Daily Briefing

Why so many nurses are leaving amid delta—and how you can keep them

As Covid-19 cases rise across the country, hospitals are struggling to treat patients amid a shortage of nurses and other frontline workers—and worrying they may lose even more workers as surges continue, the Associated Press/NPR reports.

States struggle amid surges and staff shortages

According to AP/NPR, Arkansas, Florida, Louisiana, and Oregon each have more Covid-19 hospitalizations now than at any other point during the pandemic. And other states, including Texas and Hawaii, are also struggling under a surge of new cases and hospitalizations.

Amid this surge in Covid-19 cases, ambulance services in hot-spot states are struggling to transfer patients to hospitals, in part because so many hospitals are short-staffed on nurses and other frontline providers, AP/NPR reports.

For instance, in Florida, Pinellas County administrator Barry Burton said some patients may wait up to an hour inside ambulances before they can be admitted into hospitals since so many beds are already occupied by Covid-19 patients. Before Covid-19, that wait was usually just 15 minutes.

Similarly, in Louisiana, Joe Kanter, the state's chief public health officer, said one patient who suffered a heart attack had to be transferred between six hospitals before an ED in New Orleans had room to take him in. "It's a real dire situation," he said. "There's just not enough qualified staff in the state right now to care for all these patients."

And in a hospital ED in Honolulu, patients have had to wait on gurneys for more than 24 hours because of a lack of staff to open more beds, Patrick Switzer, a nurse, said.

"Somebody who's been sitting in the [ED] for 30 hours is miserable," Switzer said. He also said working felt like being in a "constant state of anxiety, knowing you don't have the tools that you need to take care of your patients because we're stretched so thin."

Hospitals are losing nurses to out-of-state opportunities, burnout

According to AP/NPR, two issues are driving many of these nursing shortages amid the Covid-19 surge: pandemic burnout and lucrative out-of-state offers. Hospitals are trying to address these issues with new retention strategies.

For instance, Julie Staub, EVP of Jackson Memorial Health System in Miami, said her health system has been losing nurses to staffing agencies and hospitals in other states that offer them double and triple the salary. "You are seeing folks chase the dollars," Staub said. "If they have the flexibility to pick up and go somewhere else and live for a week, months, whatever and make more money, it is a very enticing thing to do. I think every health care system is facing that."

To retain more nurses, Staub said the system's hospitals are offering retention bonuses to nurses who stay for a set amount of time and paying nurses who work additional 12-hour shifts the usual time-and-a-half overtime, plus $500 per shift. However, even with these incentives, the health system has still had to turn to staffing agencies to fill openings.

Some nurses—many of whom are already fatigued from working throughout the pandemic—are also leaving the profession completely due to burnout.

According to AP/NPR, providers are dealing not only with an extraordinarily high number of Covid-19 patients—with the country reporting a daily average of more than 116,000 new coronavirus infections and 50,000 hospitalizations, averages not seen since the winter. This means providers are not only dealing with an extraordinarily high number of Covid-19 patients, but also seeing more non-Covid patients now for accidents, postponed surgeries, or other situations.

"Anecdotally, I'm seeing more and more nurses say, 'I'm leaving, I've had enough,'" Gerard Brogan, director of nursing practice with National Nurses United, said of the increasing burden on nurses. "'The risk to me and my family is just too much.'"

For instance, Michelle Thomas, an RN and ED manager in Arizona, resigned three weeks ago, saying that she was unsure if she would ever return to nursing after her experiences during the pandemic. "There was never a time that we could just kind of take a breath," Thomas said. "I hit that point ... I can't do this anymore. I'm so just tapped out."

"It's ... incredibly taxing and traumatizing," she said. (Associated Press/NPR, 8/10)

Get Advisory Board's take

We’ve reached the tipping point—how do organizations move forward? See our 3 keys.

Katherine-VirkstisBy Katherine Virkstis, Managing Director and Senior Research Partner


Nursing shortages and burnout are not new—they were challenges long before the pandemic began. I've discussed why nurses are increasingly burned out and leaving the profession. But this NPR story highlights an unfortunate reality: after nearly 18 months of shouldering the weight of the Covid-19 crisis, the nursing workforce has now reached a tipping point as health systems navigate yet another surge in hospitalizations. How did we reach this tipping point? And more importantly, how can organizations begin to address the nursing shortage they are facing today?

How we reached the tipping point

  • Health systems haven’t been immune to the labor shortages and economic forces affecting nearly every industry in the wake of the pandemic.
  • There are ripple effects across the care continuum. If post-acute settings don’t have the necessary staff (including RNs, LPNs/LVNs, and CNAs), it creates a bottleneck for patients who would otherwise be discharged. This adds to the already high demand on hospitals.
  • The supply of experienced RNs (especially in specialty areas like ED, OR, L&D, and ICU) is declining. Some of this is related to burnout, but that is not the sole contributor.
  • RNs in the workforce are seeking new paths: advanced practice degrees, ambulatory care roles with more flexibility and a better work-life balance, or specialty roles that provide higher pay.
  • Regional dynamics are an important factor. Data and projections that indicated a sufficient supply of RNs at the national level have little to no bearing on local market dynamics that point to a vastly different supply outlook. 

3 key ways organizations can address the nursing shortage

It won’t be enough to rely on traditional staffing methods to get through this crisis. You will need to think differently and explore innovative solutions. Most importantly, be open to change.

1. Revisit conversations about compensation.

Start by conducting a compensation analysis for your market post-onset of the pandemic. Even though retention bonuses and premium labor are costly, they may be necessary and prudent to maintain safe staffing and ensure the stability of the practice environment in the short term. Medium to long-term reliance, however, could be a sign that you’ll also need to think about increasing base compensation. Either way, treat any casual labor or travel nurses in your organization as potential candidates to hire if your contract allows. In our research, we’ve detailed ways for nursing leaders to still find cost savings in labor budgets.

2. Get serious about flexible work arrangements that attract and retain talent.

Flexibility is about allowing employees to alter their schedules, and sometimes, location, to better tailor work to their own individual needs.

Consider allowing staff to leave for a travel contract but maintain their employment status with your organization to facilitate their return upon completion of their contract. If your system has sufficient scale, consider developing an in-house travel staffing resource pool that competes with traditional agencies on compensation.

Another way to offer flexibility involved reinventing your inpatient float pool. Four options include the following: short-shift float pools, ambulatory float pools, system-wide float pools, and internal travel agencies.

Lastly, offer different types of shifts and roles at your organization. Short-shift roles are one example. The following is a starter list of nursing short-shift roles:

  • A designated nurse to manage admission, discharge, and transfer paperwork for the unit;
  • Nurses working 10-hour shifts can take a patient assignment in a procedural area;
  • Emergency department nurse, since most EDs offer shorter shifts to begin with and have more extreme fluctuations in volume; and,
  • A nurse that serves as an extra pair of hands for another RN with a higher or more complex patient assignment.

3. Build out nursing support staff.

(Re)invest in CNA pipeline programs, and target staff seeking upward career mobility, such as staff working in environmental or food services. In most markets, part of the solution will likely include reintroducing LPNs/LVNs and team-based care models. Set your teams up for success so that all care team members are working at the top of their license. And as we continue deeper into the world of telehealth, consider utilizing technology-enabled staffing solutions, such as virtual expert RNs. As you build out nursing support staff, you may run into the experience-complexity gap challenge. Take a look at our research for strategies and best practices to close the gap.

To help you, we’ve compiled a few resources that will guide your strategy to not only address nursing shortage and burnout but to seek innovative ways forward. You can review our recommended 4 strategies to build a flexible nursing workforce and our 4 options to reinvent the float pool. We’ve also designed a toolkit that includes best practices, resources, and tools to better match staffing to patient demand and reduce labor costs while safeguarding nursing personnel.

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