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

Genevieve Carlton, Ph.D.
Updated January 26, 2024
Edited by
    Vermont wants to strengthen its healthcare workforce. Yet only a fraction of the state’s nursing incentives have reached nurses.
    Vermont state flagCredit: Getty Images

    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.

    [I]t is vital that precious funds be spent in ways that most effectively recruit and retain nurses and that maximize those nurses’ contributions to our health care workforce.”

    The Nursing Shortage in Vermont

    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.

    Vermont Nursing Incentive Programs

    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:

    • Healthcare Workforce Scholarships: Vermont residents attending nursing school qualify for full tuition at in-state public colleges or up to in-state tuition to attend a private or out-of-state college; full tuition at a VT public institution or up to UVM’s in-state tuition at a VT private or out-of-state institution. Recipients agree to work as a nurse for one year in Vermont.
    • Educational Loan Repayment Program for Health Professionals: Nurses working at eligible sites in Vermont qualify for up to $50,000 in loan repayment. The program comes with a 1-2 year service obligation.
    • Nurse Faculty Program: Nursing students training to become nurse faculty and current nurse faculty qualify for full tuition or up to $50,000 in loan repayment. Recipients agree to teach at a Vermont nursing school for each year of their award.
    • Vermont Health Care Professional Loan Repayment Program: Current nurses working at eligible Vermont locations qualify for up to $15,000 in loan repayment. The program comes with a service obligation of one year for each year of loan forgiveness.
    • Psychiatric Mental Health Nurse Practitioner Programs: Vermont’s programs for advanced practice nurses specializing in mental health offer full-tuition scholarships and forgivable loans. Recipients must practice for one year in Vermont for each year of the award.

    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.”

    Vermont State Auditor’s Suggestions for Nursing Incentive Program Improvement

    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.