we recognize the employment challenges, and I think what’s happened to the health care system a little bit is, it’s so disrupted that we don’t know where it’s going to settle out yet.”

Engel said that considering the current marketplace, he recognizes replacing a nurse at one of his facilities would be difficult right now.

“I just haven’t had to do it in a couple of years,” he said, attributing the high retention rate to luck, timing, and hard work. “You’ve got to believe in the fact that ‘It is my job to make sure that they have a great work environment,’ or we don’t. There’s no in-between. … Professional nurses respect that. And they appreciate that I say I’ll put people before money.”

Tina Maakestad, director of Rolling Hills Health Care in Belle Fourche, agreed there is not only a local nursing shortage, but a nationwide nursing shortage and that she has experienced difficulty hiring at her facility.

“We are currently fully staffed with nurses,” said.

She attributes the turn-around in staffing to company culture.

“The company that owns us, Eduro, takes pride in making sure that their employees are taken care of,” said. “Our core values are wellness, compassion, experience, and results and so, we understand that if we can’t take care of our employees, how can we expect our employees to take care of our residents?”

Kerkenbush said the 10- and 15-year trends indicate demand will outpace the current workforce.

“We really need to work to educate our young folks, what opportunities there are for them in health care,” Kerkenbush said. “What does it mean to be an LPN? What are the opportunities in those fields? Nursing is such a widely varied profession.”

Kerkenbush said an emphasis must be made on building that workforce.

“How do you build that work force for the long term?” she said. “Because health care is something that eventually, everyone needs … and if we don’t have nurses to provide those health care needs, I think we’re going to be in a really bad situation in the future.”

Nurturing the nursing need

In the wake of the nursing shortfall and as a relevant community response, Western Dakota Technical College (WDT) has upped its game when it comes to nursing recruits and enrollment.

“Talking with employers, it seems that what they’re looking for is students that are ready to tackle that profession,” said Christi Keffeler, director of nursing at WDT. “So the more we can train them to be work ready, the better off the students are, and the better off the community is.”

Keffeler said partnerships in the community that provide learning experiences are key to training students to be ready for the work force, as they provide high levels of clinicals and training, while the college’s state-of-the-art simulation center provides the safe learning experience, safe learning environment.

“And that’s a great place to make the mistakes, so when we do go out into the community, the students are ready. They know what to do. They know how to take care of these patients.”

Nursing is multi-leveled.

At Western Dakota Technical, a certified nursing assistant (CNA) can be earned in eight weeks.

The LPN degree can be earned, once the students are done with their general education requirements, in two semesters. A board certification test must be taken at the end of those technical courses to earn the licensure.

From there, WDT offers an associate level RN degree.

Once the general education requirements are finished, it will take an additional two semesters. A licensure test is required to obtain the RN license as well.

“What we’ve done in the nursing department is, we’ve made it pretty simple for people to get their degree,” Keffeler said. “For example, we have created hybrid programs, so some of it is online. We’ve shortened up some of the labs, so when people have work and families and different things like that going on, we made it easier for the public to come in and get a degree.”

Many WDTC graduates have job offers before they finish school.

“We make sure that we are partnering our students with the employers early on,” Keffeler said. “They go from here right into the work force.”

Last year’s group of students earning their RN degree was the first cohort coming out of WDT and the class pass rate was 90%.

Gov. Kristi Noem appointed Keffeler to the South Dakota Board of Nursing in October 2019.

“It helps me put policies in place and make sure that these programs are stellar programs,” Keffeler said.

To give an idea of how many nurses WDTC is putting in the pipeline, Keffeler said that every semester for the LPN program, she enrolls 24 to 32 students.

“So that’s 48 a year for LPNs,” she said. “And, then, RN, last year I capped at 16 and this year it’s 24 … and then, next year, our RNs will enroll 48 a year.”

Graduates from all programs are needed.

“It takes all levels of nursing in the health care world to take care of a patient,” she said. “It’s not just one RN or one LPN.”

The difference between the two levels of nursing is scope of practice. The RN will generally be the one in charge of care and the LPN will carry out that care.

“Once you have that license, whether it’s LPN or RN, the sky’s the limit. You can do anything. You can go anywhere. You can be whatever you want to be,” Keffeler said. “Nursing is one of those professions that there are so many doors that are opened. You can travel. You can specialize. You can go into administration. You can go into education. There are so many options.”

New opportunities

The West River Health Sciences Center is set to open this fall at Black Hills State University-Rapid City.

The benefit of the center is that those interested in pursuing a career in the health care field can go to one place to explore the myriad of medical careers, and institutions of higher learning that will help them attain their degrees.

“We want to encourage people to look at all facets of health care and figure out something that feeds their passion, feeds their desire for learning, and make a good fit. I think the West River Health Sciences Center is going to be a huge benefit for the whole of the Black Hills,” Keffeler said.

She said a four-year college isn’t the right thing for everybody.

“And some people need to do something, try it out before they even commit to a four-year degree and that’s where I think WDT’s programs are so amazing.”

The college is adding its first satellite campus in Whitewood to directly cater to the nursing program.

“Everybody has different needs and different desires, and I believe firmly that everyone can find something that fits their needs and desires and abilities, in health care. Anyone can. We just have to help them find it,” she said.

Anyone who is at least 18 years old can apply for a job as a patient care champion at Monument Health.

Although South Dakota lands at the bottom of salary rankings, Kerkenbush said that a lot of times those surveys don’t take into account the fact that South Dakota doesn’t have income tax, the benefits packages that some employers offer, cost of living, and quality of life.

“We are starting to see interest in South Dakota,” she said. “Our goal is to remain competitive with other health care institutions in the state and the surrounding states, because we don’t really compete for work force with the eastern side of the state, but we definitely do with Wyoming, Montana, Colorado, Nebraska.”

Monument Health starting hourly pay is as follows: patient care champion $14, medical assistant $14.68, $17.60 LPN; clinic RN $24; acute RN $26.40.

The Bureau of Labor and Statistics web site lists the median 2019 pay for RNs as $35.24 per hour, LPNs as $22.83 per hour, and nursing assistants and orderlies as $14.25 per hour.

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