Patricia Shinn knows demand outstrips supply when it comes to having enough licensed nursing assistants (LNAs) and licensed practical nurses (LPNs) to provide care for the region’s residents.

As chairwoman of the nursing department at River Valley Community College in Claremont, Shinn knows that nursing homes like Maplewood in Westmoreland and developmental education centers like the Cedarcrest Center for Children with Disabilities in Keene rely on those nurses for their day-to-day operations. She knows those facilities are penned in by financial constraints that make more highly qualified registered nurses too expensive to hire, and that the lack of training programs for LNAs and LPNs near Keene has shortened the supply of those nurses.

But Shinn also understands the industry is changing: demand is shifting toward the more time-intensive RN degree — attainable as a two-year associate’s or four-year bachelor’s degree — and students are following. The RN degree is more sought by hospitals because it’s more versatile in clinical environments, and it carries a higher salary, one factor behind the rise in student interest.

So in 2014, as River Valley was facing an uphill climb to regain accreditation for its nursing program, Shinn knew a sacrifice had to be made. The college had lost accreditation — the license given to it by a national nursing commission to legally teach nursing students — the year before due to low National Council Licensure Examination (NCLEX) test scores by graduates, and Shinn was the newly appointed nursing chairwoman tasked with getting the program back on track.

Redesigning the program, Shinn made the call to cut the college’s standalone LPN training course — a one-year commitment — and restructured the curriculum to focus on the two-year or four-year RN degree. The Accreditation Commission for Education in Nursing restored accreditation for the college in July.

Now, River Valley only accepts students who have chosen the RN degree program, which, though more sought by hospitals, is also a bigger commitment in time and money. Students can take their exams to be an LPN after a year and a half into studying for the RN — and potentially work as they complete their degree — but having already paid for the two-year RN degree, there’s little incentive to do so.

With the elimination of the separate one-year LPN program, the pipeline to places like Maplewood, the county nursing home, and Cedarcrest, has all but disappeared, their directors say. Those facilities once had a steady stream of LPN graduates, many of them adult learners with families to feed, according to Maplewood Administrator Kathryn Kindopp; now there isn’t an LPN training program within easy driving distance of Keene.

Assessing the local landscape, Shinn said she knows the situation is less than ideal. But facing the challenges of re-accreditation, the college’s limited staff numbers, and the changing nursing market, she said axing the LPN and LNA programs was the only real option for the college.

“We decided to put all our eggs in the RN basket,” Shinn said. Speaking to the region’s lack of LPNs, she added, “We’re in a dilemma, we really are, and I don’t know how we’re going to work it out.”

“We don’t have people knocking on my door for LNAs (anymore),” Shinn said.

The problems come as fewer Americans are choosing to pursue nursing degrees of any kind, creating a national shortage for hospitals and care facilities.

Locally, River Valley’s RN program is struggling to fill classes, Shinn said. In its 2014 restructuring, the school decided to admit students to its Keene program only every other year. But this fall, after a low applicant pool in Keene she said she could only fill 15 places in a class designed for 16 students. To fill the class even that much, Shinn said she admitted everyone that met minimum standards.

Shinn said she’s received pressure, from legislators and community members, to try and reverse the trend, perhaps by lowering admission standards.

But with the demanding workload of the degree, not to mention the National Council Licensure Examination (NCLEX) required after studies, Shinn doesn’t want to lower standards. Some of her freshmen students this year are already struggling, and with the college’s recent experience with reaccreditation, Shinn says the last thing she wants to do is to open the floodgates wider.

Yet despite the external pressures, Shinn says the program is doing well so far. It has a 70 to 80 percent retention rate for students moving from first to second year — higher than the national average of 50 to 60 percent, she said. That puts it on par with the other six community colleges across the state, according to Shinn.

But the local LPN dilemma, she says, remains.

This story is part of a series of articles outlining the nursing shortage in the Monadnock Region.

Ethan DeWitt can be reached at 352-1234, extension 1439, or edewitt@keenesentinel.com. Follow him on Twitter at @EDeWittKS