Vermont State Auditor Urges the State to Use or Lose $22 Million in Nursing Incentives

Vermont appropriated $22.6 million for its nursing incentive programs in 2023. And yet by late November, the state had only spent $2.6 million.

That’s the conclusion of a Dec. 2023 report from Vermont State Auditor Doug Hoffer. While the state legislature has made a significant investment in its nursing workforce, only a fraction of the funds have reached nurses.

Many states face a persistent nursing shortage. On a national level, the country has 9.22 registered nurses per 1,000 people in 2022, according to NurseJournal research.

Vermont reports slightly higher numbers with 10.71 RNs per 1,000 people. In a state with a population of 647,000, that translates to under 7,000 RNs, leaving hospitals short-staffed across the state.

Hospitals have had to rely on travel nurses to meet staffing needs. Yet travel nurses cost around twice as much as permanent staff. Vermont’s 14 hospitals spent an estimated $357 million on travel staff from 2021-2023, according to the state auditor’s report.

In addition to the high monetary cost, depending on temporary travel nurses also harms retention efforts for permanent staff due to the higher salaries of travel nurses. By reducing spending on travel nurses, hospitals can invest more in the recruitment and retention of local Vermont nurses.

Similarly, by encouraging nursing students and nurses to take advantage of the state’s nursing incentive programs, Vermont can reduce its reliance on travel nurses.

The nursing incentive programs in Vermont represent a significant investment in the state’s healthcare workforce. In 2023, the state legislature appropriated $22.6 million to meet the state’s nursing workforce needs, according to the report. These programs provide financial support for nursing students, advanced practice nurses, current nurses, and nurse faculty.

Most of the programs come with a service obligation. Generally, for every year of scholarship or loan forgiveness, recipients agree to work for one year in Vermont.

The state’s nursing incentive programs include:

From covering full tuition to forgiving up to $50,000 in loans, these programs provide substantial support to nurses. However, the state only awarded $11.2 million of funds through these programs in 2023, while spending just $2.6 million, according to the report.

“What we have are a bunch of programs that are not well coordinated. They have virtually no performance measures of any value,” Hoffer told WCAX. “They’re not consistent. They don’t reflect what’s going on in the hospitals.”

In his Dec. 2023 report, Vermont State Auditor Doug Hoffer recommended new policies and procedures to improve the state’s nursing incentive programs.

Hoffer suggested clearer reporting and assessment procedures, including creating performance metrics to measure the success of each program. The report recommended standardizing the service obligation, performance measures, and reporting requirements across programs. Hoffer also suggested coordinating with hospitals that offer recruitment and retention programs to bolster their efforts.

Nurses can play a role in improving the programs. Hoffer recommended contacting Vermont nurses who have left the state or practice in a neighboring state. These nurses could provide vital information to improve Vermont’s recruitment efforts.

Encouraging nursing students to study in Vermont benefits nurses and the state. Vermont nursing students “learn about the state, they make friends, they put down roots,” Hoffer told WCAX, which means they are more likely to stay in Vermont. By investing in the state’s nursing incentive programs, Vermont hopes to invest in its future.