Nurses are the lifeblood of healthcare, but that blood supply has been at crisis-level for some time. If left untreated, the shortage could have dire consequences for the industry and for patients.
The reasons for the shortage — from inconvenient shift hours to the threat of physical violence from patients angry about government mandates — are as varied and complex as the solutions to the problem. Much of this was happening before the Covid-19 pandemic. That just made it all worse.
If you haven’t needed a nurse recently, consider the longer, post-pandemic wait times it took (and maybe still does take) to get your favorite dish at your favorite restaurant. Staffing shortages in the food service industry are, in some ways, analagous to those experienced in hospitals and clinics across Memphis and the country. But, needless to say, the stakes are so much higher in healthcare. They can be life-threatening.
“What we’re at risk of in our crisis is the lack of care that hospitals exist for,” says Dr. Wendy Likes, dean of the College of Nursing at the University of Tennessee Health Sciences Center (UTHSC), “which is caring for the sickest of the sick.”
Healthcare leaders are fighting to stem the tide. Financial incentives — pay raises, sign-on bonuses, and the like — have been prevalent, especially during the pandemic. But some leaders call these incentives unsustainable. They are looking beyond money to help students choose nursing, help recruit graduates, and keep them nursing in Memphis.
photograph courtesy methodist le bonheur healthcare
Registered nurse Westley King (left) and clinical director Anita Larkin, also a registered nurse, make the rounds at Methodist University Hospital.
Supply, Demand, and Covid-19
Nursing is being stretched at both ends. Demand is heading to a record high. Supply is expected to sink soon and some experts fear it could happen with a roller-coaster drop.
On the demand side, one set of federal data shows the nursing workforce will grow from 3 million in 2019 to 3.3 million in 2029, up 7 percent. Another set of data says 194,500 jobs for nurses will be open each year until at least 2030, an increase of 9 percent needed in the workforce.
Long hours, a dangerous workplace, and a seemingly never-ending line of very sick (and sometimes dying) patients compelled many nurses to search for a door to their next job. But the pandemic alone didn’t cause the nursing shortage.
The demand side will be pushed, largely, by aging Baby Boomers. They’ll need more healthcare as they age, and federal data say the United States now has the highest number of Americans over the age of 65 than at any other time in history. In 2029, the last Baby Boomer will reach retirement age, government data say, resulting in a 73 percent increase from the 41 million recorded in 2011.
On the supply side, about 176,000 nurses — many Baby Boomers themselves — are expected to retire in this decade. A third of U.S. nurses are over the age of 50. They won’t all retire on the same day, of course, but likely within the same decade, taking their decades of experience with them.
In all, the U.S. will likely need almost 400,000 more nurses this decade just to keep up, according to figures from the U.S. Bureau of Labor Statistics. But many say we’re already behind. They say, too, that patients have already felt it, pointing to hours-long encampments in emergency waiting rooms before ever seeing scrubs or a lab coat.
The Great Burnout
photograph courtesy regional one health
Linda Hughlett, chief nursing officer at Regional One Health
Talk to enough nursing veterans and they’ll say there’s always been a nursing shortage. Staffing, in general, deals in human resources, and humans are complex, driven by a litany of desires, life situations, priorities, and more. Covid-19 turned up the heat on all of them.
Linda Hughlett, chief nursing officer at Regional One Health, says about 25 percent of nurses around the country in 2020 just decided they were going to do “something different,” be it travel nursing (more on this later), or quitting nursing entirely for fear of bringing Covid home to their families. Then, 2021 came around.
“I call it The Great Burnout,” Hughlett says. “People were exhausted.”
Long hours, a dangerous workplace, and a seemingly never-ending line of very sick (and sometimes dying) patients compelled many nurses to search for a door to their next job. But the pandemic alone didn’t cause the nursing shortage.
“This is not something that happened because of the pandemic, but certainly the pandemic absolutely exacerbated it,” says Nikki Polis, chief nursing executive with Methodist Le Bonheur Healthcare. “People stayed home to care for their family. Some of them were of the ‘sandwich generation’ with their children and even their parents at home. They were trying to work and [take care of their family] and decided to stop working or, perhaps, working fewer hours per week.”
A late-2021 report from Incredible Health, a national technology-based nursing hiring platform, revealed that 34 percent of the nurses surveyed said they planned to quit their job by the end of 2022. Nearly half of them (44 percent) cited burnout and the job’s high-stress environment for their decision. A smaller portion (27 percent) said they were leaving because of low benefits and pay.
Some nurses, though, said they weren’t leaving the vocation. About 40 percent of those surveyed said they would leave their current job to nurse in a different venue. More than half (58 percent) of those who left their job in 2021 told surveyors they found a job with better pay and that was the motivating factor for leaving.
Many of these, surely, found work as travel nurses. These nurses are connected to staffing agencies that find them work all over the country. They go where the job is, work in a different environment without friends and family around, and are paid handsomely for their trouble.
The Travelers
photograph courtesy methodist le bonheur healthcare
Nikki Polis, chief nursing executive at Methodist Le Bonheur Healthcare.
Travel nurses, simply called “The Travelers” by many, are heralded as entrepreneurs with a sense of adventure. They’re also derided as “mercenaries” in the nurse-shortage battle.
Travel nurses may be a cause of the current nursing shortage. But they are not the cause. And travel nurses are nothing new in the healthcare industry.
For years, they’ve filled a need, helping short-staffed hospitals deliver care on-demand. But collectively, they’ve long been divisive, especially among local nurses, who often earn far less money than travel nurses. They’ve been thorny for administrators, too, who worry that their lack of connection to the community can result in a lower quality of care.
At Regional One Health, staff nurses were offered financial incentives. More money would help with burnout, Hughlett said, but it would also help to salve the sting of the pay disparity between them and the travel nurses brought in to help.
“Here I am with the same credentials, with the same job description, and you’re getting triple — sometimes quadruple — the amount of money I was getting,” Hughlett says of some of the local nurses’ attitudes toward the travel nurses. “So, a lot of them were really disgruntled.”
This attitude bears out nationally in that Incredible Health survey, with the group saying, “Travel nurses remain a flashpoint issue.” Most nurses (77 percent) said they saw more travel nurses in their units last year. Nearly a third of them (32 percent) said this made them feel extremely dissatisfied, ranking pay differences as the number-one reason.
Regarding those salaries, Likes says, “we’ve never seen anything like this” and she does not believe that the rates are sustainable for hospitals going forward. Hughlett says they were brought in at Regional One Health as a Band-Aid to cover Covid’s volume of patients. When they ripped that bandage off, a “greater hemorrhage” of dollars followed, “because we’d gotten [nurses] accustomed to this money.”
But the travel-nurse issue is about more than money. They come and go, creating constantly shifting work environments for local nurses. For this reason and others, Hughlett says, Regional One Health got rid of all of its travel nurses, saying, without them, harm events — hospital jargon for actually making patients feel worse, not better — go down.
“They don’t have to be here with you. They don’t have to see these patients in Kroger or Costco. They’re going on to their next greatest incentive. We’ve got to have a stopping point to say, ‘Enough is enough.’”
This sentiment rose around the country, enough that national healthcare associations have asked Congress for an investigation into possible price gouging of nurse staffing agencies. But Polis, from Methodist, strikes a more hopeful tone about the future of the Travelers.
“I’m crossing my fingers and we’re really looking forward to those people who left to travel to come back,” she says. “I hope they’ve really benefited from the experiences they had in other paces and learn from them [and come back].”
Pivoting
Just as there are myriad reasons nurses leave, healthcare leaders are investing in myriad programs to bring them back. Some of them are complex and some of them are crazy simple. But not all of them involve money.
Hiring fairs seem like a natural tool for recruitment. Polis wants to make them even more effective and the hiring process even easier, especially since those events can be the very first connections the hospital system makes with its future employees. So, they bring a nurse (or someone like them) to do the needed health screenings (for Covid, drugs, and certain contagious diseases) for the job there on the spot, removing a possibly complicated hurdle.
“All of this is about really reinvigorating and reimagining how we do the work we do — always with our patients and families at the forefront of all we do.” — Nikki Polis
Methodist Healthcare keeps its pay and benefits competitive, Polis says. But it also offers health and wellness benefits like yoga classes, sessions on mindfulness, exercise groups, and more. And, she adds, Methodist also continually looks at how to improve the work.
“For example, we’re looking at schedule flexibility, shorter shifts, and programs where, if you’re a working parent, perhaps you’ll only work certain [shifts] seasonally, during the time your children are at school,” Polis says. “Also, how do we streamline processes and use technology? Or, how do we create new positions that we’ll need in the future?
“All of this is about really reinvigorating and reimagining how we do the work we do — always with our patients and families at the forefront of all we do.”
At Regional One Health, Hughlett says they are attracting a growing number of nurses with an innovative nurse residency program that fuels their professional growth. The program offers nurses access to the experiences of the hospital’s diverse patient-care settings, from its Neonatal Intensive Care Unit, to its Burn ICU, and its regionally unmatched Level-1 Trauma Center.
Hughlett says 80 nurses applied in the first selected group last year and the hospital accepted 57. More than 100 applied for the next cohort, she said, so the program is growing.
“Your pipeline is now rebuilt and you’re not spending an exhausted amount of financial resources [noting that Regional One Health is a public, safety-net hospital] to do it,” Hughlett said. “So, it’s people who are not here because of the money. They’re here because they want to build a professional acumen that will enrich their professional growth.”
Both Polis and Hughlett say one simple recruitment and retention tool will help them during the nursing shortage: communication. Through various programs, they have opened their ears to the desires, needs, and concerns of their nurses. Be it surveys or floor visits from administrators, Polis says, “We really upped our game during the pandemic” on communication at Methodist, while Hughlett’s unit was reminded to keep “the main thing [their nursing team], the main thing.”
To grow the nurse workforce in Memphis, UTHSC is at the top of the funnel. Its job is to attract more students to the profession and prepare them for a job afterward at hospitals like Methodist or Regional One Health.
Enrollment at nursing schools is up across the country, according to the latest data from the American Association of Colleges of Nursing. But Likes says enrollment is down in some programs at UTHSC, due in part to Covid fatigue and the lure of those big travel-nurse dollars.
Plans to increase enrollment at UTHSC began before the pandemic, Likes says. Beginning this fall, the school will offer a traditional Bachelor of Science in Nursing (BSN) program. This program will offer two classes of 48 students for a total of 96 each year.
The school is also offering a “fast-paced” baccalaureate program that can prepare students for the nursing workforce in a year. Both programs are buoyed with scholarships from local hospitals to help students pay for tuition in exchange for commitments to work in them after school.
“It’s an amazing opportunity for our students to come out debt-free and for them to get to know their future employers and get acclimated in their culture and their ways of work,” Likes says. “It’s also a great opportunity to anchor them to our community.”
