The University of Maryland Medical System, based in Baltimore, employs about 9,300 nurses. Amid a growing nurse shortage in the state, the health system is rethinking how it trains the next generation of nurses, according to Peggy Norton-Rosko, DNP, RN, senior vice president and system chief nurse executive.
A 2021 report from the Maryland Hospital Association projected that by 2035, the state will have 55,100 registered nurses but a need for 68,900 — a 13,800 deficit. In the next five years, the shortfall is expected to reach 12,100.
To address these staffing challenges and the decline in clinical placements, UMMS leaders targeted some of the most common factors attributed to the growing nurse shortage: nurses leaving bedside roles and a shortage of nursing school faculty.
“What we all wanted to make sure of is that we could educate as many nurses as possible, as fast as possible, in the best way possible,” Dr. Norton-Rosko said.
In spring 2022, the system launched the Academy of Clinical Essentials. The program embeds nursing students in immersive, semester-long clinical rotations. Each student cohort is paired with a bedside nurse instructor for a 12-hour hospital shift each week — a shift length that mirrors real-world hospital work. The clinical instructors work within their own units — med-surgical telemetry, intensive care or emergency — and are the nurses on record for their cohort’s patient assignment.
While traditional clinical placements last six to eight hours, the ACE model’s 12-hour format allows students to receive an unparalleled “immersive” experience that prepares them for hospital shifts, according to Dr. Norton-Rosko.
The benefits extend to instructors as well. They receive a $10-per-hour premium for each ACE shift, more predictable schedules and enhanced professional development opportunities. The system’s retention rate for nurses is 84%, but among nurse clinical instructors, this rate is 95%.
“One nurse turning over, leaving an organization can cost $60,000 to $80,000 to replace that nurse,” Dr. Norton-Rosko said, adding that with the increased retention rate among ACE clinical instructors, “we definitely have returned that investment over time.”
Over three years, the program has trained more than 1,700 nursing students through 355 clinical instructors in collaboration with 11 nursing schools. One-third of participating students have been hired by UMMS after graduation. The system plans to add 100 more instructors in fall 2025.
UMMS has invested $200,000 into ACE so far, which Dr. Norton-Rosko said has generated $2 million in in-kind support for the system’s nursing school partners.
“If we could do this across the country, it would go a long way in helping us eat away at the nursing shortage,” Dr. Norton-Rosko said.
