Licensing delays are worsening Minnesota's nurse shortage

Lily Marcelius is ready to do her part to address Minnesota's nursing shortage, having completed training in October and accepted a job in an intensive care unit at HCMC in Minneapolis.

If only the Minnesota Board of Nursing would clear her to take the licensing exam.

Marcelius and others have had their nursing careers delayed by months because of a backlog at the nursing board. Hospital leaders complained about the delays as they recruited thousands of replacement nurses from other states for a three-day nursing strike in September and for a second walkout that was averted at the last moment in December.

A month later, the delays persist. The nursing board's website includes a red-lettered warning that unprecedented application numbers have slowed its processing time. In addition to new nurses, the board is flooded with temporary permit applications from contract nurses who travel to Minnesota to cover worsening staffing gaps in hospitals.

"The current licensing process is simply too slow," said Lou Ann Olson, a spokesperson for the Minnesota Hospital Association, which is seeking reforms to help fill more than 10,000 vacant nursing and other health care positions.

Marcelius is running out of money while she waits and is working in retail at the Mall of America. Had she known it would take months rather than weeks, she could have found a job in health care and added more relevant experience.

HCMC has been patient, but the 27-year-old Minnetonka woman said she is nervous: "I'm worried they're going to pull the offer. I also feel bad because their nurses are expecting [me] to be there to help. I should be on the floor by now, and I'm not."

Kimberly Miller, the nursing board's executive director, did not reply to requests to discuss the delays. But the board this week in its state budget request stated that it "is not able to meet consumer and applicant expectations for timely licensure processing."

While the strike fueled a doubling of requests from licensed nurses in other states, the board expects that number will remain high as hospitals shuffle in help. Gov. Tim Walz has proposed an additional $237,000 per year in spending — with funding from licensing fees — to add three staff members to the board in 2024 and 2025.

A nursing shortage has been looming in Minnesota because veteran nurses in the baby boomer generation have reached retirement age. The pandemic exacerbated the problem. Nurses burned out from the stress of overcrowded hospitals and an increase in agitated patients and visitors that resulted in more assault-related injuries. The most recent survey data from the Minnesota Department of Employment and Economic Development showed that more than 8% of nursing positions were vacant at the end of 2021.

Before clearing someone to take the licensing exam, the nursing board must receive a fee, conduct a criminal background check, and receive proof that a nurse received a degree from an accredited school.

The hospital association wants to expedite that process by allowing nursing students to apply for licensure in their final semesters of study. The association also backs legislation to extend the length of temporary permits for travel nurses from 60 days to 90.

Laef Johnson graduated with Marcelius from the University of Wisconsin-Oshkosh, which offers an accelerated program of online and in-person learning to turn college graduates into nurses in one year.

Johnson grew nervous as weeks went by without his license, because he is scheduled to start Feb. 6 as an emergency room nurse at North Memorial Health in Robbinsdale. After numerous calls to the board and hours on hold, the former paramedic got approval a week ago to take his exam. He learned Monday that he passed.

"The exam was challenging but I felt that it went fairly well," he said. "Things weren't quite as fresh as they were when I graduated."

Johnson said the process is frustrating and random. One classmate convinced a licenser on the phone to look up her paperwork and clear her for the test; others are told to wait.

Marcelius said it's hard to know whether to call frequently and risk annoying the licensing agency that holds her future in its hands. An unexpected turn in her career after college led her to work in a nursing home.

"I fell into it and realized I do have a passion for caring for people," she said. "I want to help people and give them the care they deserve."