November 11, 2020

How are hospitals tackling nurse shortages? $15K signing bonuses, 'microbreaks,' and more.

Daily Briefing

    As new coronavirus infection and hospitalizations rates surge across the country, hospitals—particularly those in rural areas—are scrambling to find and employ the number of nurses necessary to provide care. 

    Background

    Although there has been an increase in the national number of nurses in the past decade, some hospitals have reported a nursing shortage even before the epidemic hit—a shortage that during the epidemic is being exacerbated by burnout and exposure risk among nursing staff, according to the Associated Press.

    The rates of burnout, in particular, aren't surprising to experts, who cite not only the mental toll nurses are facing amid the epidemic, but the epidemic has presented new difficulties for younger and older nurses. According to AP, many nurses who are trained to provide acute care are over 50 years old, which means they are at an increased risk if they contract Covid-19, the disease caused by the coronavirus, while younger nurses frequently have family—including young children—whom they worry about.

    Karen Donelan, a professor of U.S. health policy at Brandeis University's Heller School for Social Policy and Management, explained, "Who can actually work and who feels safe working are limited by family obligations to protect their own health. All of those things have been factors."

    How hospitals are appealing to nurses

    Hospitals are deploying several tactics to meet the growing demand for nurses, such as training nurses to provide care in areas where they have little experience, scaling back services to make sure that a sufficient number of nurses are available to care for critically ill patients, and employing short-term travel nurses to cover gaps in their workforce.

    For instance, in Wisconsin, Aspirus Health Care is experiencing a surge in Covid-19 hospitalizations that's forced the hospital to quadruple the number of beds available to such patients. To meet demand in hot spots as they emerge, the health system is shifting around nurses between departments and facilities according to Ruth Risley-Gray, SVP and CNO at Aspirus—but those tactics aren't enough to meet demand.

    According to Risley-Gray, the health system needs to hire outside help in part because some nurses have either become infected themselves or been exposed during the latest wave, which—for Aspirus—"came with a vengeance" in August. At one point in October, 215 nurses had to isolate after either presenting with symptoms or being exposed to people who had tested positive, Risley-Gray said.

    As a result of these challenges, the health system is offering nurses who have at least one year's experience a $15,000 signing bonus, as well as employing contract nurses via private staffing companies. In addition, the system is trying to combat nurses' emotional and physical fatigue by providing microbreaks and quiet spaces where nurses can have a moment to themselves when they feel overwhelmed.

    Aspirus so far has hired 18 nurses via outside agencies, but the health system said it may have to hire more if the surge continues. "This has been a challenge, and we're been pleading with the community members to protect themselves and others" by wearing masks and maintaining a social distance from others, Risley-Gray said.  

    Meanwhile, in North Dakota, Tim Blasl, president of the North Dakota Hospital Association, said hospitals may have to scale back scheduled procedures and file for federal aid to hire additional nurses if the current surge gets worse. And in Montana, HHS has secured five nursing teams, each with a minimum of five medical professionals per team, to provide care for at least 30 days at several hospitals in the eastern and central parts of the state, when Covid-19 can caused staffing shortages.

    In Texas, Gov. Greg Abbott (R) recently said that he was deploying 75 nurses and respiratory therapists to El Paso, a city currently experiencing a surge, while Wisconsin Gov. Tony Evers has issued emergency orders making it easier for retired nurses to return to work and for nurses from other states to provide care in his state.

    On a broad level, April Hansen, EVP at Aya Healthcare, which recruits and assigns travel nurses, said because the epidemic is surging nationwide, hospitals around the country are competing for the same pool of nurses—and offering pay that ranges between $1,500 per week to more than $5,000 per week. According to Hansen, Aya Healthcare currently has more than 20,000 openings for contract nurses.

    According to Hansen, demand for nursing services has more than doubled since the epidemic's start, when New York and New Jersey had the greatest need. In comparison, amid the current surge, with cases across the country, placing nurses to meet demand is "like a giant game of whack-a-mole," Hansen said (Carbajal, Becker's Hospital Review, 11/2; Webber, Associated Press, 11/2).

     

    Advisory Board's take

    3 ways to mitigate Covid-19'simpact on the workforce 

    By Lauren Rewers, Senior Analyst

    Pre-pandemic, the Health Resources and Services Administration projected the United States would have an excess of nurses by 2030. This excess was not universally enjoyed, as employers in seven states and many rural markets struggled with localized shortages. But all in all, the efforts of nursing leaders to increase supply over the past few decades seemed to be paying off.

    Today, the question of whether most organizations will have enough nurses is a terrifying unknown. It's one most keenly felt by those experiencing the double whammy of localized shortages and Covid-19 surges. But it's too early to say for sure if the pandemic will trigger a nationwide shortage, for a few reasons:

    • First, we don't have reliable data on Covid-related turnover. There's reason to believe turnover might increase—particularly among high-risk employees or working mothers hit hard by Covid childcare responsibilities. This turnover would be a heavy blow to supply in itself. But it would also exacerbate an ongoing shortage of nursing bedside experience caused by baby boomer retirements.
    • Second, disrupted nursing student clinical rotations and licensure will likely create staffing gaps in the short term. Long-term, enrollment numbers are less sure. Those who would have entered the profession may put off enrollment for fear of their own safety. Or a shaky economy could increase interest in a profession expected to have steady growth.

    This uncertainty leaves many nursing leaders wondering how to insulate their organizations against future supply shortages. The good news is that there are three strategies leaders can start today to help mitigate Covid-19's impact on the workforce, regardless of supply:

    • Bolster emotional support to retain nurses at all levels. The best bet for improving engagement and retaining nurses over the long haul is to focus on emotional support. We recommend that organizations provide targeted support for three types of emotionally charged scenarios that staff nurses are likely to encounter: trauma and grief, moral distress, and compassion fatigue.
    • Prevent an experience-complexity chasm. As their workforce loses nursing experience, leaders can prevent an impact on quality in two ways: dramatically slowing down the first year of practice for new graduate RNs, and better leveraging the existing skills, expertise and experience of the RNs they already have.
    • Move toward a more flexible RN workforce. RNs are already flexing where, how, and when they work to respond to Covid-19 surges. Leaders can build on that momentum by permanently embedding some elements of this flexibility into nursing practice. Doing so will not only help hospitals respond to uncertain demand—it'll create flexible roles that better meet the needs of their nurses.

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