Kim Hensley, the chief operating officer at Middletown’s Atrium Medical Center, said a few primary challenges existed in the industry before COVID moved in — there were already too few nurses, and many of them were nearing retirement.
“If you go back, prior to the pandemic, nursing staffing was already experiencing some challenges,” Hensley said. “A lot of the nursing staff are aging. They’re in the time where they’re thinking about retirement.”
Any surge of disease would have added to the challenge, but the particular attributes of COVID — its easy and vast spread, the danger presented to older folks, the acuity of the disease for those who needed hospitalized, and the strenuousness of actually providing that care — left many older nurses considering retirement.
“When we started to see COVID patients — these patients are very sick. So, the work became very challenging, even more challenging than it is already,” Hensley said. “We saw a lot of the nurses retire that were thinking about retiring maybe in a couple years. They decided, ‘Well, I think I’m just gonna retire now.’”
As Hensley tells it, this phenomenon wasn’t limited to older nurses. Over the course of the pandemic, many looked for work in other areas of healthcare, or left the profession entirely for myriad reasons.
Kettering Health Network Director of Talent Doug Houghton said the network had staff leave for jobs that were less risky, or for companies outside of the healthcare industry that upped their pay during the pandemic, like Amazon.
The pandemic also shut down schools, Houghton added, which forced many parents who could previously work while their kids were in school to either stay home completely or work fewer hours.
“[At Atrium] we’re seeing retirements, we’re seeing nurses go into other fields, we’re seeing nurses go into other arenas of nursing as well to get away from the bedside,” Hensley said.
When there’s no way for the hospital to diminish the demand for care, and in a time where extenuating circumstances brings in more and more acutely ill patients, a nurse leaving the workforce without a ready-made replacement means that the demanded amount of work falls on the rest of the staff.
That additional workload could lead to burnout, a universal aspect of COVID healthcare that perpetuated itself through staffing shortages, which Houghton said Kettering Health had to manage.
“I think any community that experienced COVID had clinicians that experienced burnout,” Houghton said.
Hensley explained that, at Atrium, “We had the room for the patients and we had the capacity, [but] our staffing became even more limited.”
In order to retain existing staff and lessen each individual staff member’s workload, hospitals are incentivized to look elsewhere for their staffing.
A quick fix in years-past were staffing agencies that could connect travel nurses with hospitals in need of additional staff. These travel nurses, historically, would sign 13-week contracts and tended not to stay long past that before they moved to their next workplace.
“When they have shortages, particularly if they need an immediate fix or an immediate solution, there are third party staffing firms that provide temporary, contracted staff,” Houghton said. “That could be for nursing, it could be respiratory therapy, imaging, etcetera.”
COVID-19 deeply changed the way these traveling nurses were used, Houghton and Hensley explained.
For starters, not every place got hit with COVID-19 all at the same time, or to the same degree, but just about every place did eventually get hit. This meant that, at the start, when dense cities needed additional staff to care for the sick, staffing agencies would pull registered nurses from across state lines — which often meant regional hospitals lost some staff, Houghton explained. The problem, though, was that these were temporary contracts for a relatively permanent — and spreading — problem.
“A real practical example: New York was a hot spot. You had nurses coming from Ohio, Kentucky, Indiana — all over the US — to go help in New York and other hot spots,” Houghton said. “So, that left a deficit in staffing in all those places.”
In turn, once COVID levels back home reached a point where more staff was needed at regional hospitals, healthcare providers like Atrium and Kettering Health had to quickly turn to those same staffing agencies to provide supplemental staffing. And, in turn once again, staff would come from areas where COVID wasn’t so bad just yet.
“It was essentially shifting the workforce around the US through those travel contacts,” Houghton said.
“At the beginning of the pandemic we saw a lot of travelers come on board and we saw our own staff leave for travel agencies,” Hensley said. At one point, she said, Atrium’s rate of travel nurses was “sky high,” but has since come back down in a seesaw pattern.
“They go up and then they come down a little bit, and then we have this surge and this need again and then those rates go up again,” Hensley said. “That’s what’s really pulling those nurses.”
Houghton said most contracted clinicians slotted in right away and had the experience to do the job well; Hensley said traveling nurses have skewed younger over the course of the pandemic. Both said the nature of the job presents issues with fitting temporary folks into teams that can sometimes have years of experience working together.
“I think when you talk to clinicians and nurses who work on a unit, that’s typically what you hear as a challenge,” Houghton said.
“The other aspect is: You’re thankful that you have an experienced clinician working by your side when the employed staff have taken travel contracts and are working in, let’s say, a hot spot like New York; or they’ve decided — because of working short staffed during the pandemic — that they are going to work an administrative role,” Houghton said.
Even with traveling nurses and other contracted clinicians, maintaining adequate staffing levels remained difficult.
“We tried to get enough travelers to at least have probably a 75%-80% staffing level at all times, but sometimes that was a struggle as well,” Hensley said. And, it was harder still to get specialty nurses who could perform specific, difficult roles like critical and advanced care.
Contracted clinicians come at much higher costs to the hospitals. Houghton said it’s always been that way, but COVID-19 exacerbated the problem as demand for the contracted clinicians grew.
“I think the experience we had was similar to others, in that there were definitely times in specific places where there was shorter staffing than normal, even with travel nurses,” Houghton said. He explained it was a balance for Kettering Health to be cost efficient while also adequately staffing.
“At the end of the day, you don’t want to be short-staffed and don’t necessarily want to rely on travel nurses, just because the expense, depending on the volume, is just not sustainable for healthcare organizations,” Houghton said.
Hensley said the cost of travel nurses was “at least double” the cost of permanent staff members.
“It’s been a huge expense on our organization,” Hensley said. “That’s an expense across the country that everyone is dealing with.”
As hospitals look to continue trending back to a relative normal, officials like Hensley and Houghton are figuring out what that looks like for staffing, too, and are left unsure about when, or if, staffing will return to its pre-pandemic norm.
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