PORTLAND, Maine — Courtney Wilson and Josselyn Agura will graduate from nursing school Saturday, and already they’re worried about burning out from their chosen profession.
Nursing often means caring for patients who are sicker than in years past, with more complex health problems, in a shorter amount of time. Then there are the long hours on their feet and physical challenges of lifting and tending to patients.
But if Maine is to employ enough nurses to care for its aging population in the coming decades, it needs people like Wilson and Agura. Without action, the state will face a critical shortage of nurses by 2025, according to recent estimates.
Not only burnout threatens their ranks. Maine nurses are aging right along with the patients they treat — a coming wave of patients older than 65 will boost demand for nurses just as many are nearing retirement. In 2015, about a third of all registered nurses in Maine were age 55 or older, and younger workers who make up the biggest potential pool of new registered nurses are projected to drop by nearly 5 percent. Many nursing instructors, too, are approaching retirement age.
“What draws me to the profession and what I want to keep continuing with is developing a relationship that’s trusting and really getting to see the whole picture of each patient, as opposed to just what disease they’re being treated for,” Agura said.
That can prove a tall order in a hospital setting. So Agura and Wilson are taking a different tack in their nursing education, by getting clinical experience at Greater Portland Health’s community health centers during their final year of education at the University of New England. Rather than the pressure cooker environment of the ER or ICU, they’re focused on “community nursing” — primary care, preventing chronic diseases and ensuring patients stay or get healthy outside the walls of a hospital.
On a recent day at the Park Avenue clinic, Wilson stood in a narrow exam room, inflating a blood pressure cuff as patient Randy Cramm waited for the results.
“140 over 106,” Wilson said. That’s high. Cramm seemed unsurprised.
Then nurse practitioner Gretchen Speed stepped in, showing Wilson how to evaluate the swelling in Cramm’s legs. Speed suggested to Cramm that he get back on his medications and ordered some basic lab work.
This kind of nursing may not be as riveting as tending to a trauma patient in the emergency room, but Wilson values the ability to help people prevent or manage illness. For those who can’t avoid a hospital stay, community nurses are there to check in after patients are discharged, she said.
“You have to have people who can go out there and help people with their new medication regimens or diabetes education,” she said. “A little half-hour snippet about that when they’re being discharged, I mean they’re already stressed out. The hospital’s a stressful environment. We need more community nurses.”
Under the program, called Upstream and funded by a federal grant, Wilson and Agura spent about four weeks in Greater Portland Health’s clinics, which serve vulnerable populations including immigrants, refugees and the homeless. The students learn to scrounge up medical records and ask patients about their health histories, as well as help administer regular checkups and vaccinations.
They also learn how to communicate with patients and initiate sometimes difficult conversations. But seeing patients repeatedly over time allows for the building of a relationship that makes those conversations easier and ultimately improves their health, the women said.
After graduation, Wilson will head north to Bangor for a residency program at Eastern Maine Medical Center. Agura is still deciding where she’ll land next. Both recognize their transition to the working world may not be smooth, as they continue to learn on the job from seasoned nurses with less time and sometimes willingness to teach them.
“There’s a big learning curve,” Wilson said. “Some nurses are just there to work, and us being new students, we need that education and we want to be able to ask questions. The other staff may not as willing to teach us.”
“We know it’s hard to take on a new graduate and teach them,” Agura added.
Their coursework at UNE has included discussions about how to ease the transition, such as by learning how to identify stress triggers and either avoid or cope with them.
“If that’s five minutes alone in a stairwell, then that’s what it is,” Agura said.
Despite the challenges of the profession, both women see a future for themselves in community nursing.
“It’s such a huge part of nursing,” Agura said. “What’s happening when people leave the hospital?”