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t m c » p u l s e | a u g u s t 2 0 1 9 31 You've got a quarter of the workforce within 10 years of retire- ment. The sta- tistics for Harris County are about the same." Beyond that, the U.S. popu- lation is aging overall. By 2030, one in every 5 residents will be retirement age, according to the U.S. Census Bureau. "With the aging population, we are getting ready to consume more health care resources than we have ever consumed in our country," Stokes said. "There's no reversing that trend." Education also plays a crucial role in the nursing shortage. "As a nurse, you used to advance whether or not you went back to school. Now you see more nurses going back to school to advance," said Cindy Zolnierek, Ph.D., the CEO of the Texas Nurses Association. "With today's violence, the opioid epidemic and different expectations from the workforce, more education is needed so you can prepare for that complex health care environment." Increasingly, the gold stan- dard for nursing care in hospitals is Magnet designation, which is conferred by the American Nurses Credentialing Center. A Magnet hospital sustains excellent patient outcomes, a low turnover rate of nurses and open communication between nurses and the rest of the health care team. Mortality rates are 14 percent lower at Magnet hospi- tals, according to a 2013 analysis from the University of Pennsylvania School of Nursing. Hospitals wishing to acquire or maintain Magnet status must be able to show that 80 percent of RNs on staff have earned a bachelor of science degree in nursing or pro- vide evidence that the nursing staff will achieve that goal by 2020. But that's harder than it sounds. Educational opportunities and nursing programs are resource-intensive and scarce. A shortage of nursing schools and faculty means a limited number of places and spaces to deliver the classroom and clinical education a nursing degree requires. "To be a licensed RN, you can go to an associate's degree program or a bachelor's program—but those are the programs that have more applicants than they can accept," Zolnierek said. Stokes concurred. "Nursing schools just can't afford the faculty they need to accept all the people who want to go into nursing," he said. "Also, you make more money as a nurse than as an educator." New opportunities, new deficits Fifty years ago, ambitious nurses in hospital settings climbed a career ladder with a clear, vertical trajec- tory—moving from staff nurse to charge nurse to nurse manager/ head nurse to director of nursing. Over the past half century, that lad- der has been tipped on its side and new opportunities have proliferated across a broader landscape. "In the 1960s, if you were a nurse you likely worked in a hospital," Rozmus said. "Now you can work in a clinic, in advanced practice deliv- ering primary care services. You can get a Master's or a Ph.D. and teach. The kinds of things nurses do have expanded like a sponge." This absorption of additional duties and extension of options within the profession has been going on for decades, Stokes said. ➟ Chuck Stokes is president and CEO of Memorial Hermann Health System and a registered nurse.