Closing the Gap in Health Equity

Across the nation, significant and increasing health disparities exist, many of which are caused by barriers established at all levels of society.¹ Health equity is achieved when everyone has a fair and just opportunity to access their best health. This requires ongoing business and societal efforts to address historical and current injustices, overcome economic and social obstacles to healthcare, and eliminate preventable health disparities.² Health inequities cost the United States economy an estimated $320 billion annually in lost productivity and healthcare costs and may rise to $1 trillion annually in 2040.³

One of the largest contributing factors to the lack of health equity is the lack of services, which can put people at higher risk for poor health outcomes.⁴ This is seriously impacted by the ongoing shortage of nurses, which has reached a critical point in the U.S. Currently, there is an average of nine registered nurses (RNs) for every 1,000 people in the country.⁵ Southern states are the most affected, with an average shortage rate of 8.39% and a net deficit of 258,780 nurses.⁶ These numbers have increased rates of nurse burnout caused by factors such as an aging population, the recent pandemic, insufficient capacity in nursing schools, and prolonged delays in employment-based immigration, all of which contribute to significant gaps in the workforce.⁷

According to the U.S. Chamber of Commerce, there will be more than 193,000 job openings for RNs annually until 2032.⁸  However, the U.S. expects only an additional 177,400 nurses to enter the workforce for the entire decade leading up to 2032--less than what is needed to fill just one year of projected openings.⁹ The lack of available nurses is major aspect in the rise of hospital closures across the U.S., with 42 medical centers closing medical departments or entire facilities since February 2023.¹⁰

Here, we take a look at one corporate foundation looking to close these nursing gaps at the local level, the Blue Cross and Blue Shield of Louisiana Foundation. The Foundation shares the mission of its parent company and works to improve the health and lives of Louisianans. In addition to the health services provided by Blue Cross, the Foundation makes grants that affect health outcomes for everyday people – including a series of sustained investments in healthcare workforce initiatives that are helping change the trajectory of Louisiana’s nursing crisis.

In 2022, nearly three-quarters of Louisiana residents lived in areas with limited access to providers for primary, dental care, or mental health care.¹¹ Recent efforts to address Louisiana’s nursing shortage have yielded some results but not at the scale needed to meet an estimated deficit of approximately 6,000 RNs by 2030.¹²

“Louisiana’s nursing shortage isn’t just driving a crisis of available care; it also contributes to the skyrocketing cost of that care. Where nurses are in short supply and talent is being imported from elsewhere, the costs are substantially higher, which matriculates into the overall cost of insuring our friends, family, and neighbors. These partnerships and investments are making highly qualified, culturally competent care more readily available while also improving the quality of care, providing employment opportunities locally, and holding the line on costs in our state,” said Michael Tipton, president of the Blue Cross Foundation.

The Blue Cross Foundation started addressing the nursing shortage in 2018 when Workforce Development Board 83, one Louisiana’s rural workforce development boards, brought universities, community colleges, and hospitals together to facilitate an agreement to make more qualified nurses with masters degrees available to offer clinical rotations at nontraditional hours, to expand available learning hours and give more interested students an opportunity to participate. To date, the Foundation has made more than $5.1 in grants to coalitions of workforce development entities, hospitals, and universities. As a result of this work, partners are projecting an additional 800 new graduates from nursing programs within two years.

Lack of widely available and comprehensive nursing education has proved a significant hurdle. In 2021-2022, enrollment in nursing programs nationally dropped for the first time since 2000, with nearly 92,000 qualified applicants being turned away from programs, in part due to a shortage of teachers.¹³

By looking at the issue holistically, the Blue Cross Foundation partnered with communities to increase the availability of locally sourced nursing talent through expanding the pool of clinical instructors, by starting new partnerships among universities and institutions and by helping existing programs offer classes at expanded times and in new formats. These investments engaged new nursing students and will, over time, help provide better access to high-quality care as well as job development and economic growth in participating areas.

Through its funding, the Blue Cross Foundation also hopes to increase the number of nurses of color by 20% through partnerships with Historically Black Colleges and Universities. In Louisiana, 43% of the state's population identify as people of color—compared to 23% of registered nurses in the state who are people of color.¹⁴ The Foundation and its partners are conscious of the challenges facing the state’s patient and nursing populations, including cultural and financial hurdles. Many of its nursing workforce grants include financial and mental health supports for nursing candidates, including many who are first-generation college students and coming from backgrounds of generational poverty. An increased population of nurses of color aligns with patient demographics and represents one facet of a diversified healthcare workforce.

 Studies projecting Louisiana’s nursing shortage have shifted, showing a far less extreme and impactful deficit, and the Blue Cross Foundation’s funding has played a role in nearly halving the anticipated nursing gap by 2030. These models have been recognized across Louisiana, earning national accolades for partners and setting this approach up as a best practice increasingly adopted across the state and beyond. Some of the regional partners who have implemented similar models include:

• Fletcher Technical Community College in Schriever
• Louisiana State University at Alexandria
• Louisiana State University at Eunice
• Northwestern State University in Natchitoches
• Loyola University New Orleans
• Southern University at New Orleans
  

“It's inspiring to see communities take this challenge on with such rigor. Having so many partners focused on one goal and working together across the state is the template for how we move ourselves forward,” said Tipton.