THIRD WORLD USA
'We have critical nursing shortages across the country,' doctor warns
The U.S. nursing industry, already strained by the ongoing pandemic, is struggling with staffing as the country continues to deal with a wave of hospitalizations and deaths caused by the Omicron version of the coronavirus.
“I still think we have critical nursing shortages across the country,” Dr. Elizabeth Clayborne, an emergency physician at the University of Maryland Capital Region Medical Center, said on Yahoo Finance Live (video above). “And that is something that needs to be addressed not just in Maryland, but in several states. And I see that being a problem for several months to come.”
Maryland Governor Larry Hogan implemented drive-through COVID testing, which helped lessen the number of patients going to emergency departments to get tested. But actions like these can only do so much for an industry that still doesn't have enough nurses to go around.
“The main issue that we’re battling in my facility and several hospitals across the country is just a staffing shortage,” Clayborne said. “My family and I actually just recently recovered from COVID. So it’s not an uncommon story that a lot of our facilities that are trying to take care of COVID patients are struggling because they do not have the staff to deal with the numbers that are still coming in.”
And while hospitalizations related to COVID-19 are ebbing nationally, states — especially those with lower-than-average vaccination rates — saw major surges in hospitalizations during the winter. ICUs are currently at 30% or less capacity in all but five states.
For hospitals lacking the staff and ICU capacity to treat the influx of patients, the labor crunch can have dire consequences for all kinds of patients.
"For every additional patient a nurse cares for, a patient's risk of dying increases by as much as 7%," a New Jersey-based nurse, who requested anonymity to speak candidly, told Yahoo Finance. "The average person may not think this is important, but when you have an unexpected emergency and end up in the ER, how many other patients do you want your nurse to have? 2 or 6?"
In September 2021, the American Nurses Association penned a letter to Health and Human Services Secretary Xavier Becerra calling on the administration to "declare a national nurse staffing crisis and take immediate steps to develop and implement both short- and long-term solutions."
A study by the University of St. Augustine for Health Sciences noted that "1.2 million new registered nurses (RNs) will be needed by 2030 to address the current shortage." The shortage, which was brewing prior to the pandemic, involved factors including rising demand driven by aging Baby Boomers, retirement among nurses, lack of staff in certain areas of the country, hospital conditions, burnout, and more.
“This isn’t the first time we’ve had a nursing shortage in the U.S.,” Donna Havens, Connelly Endowed dean and professor at the M. Louise Fitzpatrick College of Nursing at Villanova University, told Yahoo Finance. “It seems to be cyclical, maybe every 8-10 years. So yet again, we’re facing a major nursing shortage but a real issue I believe might be COVID because the nurses are getting sick. They’re retiring anyhow, but they’re sick. They don’t want to do this anymore. They’re feeling they’re too old to do this.”
'Shortage of nurses willing to work in unsafe conditions'
Zenei Cortez, a nurse based out of California and president of National Nurses United, described the situation as a staffing crisis and placed the responsibility on hospitals.
“There is not a shortage crisis but there is a staffing crisis,” Cortez told Yahoo Finance. “There was no real serious nursing staffing crisis before COVID-19, but as a hospital industry, it unfortunately created a staffing crisis, which isn’t new and it has existed for many decades. I would say what they call a shortage of nurses is a shortage of nurses willing to work in unsafe working conditions.”
Recent guidance from the CDC has only worsened the problem. According to new guidelines, health care workers who are fully vaccinated and test positive can return to the workplace if they’re asymptomatic or have had mild/moderate symptoms for 5 days with or without a negative test. Though the likely intention was to help with staffing issues, it was met with poor reception from health care workers worried about working in potentially dangerous environments.
The NJ-based nurse lambasted the CDC policy as "very unwise."
"Infection control policies will not even let nurses drink water at their desk during their 12-hour shift, but it's okay for a co-worker to be COVID-positive and eat next to me in the break room?" the nurse said. "There is no separate break room for those who are COVID-positive. Should these nurses be not allowed to eat or drink on their 12-hour shift? I find it extremely dangerous and, frankly, offensive that the Center for Disease Control cares so little about controlling the spread of COVID in health care workers."
Cortez described the current circumstances with the Omicron variant as similar to when the pandemic first hit the U.S. in early 2020 when hospitals were short on PPE and staff found that there weren't enough of them to go around to help their patients.
“We were fighting for staffing," she said. "We were fighting for a lot just to stay alive in the workplace and keep our patients safe. So it’s somewhat like the same thing is happening again."
During the first wave of the virus, health care workers across the country found themselves in less than desired work settings. PPE was in short supply, meaning that some hospital workers had to come up with their own solutions, like using trash bags as makeshift protective wear.
“I hate to use the word ‘danger,’ but it’s like reliving what it was like at the beginning of the pandemic,” Cortez said. “Unfortunately, the hospital industry did not prepare. They were just using I would say bandaid solutions, not really planning ahead. So it’s really distressing that they would do this and not really prepare for what’s coming up ahead.”
Staffing ratios aren't federally mandated, but National Nurses United has lobbied for that to change. The union has proposed legislation that would keep the ratio at one nurse for every two patients in an ICU and one nurse for every three patients in an emergency room.
"Hospitals are unwilling to give raises to nurses to retain them and instead hire travel nurses to fill short-term contracts," the NJ-based nurse said. "However, a travel nurse will never be able to provide the same level of care that a staff nurse that knows the hospital and providers can. As a staff nurse, it is extremely disheartening to work next to someone who is doing the exact same job as you but making 3 to 4 times as much as you. And you as the staff nurse have to train the travel nurse and orient them to the facility, as well as help them on a day-to-day basis because they do not know the facility as well as you do. Hospital administrators are putting profits before patient safety, and patients will suffer as a result."
The nurse added that "the only thing keeping most staff nurses at their jobs is that they are close to retirement or they do not yet have enough experience to become a travel nurse. This means that the hospital spends thousands of dollars training new graduate nurses just to lose them to travel contracts as soon as that nurse has enough experience to leave. It makes no fiscal sense, and it is a huge burden on the staff nurses to constantly be training new nurses just to have them leave, whether they be new grads or travelers."
'You've got an aging nursing workforce'
Demographics of the workforce are also an important factor.
As many nurses age out of the industry, some become the patients themselves, meaning they are even more people that need to be taken care of.
“Nurses are getting older,” Havens, the nursing professor at Villanova, told Yahoo Finance. “I think the stats tell us that the average nurse taking care of patients in a hospital is about 50 years of age. And you think about the work that they do — the lifting, the pulling the weekends, the nights, the triple shifts. You’ve got an aging nursing workforce, many of whom had planned on retiring now when COVID hit.”
According to the University of St. Augustine for Health Sciences, "between 2000 and 2018, the average age of employed registered nurses increased from 42.7 to 47.9 years old. And nearly half (47.5%) of all RNs are now over the age of 50."
There are reasons for optimism in addressing the shortage: Havens said that in her program that she oversees, there’s “overwhelming interest” in entering nursing.
“We are seeing more applicants than we ever have in the history of the College of Nursing at Villanova,” she said. “We had 1,800 applicants last year for 100 spots. We’re seeing people really want to be nurses — not just those right out of high school but those who already hold a degree in another field are coming back to become nurses.”
Unfortunately, though, there is also a shortage of nursing faculty to teach this growing field of prospective nurses as many are aging out as well.
“Last year, I believe the number was 80,000 qualified applicants who wanted to be nurses were turned away because universities across the country didn’t have enough faculty to admit them and teach them,” Havens said. “The faculty are getting older.”
She stressed that the government needs to step in to help programs incentivize more people entering the educational field of nursing, like paying faculty more, helping to cover the cost of education, enhance laboratories, and even pay professors to teach in the clinical setting.
“What research has told us all over the years is the way you organize nurses in an organization to deliver care is really important,” Havens said.
Adriana Belmonte is a reporter and editor covering politics and health care policy for Yahoo Finance. You can follow her on Twitter @adrianambells and reach her at adriana@yahoofinance.com.
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