Is Colorado equipped to handle the pending nursing shortage? Maybe not.
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DENVER — Two years after the World Health Agency declared an end to the public health emergency for COVID-19 and a bevy of nurses exited the field, the health care industry has largely stabilized. Pay for nurses has leveled off after ballooning during the pandemic and employment has become less erratic.
But Colorado, like many states across the country, still faces a shortage of registered nurses — 15 percent less than projected demand by 2030. It’s an issue that will likely become increasingly noticeable in the near future. For the first time, Colorado has more residents who are older than 60 than are under 18, meaning the state will need to bolster its health care workforce to accommodate its significant population of older adults.
“What keeps me up at night is the fact that technically there's enough nurses, but they're not being treated well enough to stay in it,” said Laura Rosenthal, a professor of clinical teaching at University of Colorado Anschutz’s College of Nursing and former president of the Colorado Nurses Association.
“So is there a true nursing shortage? No. Is there one in the hospitals? Yes,” she said.
Rocky Mountain PBS spoke to several nurses across the state about their experiences and why they chose to either leave or stay in the field.
Scott Shapiro, 60, had been an ER nurse for more than 26 years in Colorado.
“You name it, I worked there,” said the Littleton resident.
After earning his nursing degree in the early 2000s, Shapiro worked as a staff ER nurse for Denver Health and St. Joseph Hospital. Then, for the bulk of his career he worked as a per-diem, or float nurse, at hospitals around the state, including in Aspen. Nurses typically take these roles for higher pay while sacrificing staff benefits such as health insurance. Shapiro’s wife is a teacher and he was able to join her health insurance plan.
But, four years ago Shapiro learned he could earn significantly more. He started traveling, on his own dime, to Northern California to serve as a per diem nurse at Sutter Health in Novato. He now flies out there twice a month and pays for his own expenses including flights, hotels and a rental car, and still earns more than he would in Colorado.
“If I was to apply for a job in Colorado with 30 to 32 years of experience in the ER, I would only be able to make about $45 an hour right now. And I was making that back in the early 2000s because I was floating,” Shapiro said.
“So the rate of pay really hasn't changed much in comparison to the cost of living out here.”
Though Shapiro travels, he’s not technically a travel nurse, which is someone who works for an agency and performs short-term contracts. He has a secure job at the hospital, with a flexible schedule and a 401K.
He flies out twice a month and works five to six shifts in a row for a total of ten to 12 shifts a month. Then he’ll take about 10 days off. Because he sets his own schedule, he chooses to work less shifts in the summer than winter.
Shapiro said he knows other nurses flying into California from other states, and Rocky Mountain PBS found nurses from across the country posting about the trend on Reddit. California has the highest average annual and hourly wages for registered nurses in the country.
“If you’re near retirement like me and you want to sock as much away in your 401K, why make less when you can make more?” he said.
Most nursing jobs in Colorado pay between $38-65 an hour , depending on experience. Shapiro said in California, he makes about $130 an hour.
Laura Rosenthal, the professor at University of Colorado School of Nursing, said Colorado’s nursing salaries are middle-of-the-road compared to the rest of the country.
The average annual wage for the state in 2023 (the latest available data) was $91,730, or $44 an hour, according to the Bureau of Labor Statistics. Nationally, the average wage was $98,430, or $47 an hour in 2024.
Rosenthal said California is an outlier.
“They’re unionized, so they have some pretty significant bargaining tools,” she said. Colorado has just a handful of unions representing nurses.
“Coincidentally, though, the cost of living isn't that much less here in Colorado than it is in California,” said Rosenthal.
One of the bargaining tools California’s nursing unions successfully pushed for are legally mandated nurse-to-patient ratios. California was the first state in the country to establish them in 1999. In California, for example, one nurse can only oversee two patients in the ICU and a maximum of four patients in the emergency room or pediatric units.
“Here we do not have mandated ratios,” Rosenthal said of Colorado, “though there are guidelines.”
Because of the lack of ratios in Colorado, Shapiro said, “you can be really busy all the time.”
Shapiro admitted the travel comes at a cost.
“It sort of sucks traveling,” he said. “It wears you down.” After a day of working and traveling, he said sometimes he’ll have been awake for more than 24 hours.
“Hopefully the hospitals in Colorado catch up [to what California is doing].”
Sarah Whiteside, a bedside travel nurse based in Denver who graduated nursing school in 2020, said she’d like to get a staff job at a hospital in Colorado but won’t anytime soon because of the pay.
“It sucks that travelers make so much more money when [health systems] could just compensate staff nurses more and offer more incentives,” she said.
Whiteside currently travels from Denver to Pueblo to work nights at UCHealth Parkview Medical Center. While she said her hourly rate isn’t that high, the real money she makes comes from housing and food reimbursements from her travel agency.
Whiteside said she loves her job but can see herself eventually leaving the bedside and going into dermatology or another outpatient setting.
“Hospitals can be very draining. You’re lifting patients, transferring patients, cleaning them, bathing them,” she said.
Whiteside said she would consider taking a full-time job at a hospital if she was compensated more.
Gunnison Valley Health (GVH), a rural health system serving Gunnison County, has been trying to move away from hiring travel nurses, which has been a significant cost expense to them, said Jason Amrich, CEO at GVH.
“There’s just a value in having permanent nurses that are invested in our community and are long-term part of our organization,” said Amrich.
The health system went from hiring a high of 144 travelers in 2022 to hiring 68 traveling staff in 2024. This year to date, they have hired 39 travelers on 13-week assignments.
The health system is instead working to entice employees to stay with them long-term.
The community-owned health system offers partially or fully paid tuition for existing high performing staff that are seeking advanced degrees in nursing or medical technology and that show commitment to the hospital and region. They currently are offering this for six staff members.
GVH also offers a program introducing nearby high school students to the medical field by offering them exposure, over the course of eight to 10 weeks, to areas like paramedics, radiology, and the operating room.
“We're trying to figure out how to develop homegrown folks that know rural, and that know what it's like to work in Gunnison,” said Amrich.
While Whiteside doesn’t see herself leaving the hospital anytime soon, many of her peers are.
“What we are finding is a lack of longevity in the profession,” said Rosenthal.
Rosenthal said the new generation of hospital bedside nurses tend to remain nurses but transition into areas such as aesthetics (e.g. administering botox), consulting or working for medical companies to, for example, conduct trainings on how to use medical equipment.
“They're not being treated well enough to stay in the hospital,” she said. “Most nurses go into the profession because they want to take care of people and they want to do it well. And when you're overloaded with patients and you feel like you're not giving good care, no one wants to go to work and feel like they're not doing a good job, so they don't want to do it anymore.”
Emily Glenn, who worked as a nurse for 20 years in Colorado Springs and Fort Collins, said a generational shift has occurred at the same time that nurse-to-patient ratios have gotten worse.
“The people who are now in their 70s and 80s did the same job for 50 years, so the mindset was just different. They just pushed through and did their job,” Glenn said.
“This generation changes jobs a lot,” she said. “They're burning out really quick because they're viewing [nursing] as a job and not being mentored to make it a career.”
The research backs it up. According to Pew Research Center, young adults are more likely than older workers to change employers in an average month. And a survey of 2,000 employed Americans conducted by Talker Research showed that 73% of Gen Z respondents and 70% of millennials would like to switch jobs or careers, compared to 51% of Gen X respondents and just 33% of baby boomers.
At the same time that younger nurses are changing jobs more, older nurses are exiting the field.
According to the 2022 National Sample Survey of Registered Nurses, 23% of RNs working in outpatient, ambulatory, and clinical settings have retired or plan to retire over the next 5 years.
As a result of the shifting demographics, newer nurses are promoted to positions of authority quicker than they used to.
“Normally when you're put into a charge nurse position, you've been on that floor for a couple of years and know what’s going on,” Rosenthal said. “Now [new nurses] have been working six months and they’re like, ‘you're in charge now.’
Gregory Roberts said the issue is especially prevalent in the labor and delivery unit, where he’s been a nurse for the past 17 years.
“You have these nurses that have worked very long careers exiting and being replaced with nurses who are new to nursing, if not brand new,” he said. “You can't really replace 20 plus years of experience on labor and delivery in a five month training period.”
Roberts said placing novice nurses in labor and delivery units where births are more and more complicated has created a number of challenges.
“These new nurses come in and get burned out and exhausted because they've been pushed to do things that normally we wouldn't have seen 20 years ago with the amount of high-risk patients,” he said.
Maternal mortality rates in the U.S. have more than doubled from 1989 to 2018, due to increases in issues including high blood pressure, preeclampsia, diabetes and advanced maternal age, according to a study in The Lancet.
“These nurses have graduated and they get on the floor, and they just didn't realize the extent of how physically demanding it would be, or the mental strain that one goes through when, say, a pregnant person comes in and realizes she's had a baby in her belly the entire time, and then you put the ultrasound on and the baby's passed away.”
Universities like Metropolitan State University of Denver are trying to better prepare nursing students for what’s to come.
The university received $10 million in state funding to develop a new-state-of-the-art skills and simulation lab to give students better real world experience. The lab, which opened last August, simulates a real-life hospital and has nine high-tech manikins, including a pregnant woman giving birth to a baby.
The manikins cost anywhere from $3,000 for a low-tech infant to $120,000 for a high-tech adult, plus licensing fees.
Video: Andrea Kramar, Rocky Mountain PBS
“I've had lots of students say, ‘I think I would have just been panicked the first time I saw birth if I had not had the opportunity to practice,” Allert said. “Manikins allow students to make mistakes and learn from their mistakes.”
Roberts who said he loves the field of nursing and the hospital he works at, Good Samaritan Hospital in Lafayette, is now transitioning in his career.
“Because of how physically demanding [the hospital setting] is, I don’t know that I can do this for 20 more years,” he said.
He’s training to be a certified nurse midwife, where he can continue serving women and pregnant patients but won’t have to be bedside for 12 to 14 hours at a time.
Glenn, who also left the hands-on-nursing practice due to burnout during Covid-19, is now privately coaching other health care practitioners on holistic health and wellness.
“The conversation for nursing mental health should be starting in nursing school,” she said. “There's not a big enough emphasis on holistically knowing how to take care of yourself. And that is integral in lasting and being sustainable in the health care industry.”
Type of story: News
Based on facts, either observed and verified firsthand by the reporter, or reported and verified from knowledgeable sources.
Based on facts, either observed and verified firsthand by the reporter, or reported and verified from knowledgeable sources.
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