August 25, 2021

'Like forgotten soldiers': What the nursing shortage looks like on the front lines

Daily Briefing

    As Covid-19 cases surge across the United States, many hospitals are grappling with shortages of nurses, driven by early retirements, career changes, or moves to bigger hospitals offering higher wages and larger bonuses, Andrew Jacobs reports for the New York Times.

    Sept. 15 webinar: Retain experienced nurses by meeting their workforce needs

    'Exhausted, both physically and emotionally'

    Cyndy O'Brien, an ED nurse at Ocean Springs Hospital in Mississippi, says the health system is "barraged with patients and [has] nowhere to put them"—but not due to a lack of physical hospital space. Nearly 30% of the health system's beds are vacant, but because the system has more than 100 unfilled nursing positions, those rooms must be kept empty, Jacobs reports.

    Since the start of the pandemic, many nurses have opted to either retire early or move away from stressful ED positions to jobs at schools, summer camps, or private doctor's offices.

    Mississippi, for example, has 2,000 fewer RNs than at the start of the year, according to the Mississippi Hospital Association.

    "We're exhausted, both physically and emotionally," O'Brien said.

    "Our nurses are at their wits' end," Lee Bond, CEO of Singing River, a health system that includes Ocean Springs Hospital, said. "They are tired, overburdened, and they feel like forgotten soldiers."

    What nursing shortages mean for patients

    According to hospital executives, state health officials, and medical workers, the shortages are complicating efforts to treat hospitalized coronavirus patients, leading to longer emergency room waiting times and rushed or inadequate care.

    Jacobs notes that EDs and ICUs can't move patients if hospitals don't have enough nurses to treat patients who need less intensive care. That creates a logjam, making it harder to admit new patients. 

    Further, an analysis conducted by the Times found that one in five ICUs are at least 95% capacity, which makes it difficult for providers to maintain standards of care for patients, experts said.

    "When hospitals are understaffed, people die," Patricia Pittman, director of the Health Workforce Research Center at George Washington University, said.

    In a Florida county where hospitals are exceeding their capacity, officials have urged the public "to consider other options" before they call 911. One man in Houston who had six gunshot wounds had to wait a week before he was able to get surgery to repair his shattered shoulder, Jacobs reports.

    "If it's a broken ankle that needs a pin, it's going to have to wait," Maureen Padilla, who oversees nursing at Harris Health in Texas, said. "Our nurses are working so hard, but they can only do so much." According to Jacobs, Harris Health currently has 400 openings for nurses, including 17 that opened up within the past three weeks.

    "You want to be there in someone's moment of need, but when you are in disaster mode and trying to keep your finger on the leak in the dike, you can't give every patient the care they deserve," LouAnn Woodward, the top executive at University of Mississippi Medical Center, said.

    Staffing shortages have led to a bidding war for nurses, with larger hospitals able to offer more enticing wages and bonuses. For example, Texas Emergency Hospital has lost experienced nurses to recruiters offering $20,000 signing bonuses and $140 per hour wages, Jacobs reports. 

    "That's ridiculous money, which gives you a sense of how desperate everyone is," Patti Foster, COO of Texas Emergency's health system, said. By comparison, Texas Emergency pays nurses $43 an hour, plus a $2 stipend for nurses who work the night shift.

    The difficulty of increasing the nurse workforce

    Among the factors driving the shortage are that many of the nation's current nurses are nearing retirement, many more are burned out from the pandemic, and few educators are available to train new nurses, Jacobs reports.

    Currently, the United States graduates around 170,000 nurses a year, but 80,000 qualified applicants were rejected in 2019 because there weren't enough teachers, according to the American Association of Colleges of Nursing.

    "We can't graduate nurses fast enough, but even when they do graduate, they are often not prepared to provide the level of care that's most needed right now," Katie Boston-Leary, director of nursing programs at the American Nurses Association, said.

    Boston-Leary added that new nurses need on-the-job training from more experienced nurses, which adds to already-strained hospital resources.

    And experts are concerned that pandemic burnout will exacerbate the current exodus. Surveys suggest that nurses are feeling increasingly embattled from the current workload and dismayed as EDs fill with unvaccinated patients, Jacobs reports.

    "This simplistic notion that the labor market will just produce the number of nurses we need just isn't true for health care," Pittman said. "Nursing is in crisis, and maybe the pandemic is the straw that will break the camel's back." (Jacobs, New York Times, 8/23)

     

    Advisory Board's take

    The biggest health care crisis of 2021. (And it isn't just about Covid-19.)

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

    We are reaching a point in time in which the mounting workforce shortage is arguably becoming a greater health care crisis than the one caused by Covid-19. The workforce shortage is no longer “looming.” It’s here now, and it’s a crisis.

    This applies to all teams, but especially nurses and other roles providing direct care to patients. It’s easy to blame the pandemic for the current shortage. While it has certainly accelerated and exacerbated the challenge, several contributing factors have been at play for quite some time. An aging population with more acute needs has led to growth in demand for health care services. With higher patient acuity, there’s also a growing demand for more specialized skills. And all of this has been happening as aging nurses are retiring, new job opportunities within health care are expanding, and demand for ancillary staff is outpacing supply.

    The emerging picture is one in which RN vacancies are hitting an all-time high in many geographies amidst an acute supply-demand imbalance of qualified applicants. A snowball effect begins to take shape: health care leaders report an increased time-to-fill for nursing roles and are struggling to maintain adequate staffing levels. They must rely heavily on premium labor, and in many markets, can’t compete without offering large signing bonuses. Tenured staff, frustrated that they themselves aren’t eligible for such bonuses, are exhausted from the relentless workload and many find themselves on a path toward (if not the brink of) burnout. This contributes to rising turnover rates, which leads to more vacancies, and so on. A truly vicious cycle. As if that grim depiction isn’t enough, it seems that Covid-19 is here to stay.

    What’s clear is that leaders will need to confront this challenge differently than cyclical shortages they’ve managed in the past. This will require a mix of tactics you can readily put in place now, and longer-term strategies that focus on more sustainable future roles.

    Near-term tactics include:

    • Double-down on an early-tenure nurse retention strategy;
    • Hardwire emotional support;
    • Run an alumni return campaign;
    • Balance retention bonuses with signing bonuses; and,
    • And go big on flexible work options.

    Long-term tactics include:

    • Commit to team-based staffing models that are led by expert nurses and supported by a mix of more novice RNs and ancillary staff;
    • Build and bolster entry-level nursing and support roles by revisiting baseline compensation;
    • Offer entry-level training programs and create career paths that make entry-level positions more attractive; and,
    • Embrace virtual technology to scale inpatient care delivery, reduce costs, and improve quality.

    Finally, it’s time to redefine the value proposition for bedside care delivery roles. Build a set of commitments that reflect what matters most to your staff and differentiate your brand from the competitors in your market. That likely will mean revisiting compensation, total rewards, factors that support an enjoyable work environment, and new ways to care for the whole employee.

    To learn more about workforce recovery amid the Covid-19 pandemic, check out our take on tangible solutions to implement. Review our take on building flexible nursing workforce, and make sure to check out how telemedicine can help scale nursing expertise and increase inpatient productivity. And finally, as nurses and other health care professionals face the emotional toll of the pandemic, review our resource library of emotional support options.

    Karl Whitemarsh contributed to this article.

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