State Senator Jen Kiggans (R-Va Beach)

By Ashley Spinks Dugan

There are 41,000 Certified Nursing Assistants (CNAs) currently working in Virginia. And it’s not enough. 

Virginia was already dealing with a fairly severe nursing shortage prior to the pandemic. A 2010 study by the Virginia Nurses Association predicted that by 2020, one in three Virginians would not be able to access the healthcare they needed because of nursing shortages. And in a recent report, the American Association of Colleges of Nursing pointed out that given the United States’ aging population, the demand for healthcare workers will only increase in coming years.  

Long hours and stressful working conditions during this public health crisis have made nursing an even less attractive field. Virginia Sen. Jennifer Kiggans (R-Virginia Beach) has proposed legislation she thinks will help mitigate the shortage. Kiggans is the chief patron of Senate Bill 1147, which would expand eligibility for the Virginia Department of Health’s Mary Marshall Scholarship

The scholarship currently is open to Virginia students training to become Licensed Practical Nurses (LPNs) and Registered Nurses (RNs). Kiggans’ bill would expand eligibility to CNA students. Successful applicants for the scholarship receive up to $2,000 per year while pursuing their degree, in exchange for service in Virginia after graduation. 

Senate Bill 1147 is the product of a work-study completed by the General Assembly last year, Kiggans said. The study examined staffing ratios at long-term care facilities, another issue close to Kiggans’ heart. She said the work-study group met for several weeks over the summer. Meetings lasted three or four hours at a time, she explained and included a wide variety of stakeholders—from nursing advocacy groups to industry and administration representatives. Thirty-five solutions came out of the work-study group, and Kiggans transformed four of them into pieces of legislation for the 2021 session.

Kiggans is a geriatric nursing practitioner by trade, she said, and has seen first-hand the burnout that can result from long-term care facilities being chronically understaffed. “Being a nurse in those facilities, I know…there’s just not enough of us to go around,” Kiggans said. “We don’t have breaks and we’re asked to see so many patients. And we too want to come home and sleep eventually,” she added.

Kiggans explained how providing quality patient care in long-term care facilities is time-intensive work. The residents of such facilities may be elderly or have limited mobility. They need help bathing, eating and walking around. Kiggans said investing this necessary time is difficult when nursing staff is stretched so thin. Most of the time, she said, CNAs in particular are on the frontlines of this work. As a nurse practitioner, Kiggans explained, “I’m not the person answering the call bell.” Rather, it’s a CNA responding to the urgent needs of residents.

Over the past year, Kiggans noted, CNAs have faced even more stress and personal risk while on the job because of the COVID-19 pandemic. About 45% of Virginia’s total deaths from the virus occurred in long-term care facilities. “In that congregate setting, you have so many people in close quarters. Between lack of PPE and staffing shortages and just a frail population, it was kind of a recipe of disaster,” Kiggans explained. She hopes that the one silver lining of a tragic situation is that it highlighted the need for more healthcare professionals. 

Last year and again during the 2021 session, Kiggans proposed legislation to mandate staffing ratios at long-term care facilities. The bill did not progress. Instead, the issue was sent to the Joint Health Commission for further study. Kiggans said she’s already familiar with industry arguments against staffing requirements. Kiggans said during an interview that In addition to not wanting to pay for the extra staff, industry leaders will say “we can’t mandate that facilities have a certain number of staff in place, because there is not enough nurses out there.” 

Kiggans explained that her Senate Bill 1147 is an attempt to take “ten steps back” and address the root of that shortage so that eventually staffing ratios can be mandated without excuses. Kiggans argued that staffing ratios improve the job experience for nurses, lead to better patient care and help residents’ loved ones feel at ease. About 30 other states already have staffing ratio requirements, Kiggans said, and Virginia is not among them. 

“People leave jobs in long-term care because they’re overworked and underpaid,” Kiggans said. She pointed out that to earn a credential as a CNA takes mere months. “It’s definitely something we can pay for at the state level, just as an incentive,” she said of her effort to expand the Mary Marshall Scholarship. Kiggans’ bill passed out of three Senate committees without garnering a single nay vote before passing unanimously before the full chamber. On Feb. 16, it passed the full House and now is headed to Gov. Northam for his signature. 

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