BISMARCK — North Dakota will give health care facilities money if they can attract nurses who will work in the state for four years.

The state Department of Commerce announced last week it opened applications for its nonresident nursing employment recruitment program, an initiative aimed at attracting and retaining nurses amid a shortage. Health care facilities will receive up to $4,000 for each nurse relocated to North Dakota, a news release said.

“We have had a chronic shortage of nurses in North Dakota for at least 15 years,” said state Sen. David Hogue, R-Minot. “In our school system, we cannot grow the amount of nurses that we need organically in North Dakota. So that tells me we have to get them from out of state.”

In an amendment to the commerce department’s 2019-21 budget, Hogue proposed adding $500,000 to create the program.

Other states also offer incentives to combat the nationwide nursing shortage, Hogue said, adding the program could be renewed.

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“We have to out-compete them,” he said.

Growing need

State leaders and health care experts investigated the nursing shortage and how to best address it. A task force convened by Gov. Doug Burgum shortly after he took office in 2017 found a gap in the number of nurses licensed in North Dakota versus the need.

“With projected increases in population throughout the state, ... nursing jobs are expected to continue to grow through 2026, resulting in a need to increase licensed nursing staff" by over 200 per year, a report from the task force said.

North Dakota had 14.25 registered nurses per 1,000 people in 2016, more than the national average of 9.45 per 1,000, according to data from the North Dakota Center for Nursing. But 19 counties had fewer nurses than the national average, the center said.

Many of those low-concentration counties were in western North Dakota. Sioux County had three nurses per 1,000 residents, the lowest rate in the state, according to the center. Slope County had almost four and McKenzie County had five.

More populated counties typically had heavier concentrations of registered nurses in 2016. Cass County reported almost 18 nurses per 1,000 residents, second to Burleigh and Adams counties — each had 20 nurses per 1,000, the center said.

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Baby boomers are at the age where they need more care, which translates into a higher need for nurses, said Tessa Johnson, board president for both the center and the North Dakota Nurses Association. Fewer nurses means less access to health care, and the state needs to make sure the medical field has safe staffing levels.

"I think there is not one of us that lives in a rural area or in a larger community in the state that isn't touched by health care in some way," she said.

Complex problem

There are a number of ways to attract nurses to North Dakota, but a grant would do more to bring in and retain nurses than spending money on education and scholarships, Hogue said.

“It does us no good to educate all those (North Dakota State University) nurses and then over half of them go to Minnesota because they are getting paid more,” he said during a Senate Appropriations Committee hearing in March.

The North Dakota Constitution has an anti-gift provision that says state and political subdivisions cannot "loan or give its credit or make donations to or in aid of any individual, association or corporation except for reasonable support of the poor." Burgum previously told The Forum offering "straight cash" incentives to bring people to North Dakota may result in a legal challenge.

Hogue told The Forum a gift implies the state gives a person something without the expectation of getting something in return. Nurses who are attracted through the program must be licensed in North Dakota and have to work in the state for at least four years. They also must live in North Dakota or bordering states.

Those stipulations "take it out of the realm of being a gift,” he said.