This entry in the Nonprofit Journal Project is part of a series of articles about how Michigan health care professionals are responding to the state's health care workforce shortage. It is made possible with funding from the Michigan Health Endowment Fund.

A 2023 National Council of State Boards of Nursing study reported that 100,000 registered nurses left the workforce during the past two years due to stress, burnout, and retirements. Another 610,388 reported an intent to leave by 2027. And, according to a University of Michigan study released in April 2023, about 39% of Michigan’s nurses intended to leave their jobs in the next year. By November 2023, Brian Peters of the Michigan Health and Hospital Association reported that 8,500 open positions for nurses existed. He said, “The reality is we are in the midst of not just a Michigan nursing shortage but a national nursing shortage.”

That shortage is not only impacting hospitals. The state’s Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs), which cater to low-income, rural, and other underserved populations, are also feeling the sting. To address this shortage and encourage more new nurses to pursue work at FQHCs and RHCs, the Michigan Primary Care Association (MPCA) is collaborating with nine of Michigan’s state universities to provide nursing students with opportunities to train in such clinics.

Organizers aim to launch the program this fall — and recruit students who will find the experience rewarding and decide to start their careers at one of Michigan’s FQHCs or RHCs. We recently spoke with Amber Desgranges, MPCA’s key partnerships and initiatives officer, and Rachel Ruddock, MPCA's director of workforce and health professions training, about the program.

Q: How will the new project facilitate partnerships between universities, FQHCs, and RHCs?

Ruddock: This project is designed to bring together state universities, Federally Qualified Health Centers, and Rural Health Clinics to provide clinical experiences and internships for undergraduate nursing students. We know that undergraduate nursing students are not typically offered much exposure in the outpatient ambulatory primary care environment. This is an opportunity to give these nursing students exposure to a nursing work environment that they would not receive otherwise. That’s what's bringing all of the universities, the FQHCs, the RHCs, as well as MPCA and other partner organizations, together.

Q: What kinds of training opportunities will nursing students have in underserved areas?

Ruddock: That's still being developed in collaboration with the universities. The universities are guiding what opportunities the students will have because we have to work within the lines of accreditation. The universities are determining what opportunities they are able to do and what responsibilities they're able to have. Also, these are undergraduate nursing students, so these students do not yet have nursing licenses. So we do have to work within the confines of accreditation, licensing, et cetera. It is going to be designed to be a community clinical rotation. The students are going to be exposed to the inner workings of a Federally Qualified Health Center and the services that are provided to patients and to the community in that outpatient primary care setting.
 
Q: How does this experience differ from the hospital rotations undergraduate nurses usually take part in?

Ruddock: All nursing students are given the opportunity to have clinical experiences in hospitals. That acute-care experience is built into their curriculum and built into their rotations. But not all nursing students are given the opportunity to have clinical experiences at Federally Qualified Health Centers or Rural Health Clinics. The experience itself is very different. Federally Qualified Health Centers are typically open Monday through Friday, 8 a.m. to 5 p.m. Some do have evening hours or weekend hours. It’s typically a very different schedule than, say, the 12-hour shifts working in a hospital. The type of care that is provided is different. FQHCs are focused on primary care, mental behavioral health care, and oral health care. Some health centers have specialty services like podiatry and optometry. That is exposure that the students might typically not receive within a hospital setting.

Desgranges: One of the recruitment points that Federally Qualified Health Centers have is that there is a greater opportunity for work-life balance. Not to say that there aren't stressful moments at health centers. In the industry as a whole, there's stress. However, this does lend itself to greater work-life balance just by the pure schedule, hours, and work that is done.

Q: Sixty clinical and 30 internship opportunities will be made available. Which universities will the students come from? What areas of the state are the FQHCs and RHCs located in?

Ruddock: There are 15 state universities in Michigan. Nine out of those 15 indicated interest in participating in this opportunity. These are geographically located all throughout the state, from the Upper Peninsula to Detroit and everything in between. Participating universities include Central Michigan University, Eastern Michigan University, Ferris State University, Lake Superior State University, Michigan Technical University, Saginaw Valley State University, University of Michigan – Flint, Wayne State University, and Michigan State University.

Q: How are nursing workforce shortages currently impacting Michigan’s FQHCs and RHCs?

Ruddock: The nursing workforce shortage is well documented. It certainly is challenging for our health centers in the areas of workload and burnout. When there's not enough nurses to do the work, that is obviously going to spill over to others, the ones who are there. That can lead to stress over workload that can lead to burnout. This solution will be recruiting and bringing in newer nurses, giving them an exposure to Federally Qualified Health Centers and Rural Health Clinics so they may want to go and work there one day and be part of that nursing workforce. Opportunities at health centers and Rural Health Clinics do exist, and they are great opportunities. I don't think many students know about the opportunities in these as they do about hospitals. This is that opportunity not just to get them there working with the community, but also helping them expand their scope of what nursing could be outside of a hospital system.

Desgranges: The nursing opportunities that we have available at these health centers are very different from the nursing opportunities that are available within a hospital. We have lots of nurses that work as care managers, working with patients with very high needs in terms of social determinants of health. They are practicing nursing in a different way.
 
Ruddock: Federally Qualified Health Centers have been around since the civil rights movement, but they are often the best kept secret. [We are] letting students know that this is a great career opportunity. Working at a Federally Qualified Health Center or Rural Health Clinic can be a really fulfilling, great career. On the flip side of that, the program will certainly help the health centers that are experiencing shortages, need help with recruiting, and need help with retaining nurses. This exposure will help them bring in more nurses and grow their nursing workforce.

Estelle Slootmaker is a working writer focusing on journalism, book editing, communications, poetry, and children's books. You can contact her at Estelle.Slootmaker@gmail.com or www.constellations.biz.

Photos courtesy of the subjects.