Makenzie Huber, South Dakota Searchlight
Norma Torres Ortiz quit her full-time job at a Huron nursing home in February 2019 to spend her days studying for the national nurse licensure exam.
Her first language isn’t English, it’s Spanish. Originally from Puerto Rico, she still considers English a struggle.
To pass a challenging professional exam in a language she’s still learning, she had to work twice as hard.
It took the 47-year-old two years to pass the test, succeeding in June 2019. Now, she’s a travel nurse contracted with Avera Health and working part time at the Huron Regional Medical Center.
“Every single time I write ‘RN’ by my name, I stop and feel so grateful,” Torres Ortiz said. “I didn’t think I’d ever pass.”
After moving to South Dakota in 2018 in the years after being displaced by Hurricane Maria, Torres Ortiz learned that many other non-English-speaking U.S. citizens, immigrants and refugees with professional nursing backgrounds live in the Huron area.
But like she was initially, they were standing along meatpacking assembly lines or cleaning houses. Studying for the licensure exam, or NCLEX, would mean they’d have to study English harder, take time off work or quit their jobs entirely, she said.
It’s a missed opportunity, Torres Ortiz said, as health care systems in Huron, elsewhere in South Dakota and across the country suffer a nursing shortage. South Dakota is projected to have one of the highest nursing shortages in the county by 2030. There are 11 nursing vacancies at Huron Regional Medical Center currently.
So Torres Ortiz led an effort to help non-English speaking nurses study for the exam. It turned into the state’s first registered nursing apprenticeship through Huron Regional Medical Center. The program was approved by the state in February.
Apprenticeship serves as alternative to international hiring program
Larger health care systems like Sanford, Avera and Monument are building international nursing programs, recruiting and hiring nurses through work visas. International nurses must also pass the NCLEX to work in the state.
Avera Health has commitments from more than 170 international nurses, with one starting with the hospital system this year and another six planning to start working before the end of the year. Monument has hired international nurses since 2017. Though the program in western South Dakota has employed about 30 nurses a year, the program has dwindled to less than 10 due to federal visa backlogs. Sanford employs more than 700 internationally trained nurses across its five-state footprint, with plans to hire another 300 in the coming year or two.
Employing international nurses is a “long-term strategy” to stabilize the health care workforce, said Erica DeBoer, system vice president and chief nursing officer with Sanford.
“With an aging workforce and population, there’s truly not enough individuals to help care for all the patients that need our support,” DeBoer said.
Smaller systems like Huron can’t afford to hire large numbers of international nurses through an agency, said Brooke Sydow, program manager for the health system. The study group and apprenticeship program allows the system to tap into a market beyond its traditional university and technical college pipeline.
And apprenticeship programs aren’t new to the health system. Sydow said the system launched a practical nursing apprenticeship to build its workforce in 2018. A licensed practice nurse provides basic nursing care to patients and works under the supervision of registered nurses.
Reflecting the diversity of the Huron community
Apprentices start the new program by taking a medical language course for English language learners, enrolling in the licensing exam preparation class and training at the Huron hospital alongside a veteran nurse. There are five students in the group, which started in May last year, though Torres Ortiz hopes to see more join.
The classes alone cost the hospital about $1,350 per person. Sydow expects the total cost per apprentice will vary between $25,000 and $50,000, depending on how long they shadow another staff member. Sydow plans to cover all, or nearly all, expenses for apprentices through the hospital or with state funding, to financially support apprentices while they train so they can quit their other jobs and focus on their education. She plans to hire three apprentices in the first round.
It’s worth the cost, Sydow said, because the health care system is investing in Huron’s increasingly diverse community.
Beadle County is 68% white, 15% Hispanic or Latino and 12% Asian, according to 2023 estimates from the U.S. Census Bureau. The county has the highest percentage of Hispanic or Latino residents in the state.
That diversity is largely due to refugees from the Karen ethnic group, originally from Myanmar (formerly Burma), who moved to Huron starting in 2006, initially to work at a turkey plant. A wave of Hispanic immigrants moved to the county since 2000, also attracted by food processing and manufacturing plants.
“We’re trying to make our workforce reflect our community population,” Sydow said. “So that’s a big piece of it: helping the community feel more connected and at home, so we have practitioners, providers and nurses who are the same as them.”
Torres Ortiz would like to help more Puerto Ricans fill immediate nursing needs in South Dakota.
Before she moved to Florida in 2017 after being displaced by Hurricane Maria, she earned her bachelor’s degree in nursing in Puerto Rico. But she wasn’t able to find a job because there were too few positions for the number of nurses at that time, she said. Instead, she cleaned houses and businesses. She followed her son to South Dakota after he started working in the area.
“When you post a nursing job in Puerto Rico, you could get 20 applications in an hour,” Torres Ortiz said. “Here in Huron, you wait months to find and hire someone.”