CHARLESTON, W.Va. — With one of the lowest workforce participation rates in the country, West Virginia needs jobs.

On a constant search and offering sign-on bonuses of tens of thousands of dollars, West Virginia’s hospitals desperately need nurses.

It’s getting the two needs to align that’s the real trick for potential employees, medical facilities and the colleges where prospective nurses go to be trained.

“We have a significant nursing shortage in West Virginia,” said Sarah Tucker, the state’s chancellor for Community and Technical College Education. “It’s a national problem, but we have a big one for sure.”

WVU Medicine, at the beginning of November, began offering $10,000 sign-on bonuses in an effort to hire 200 nurses in 150 days. The medical system met the goal but is still offering the bonuses and continues the drive to hire nurses.

In Huntington, St. Mary’s Medical Center tries to keep up its supply of nurses by providing free tuition to an associated School of Nursing for all full- and part-time employees.

Similarly, Charleston Area Medical Center has a direct partnership with BridgeValley Community and Technical College to cover the cost of training in exchange for a work commitment at the hospital.

The Thomas Health System, which includes Thomas and St. Francis hospitals in the Kanawha Valley, employs 402 total nurses. From 2014 to now, 487 nurses have left their jobs, meaning that some nursing positions have turned over multiple times, a spokeswoman for the health system said.

Nursing shortages are not confined to West Virginia. The Wall Street Journal reported last fall that many nurses who held onto their jobs during the economic downturn are now feeling the financial confidence to retire or cut back hours. That has led to renewed demand for nurses all across the country.

Pikeville Medical Center in Kentucky has stretched its recruitment efforts across the West Virginia border with advertisements and recruitment fairs offering a $25,000 signing bonus and free housing if you live 75 miles away from the city.

But in West Virginia, the gap between the demand for and the supply of nurses — generally well-paying jobs — is particularly significant and expensive.

A casual glance at the latest number of registered nurses in West Virginia shows growth, according to state government data gathered from the most recent annual report published by the West Virginia Board of Examiners for Registered Professional Nurses.

But that’s not the full story.

Because the shortage of locally-produced nurses is so profound, state medical providers have to dip into a pool of traveling nurses who are contracted through companies. The medical facilities are thankful for the help, but the traveling nurses — because of demand and the need to be flexible — come at a greater cost than nurses produced in-state.

This adds significant costs to the health care delivery system at a time when costs for health care are going up and dollars are scarce.

Data gathered from the nursing board report shows West Virginia issued more than 2,700 RN licenses during fiscal 2016. A little more than a third are from West Virginia, more than a third from bordering states and the remainder from non-bordering states. It’s reasonable to assume that some of the nurses from bordering states aren’t necessarily from right on the border.

Of the total number of registered nurses in West Virginia, most — 19,746 — are home grown. Contiguous states contribute heavily to the number of registered nurses here: Ohio, 2,810; Pennsylvania, 1,546; Kentucky, 749; Virginia, 654; and Maryland, 450.

But other several non-border states contribute significant numbers to West Virginia’s overall nursing supply:North Carolina, 319; New York, 260; Florida, 233; Georgia, 185; Texas, 125; and Colorado, 102.

For a state struggling with economic growth, this reveals a missed opportunity. West Virginia residents are losing out on attractive employment opportunities while health care providers turn to out-of-state RNs who work short term at high costs.

So here’s the big question: Can West Virginia bridge the gap between the number of nurses it needs while helping to improve employment opportunities for state residents?

Tucker, the chancellor for West Virginia’s community and technical colleges, started noticing the shortage because it’s her job to monitor what sectors of West Virginia’s job markets need workers and match that to where students are being directed.

“Our institutions, I believe all of them, are at capacity in their nursing degrees,” Tucker said. “They are teaching as many nursing students as they are allowed to teach. The problem is, the need is more significant than the number of nurses they are allowed to teach.”

She said the state’s nursing educators need to get together soon with the hospitals, nursing homes and other medical facilities that need nurses to brainstorm ways to address the shortage.

“We all need to sit down and talk about this problem collectively and think about what each of us can do to produce the nurses the state needs.”

To Tucker’s mind, there are several factors at play:

— Nurses have to be placed in clinical rotations at medical centers, but there are only so many spots available.

— Nursing is highly-regulated, and that limits the number of nursing graduates that state institutions may produce. “You don’t want someone who isn’t well-trained being your nurse,” Tucker said. So determinations are made about how many nurses community colleges may produce. The number of qualified faculty members and the physical space and its capacity are limiting factors.

— There are significant qualifications for educators who are allowed to teach nurses. “Nurses make a whole lot more money practicing nursing than they do teaching nursing,” Tucker said.

Tucker has a few solutions in mind. She proposes more clinical opportunities for nurses to complete their degrees. She also suggests even greater cooperation between schools and hospitals. Part of that would be encouraging hospitals to let their experienced nurses keep their jobs but also devote some time to educating nursing students.

“If we could come up with an opportunity for partnerships like that across the state with hospitals and health service organizations to get qualified nursing faculty into our colleges and pay them something even remotely competitive and, therefore, worth their time that would be very beneficial,” Tucker said.

During the past decade, the number of registered nurse graduates in West Virginia peaked in 2009 at 1,216.

By 2016, the number of RN graduates was 1,025.

West Virginia schools are graduating fewer nurses during a period of increased demand.

As baby boomers reach retirement age, the nursing shortage has been compounded, said Pamela Alderman, dean of the Bert Bradford School of Health Sciences at the University of Charleston. Alderman is also chairwoman of the West Virginia Center for Nursing board.

Pamela Alderman

“We have a critical shortage of nurses, not only in West Virginia but throughout the United States,” Alderman said. “I’m hearing of a critical need for nurses. There’s sufficient numbers of schools. The problem we have is finding qualified faculty. Without qualified faculty, we cannot increase the numbers.”

Alderman agreed that when nurses reach the requirements necessary to, potentially, become a teacher they could make much more money by actually practicing nursing.

“It still doesn’t compare, though, to a nurse practitioner who the first year is going out and making a six-figure salary,” Alderman said. “You have to love teaching. It’s a wonderful career. It’s a wonderful field.”

Nursing schools are trying to give prospective students flexibility by offering more classes at night or on weekends, she said.

“We’re having to look at things differently,” she said. “We have a weekend program. Every other week, the students come to class and then are taught hybrid, online courses. We’re seeing three times the number of applicants for that program. Students can work. It’s teaching a nontraditional student market.

“Fairmont State is looking at the same thing. It’s either going to start in the spring semester or in the fall. A couple of other schools, I think, are investigating it as well. We’ve had really good results with that program.”

St. Mary’s Medical Center in Huntington acknowledges a need for nurses and has worked to strengthen its partnership with St. Marys School of Nursing. That includes the free tuition incentive for all full- and part-time employees.

“St. Marys has responded by devoting more resources to retaining and recruiting,” said Angela Henderson-Bentley, the public relations manager.

In the Kanawha Valley, the Thomas Health System has seen nursing turnover coincide with the downturn in the coal industry, said Paige Johnson, spokeswoman for the system.

“The last part of 2015 and really 2016, that’s when we really started to notice something going on,” Johnson said. “When you lose a major industry in the state, it’s not just affecting one person because there’s so many families involved.”

Thomas Health System has launched a social media campaign to let potential nursing employees know jobs are available. That includes video spotlights on current nurses who talk about why they enjoy where they work and what they do.

“It’s been a challenge, but we’re facing it,” Johnson said.

She noted Thomas Health System’s nursing turnover rate of 487 since 2014. She said the hospital has filled 304 of the positions and still has current openings.

“It’s definitely turnover. So you can see the issues. I’m sure that’s not atypical of other hospitals in the state. That’s what we’re seeing.”

Thomas, like other medical systems, fills some of its needs by hiring traveling nurses through a contracting company. These nurses come at a premium because the need is so great that they can command it and because they are willing to travel. Thomas Health System currently has 33 travel nurses at Thomas Hospital and five at St. Francis, Johnson said.

WVU Medicine also fills needs by hiring travel nurses, said Leann Cerimele, chief human resources officer.

“We’ve had to use highly-qualified, trained traveling nurses at different periods of time,” Cerimele said.

“If you do run short on staff, our main priority is to ensure we do provide high-qualified patient care. We will do that if there is a need. We ensure that the individuals that are working with us are highly-skilled and trained as well. I’m glad there are companies that provide that type of service. It’s truly needed.”

Traveling nurses aren’t ideal for West Virginia’s medical institutions because they drive up costs and eventually result in more turnover. But they fill a need temporarily and present a lifestyle that is desirable for some in the nursing field.

“There are a lot of really good nurses that travel that work for temporary agencies, and they do it because they enjoy moving around,” Cerimele said. “They enjoy seeing different cities, different towns and they like the change of pace. They just like to do that. I think it’s good there’s an opportunity for people who like to do that type of work to have some ability to move around.”

Leann Cerimele

WVU Medicine has gone through such expansion recently, it has been hard to keep up with the need for nurses, Cerimele said. She said systems like WVU Medicine are having to develop plans to ensure a pipeline of nurses who can be ready when those in the current workforce start to retire.

“The area is kind of drying up because, especially within WVU Medicine, there’s been a lot of expansion over the last 12 months,” she said. “We’ve recruited a lot of nurses from the state of West Virginia to work here but also a lot from outside the state to fill roles and needs we have.

“Because we’ve had to expand our search area, I believe our surrounding communities are drying out. Not that there aren’t nurses, but they’re working. We also have an aging workforce, so we have to think about that.”

WVU Hospitals, which is part of WVU Medicine, hired more than 2,000 new employees in 2016 — and more than 500 of those were nurses, Cerimele said. Of the total number of hires, 800 employees were for new positions to the organization.

The organization’s drive to hire 200 nurses in 150 days, aided by $10,000 sign-on bonuses, was a success. But the search for additional nurses continues.

“We really have some strong partnerships with area schools, obviously the university; we partner with them to help train nursing students,” Cerimele said. “We do need to ensure that we are working on continuing to create that pipeline. There is going to be a continued need for nurses.

“It actually starts with the high schools, talking to students who are high school-aged. They need to know there is a really good career path in nursing.”