In 2019, the state was about 17,100 nurses short, according to a report commissioned by the Florida Hospital Association and Safety Net Hospital Alliance of Florida. By 2035, that shortfall is predicted to hit 59,100.

Over the past two years, the pandemic has accelerated the crisis, depleting the ranks of bedside nurses and creating what Neil Finkler, chief clinical officer for the Central Florida division of AdventHealth, described to state lawmakers as a “great existential threat” to health care delivery.

At the height of the pandemic, AdventHealth was filling up to 79% of nursing vacancies in certain clinical care units with agency staff to care for COVID patients. “A lot of nurses left nursing altogether, they left the bedside or they went to become travel nurses because they were getting upwards of $10,000 a week” to work at COVID hotspots across the nation, Finkler said at the September hearing.

As the nursing supply dwindled, the nurses who remained cared for more patients. With no immediate letup, the hospital units transitioned to team-based care — one nurse acting as a manager, delegating tasks of patient care to a team of other nurses and ancillaries — and began looking at “virtual nursing,” which involves remote monitoring of patients using digital tools. “I don’t see us in the near future going back to nursing models (we had) pre-pandemic because I don’t think we’ll have the nursing supply left,” Finkler said.

Nursing schools have also felt the crunch. Ora L. Strickland, dean of Florida International University’s Nicole Wertheim College of Nursing & Health Sciences in Miami, says some of the school’s adjunct professors have left amid fears of bringing the virus home to family, and older faculty members are retiring earlier than they otherwise might have. “They’ll say to me, ‘Dean, I’ve been diagnosed with a chronic condition. I can’t do clinical teaching anymore,’ And where do we need nursing faculty to be to really teach students? In the clinical hospitals, where the COVID virus is rampant.”

Strickland says FIU has been trying to get more nurses into the faculty pipeline via an 18-credit-hour certificate program for nurses who already have a master’s degree or a doctorate. It takes about a year or two to complete, depending upon whether the nurse goes full time or part time — and she says they could churn out more graduates if the state dedicated more funding to student scholarships. “If you’re going to take experienced nurses and teach them how to teach, they’ve got mortgages, car notes; many of them have children. They can’t walk away from all that without scholarship money,” she says.

Some health care systems are investing in growing their own pipeline of nurses.

Two years ago, HCA Healthcare acquired Galen College of Nursing, which has 12 campuses around the country, including in Gainesville, Miami, the Tampa Bay region and Sarasota. Registered nurses at HCA Healthcare can complete their BSN degrees online through a Galen program with no out-of-pocket costs.

AdventHealth University, which has campuses in Orlando and Denver, graduates about 200 nurses per year and wants to triple that number over the next five to 10 years. The 30-year-old school also plans to open a nursing campus in Tampa. More than 80% of the school’s graduates go on to work in AdventHealth facilities — and retention rates are almost double that of nurses trained in other programs.

This year, AdventHealth also started offering its employees “debt-free” education in partnership with AdventHealth University and other colleges and universities.

“One of the barriers we found was that many traditional tuition reimbursement programs didn’t work for patient care technicians earning an entry-level wage,” says Olesea Azevedo, senior vice president and chief human resources officer at AdventHealth and a member of AHU’s board of trustees. “We removed that barrier. We pay that college directly.”