If the nursing shortage is bad now, chances are it’s going to get much worse.
“Hospitals were having difficulty finding nurses to fill positions before the pandemic,” notes Kendra McMillan, MPH, RN, Senior Policy Advisor for Nursing Practice and Work Environment at the American Nurses Association (ANA). “In fact, according to the US Bureau of Labor Statistics, 175,900 RN openings were projected each year through 2029, when we factor in nurses leaving the workforce for reasons such as retirement.Unfortunately, the pandemic’s demand on the healthcare system has further exacerbated a long-standing projection that has burdened our nursing workforce.”
Doctors and nurses are overworked, thanks to chronic staffing shortages made worse by a pandemic that drove thousands from the field, writes The New York Times. On the West Coast, “the nursing shortage affecting the whole nation is impacting the Northwest region as well,” according to an article in The Bulletin (headquartered in Bend, OR), quoting a Kaiser spokeswoman.
“Finding experienced nurses has always been a challenge in Southern California,” according to Cherie Fox, RN, MSN, CCRN-K, Executive Director Acute Care Services, Providence Mission Hospital, Mission Viejo, California. “Following the COVID-19 pandemic, we are seeing nurses retire, move out of the area, and reduce hours, all of which has amplified our staffing challenge just a bit.” Fox led the initial team that opened the COVID ICU and telemetry units during the pandemic. She recently coauthored a paper in Critical Care Nurse detailing Providence Mission Hospital’s COVID response.
And a recent study found that nurses are reporting large declines in their mental health. More alarming, nurses, especially those who are younger, are feeling less committed to the profession.
Multiple factors, coupled with the pandemic, are influencing the nursing shortage, according to McMillan. These include burnout, work environment stress, workplace violence, an aging workforce that is retiring, and an aging population with comorbidities.
To address the growing crisis, hospitals are pursuing multiple solutions, including hiring travel nurses. “I’ve talked to several emergency departments across the country that are having those issues where they’re having to have temporary nurses come in to the emergency department,” says Ron Kraus, MSN, RN, EMT, CEN, TCRN, ACNS-BC, Emergency Nurses Association president and Emergency Department Clinical Nurse Specialist at Indiana University Health Methodist Hospital.
Providence Mission Hospital has also made use of travel nurses and offers a referral bonus to current caregivers. Fox notes that nurses are taking time off while others are getting ready for vacations. “While the time off is needed and approved, it does add further to dependence on traveling nurses.”
“Hiring bonuses, tuition reimbursement, and loan repayment are examples of incentives offered to nurses to boost recruitment and retention efforts,” notes the ANA’s McMillan. But, she adds, hiring bonuses don’t support efforts to retain nurses who are already employed in the organization.
“Nurses are facing longer shifts and are working more consecutive shifts to meet the persistent demands on our healthcare system” notes McMillan. The nurses who remain are burned out physically, mentally, and emotionally.”
The ENA, notes Kraus, is focusing on helping hospitals create a healthy work environment. Having a healthy work environment that empowers nurses, while supporting their needs, helps to overcome fatigue and moral distress, notes Fox.
Calling it an “amazing profession,” Kraus would encourage individuals to enter the profession. For a lot of us, it was very trying, but it’s a calling,” he says.
For a change of pace, this Nurse of the Week was on the receiving side of a rescue—and, instead of driving her car to work, she ended up riding there in an ambulance. The off-duty nurses who (in these stories) usually play the role of impromptu first responders were occupied elsewhere that evening, but fortunately, two strangers pulled over and filled in—which is a relief, since sometimes, nurses need to be saved too.
It happened in the blink of an eye. Pendleton, Indiana RN Ericka Cosby was driving to her evening shift, her mind probably on the pending handover. As she rode over a bump in the rural road, the jolt dislodged her mobile phone, which slid to the floor. Without thinking, she reached down to retrieve it before it could become lost under the seats. As Cosby started to lower her arm, her mind cut in and arrested her movement, but it was already too late.
Describing her ordeal to a local news station, Cosby said, “I didn’t even make it to pick it up before I was heading straight into the guardrail. The police officer said I rode down the guardrail for about 10 feet and flipped down the hill two to three times—not sure how many—but I landed upside down, half in the creek and half on the grass.” When her car finally came to a rest, Cosby found herself upside-down and trapped by an inflated airbag. Being tumbled about inside the auto as it fell 10 feet and flipped repeatedly did not leave her unscathed: she broke her nose, fractured an orbital, and suffered various contusions; the airbag did its part by burning her in various places while it trapped her. Cosby was also phoneless, of course, and as luck would have it, she could not reach the button to activate her On-Star service.
A local nurse is thanking two strangers she credits with saving her life after she was involved in a violent crash. https://t.co/PPjsDnnzGp
The injured nurse was able to reach the horn, and—to attract attention on the quiet country road—she pressed down and honked repeatedly at intervals. The upside-down car’s lights were still on, and smoke began to creep out from under the hood. Now, though, luck started turning her way. Two passersby—a woman and a man—noticed the smoke and lights and pulled their cars over to offer help. The efforts of Cosby’s Samaritans, however, were hampered by difficulties posed by unfastening her seatbelt as she hung inside the overturned car. “I was very afraid if I unbuckled the seat belt, I was just going to land straight on my face… because I couldn’t bend my knees to get them out anywhere [and] there was glass,” Cosby recalled.
The rescuers were determined, though, and the male bystander, she says, “actually crawled into my car on all fours and acted like a tabletop for me. That man didn’t know me, and he literally let me fall onto him.” As the man held her, the unknown woman quickly unlatched the seatbelt, and the two pulled her out of the car. Then—in one of those Hollywood moments that no one wants to pop up in real life—while they helped her away from the auto, it burst into flames (Really. Take another look at that Twitter photo.).
Now recovering in the hospital, Cosby expects to be discharged soon (so she can go to work in her preferred fashion). She told local reporters that the two strangers were her “guardian angels.” The male angel, Robert Wilson, said, “I don’t feel like I did anything that someone else wouldn’t do. I was brought up to help people.”
For more details on this story, go to Fox 59 in Indiana.
Every year, tens of millions of Americans avoid the flu vaccine. During the 2019-2020 flu season, fewer than half of U.S. adults got the shot.
The Latino population is more reluctant than most other groups to get the flu vaccine and often pays a high price with their health. An analysis by the Centers for Disease Control and Prevention of 10 flu seasons showed the Latino community had the third highest flu-related hospitalization rates of any demographic group.
Here are a few reasons: Latinos worry about whether the shot is safe. They wonder if it works. They question whether it’s actually needed. Confidence in the vaccine is a major predictor of influenza vaccination among Latina women.
Getting a flu shot not only stops the spread of the flu. It might also be an indicator of who is willing to get a COVID-19 vaccine – and conversely, who is not, and why. So it is more important than ever to understand why large groups of people are reluctant to get vaccinated – and what might be done to earn their trust. We think our experience at a clinic in rural Indiana might shed some light on this important issue.
Historically Low Rates, Despite High Rewards
Reports from the 2019-2020 influenza season say that 38% of Latino adults were immunized, compared to 41% of Blacks, 42% of American Indian or Alaska Natives, 52% of Asians and 53% of whites. However, when children are included in the calculation rates, numbers for Latinos go up; Latino children are typically immunized with greater frequency than their parents.
Those receiving the shot have fewer lost work and school days. They reduce the risk of seeking medical intervention by 40% to 60%. That includes visits to crowded emergency rooms. In communities with known influenza virus circulation, vaccinations decreased pediatric hospitalizations by 41%. For adults, vaccines reduce the likelihood of admission to an intensive care unit by 82%.
Those with the lowest influenza vaccine rates are also disproportionately affected by COVID-19. Since both illnesses show some of the same symptoms, testing is needed to distinguish one disease from the other. This will divert health care personnel from other tasks. Hospitals already crowded with COVID-19 patients will be asked to make room for those with severe influenza.
This is particularly important this year, as health care providers scramble to prevent the possible “twindemics” of influenza and COVID-19. Even during normal times, the Latino community may be at increased risk of exposure to the flu virus; many have jobs in crowded work environments, like meat packing plants, warehouses and agriculture enterprises.
The Family Health Clinic in Monon, Indiana, a rural community in White County, Indiana, has worked to build trust with the local Latino population by taking some relatively simple steps. The clinic, recognized by the U.S. government as a place that provides high-quality care to a traditionally underserved population, is staffed by nurse practitioners. Partnering with the Purdue University School of Nursing, the Family Health Clinic serves a clientele that is 52% Latino.
One important part of gaining trust was in making sure the staff were bilingual. Other strategies the clinic used to establish relationships with the Latino population included sponsoring community activities and inviting Latino participation on the clinic board. Perhaps of most importance was generating a reputation for providing a secure, affordable and respectful place for excellent health care in a setting where staff listened to and responded to questions about vaccines.
Brenda Andrade is one of the many who recently received her influenza shot there. She has five children, ranging in age from 4 months to 9 years. Andrade was willing to receive a shot because she wanted to “make sure her family is protected.”
Two more local residents, Juan and Elidia Miranda, also made the flu shot a priority. “We’ve gotten colds every so often, but not influenza,” said Juan Miranda. After talking with clinic staff, they realized the benefits of staying healthy for themselves and their families.
Community health centers like the Monon clinic have long been a trusted source of care for those who don’t otherwise have health care access. They are more than equipped to handle the reasons often given by Latinos as to why they don’t get the shot. But will this willingness to receive the flu vaccine from a trusted source translate to receiving the COVID-19 vaccine when it’s available?
The answer is likely yes. A history of having taken other vaccines is a significant predictor of future behavior, as is a vaccine recommendation from one’s trusted health care provider. Monon clinic staff have already initiated discussion of the rationale for being vaccinated, sharing available safety and efficacy data with patients.
In a year in which so many nurses displayed bravery, suffered hardships, and shone in countless ways, DailyNurse might easily have featured a “Nurse of the Day” instead of a Nurse of the Week.
Nurses have always gone the extra mile to communicate with patients and make them feel more comfortable and cared for, and we all know former patients who were so inspired by their nurses that they decided to enter the profession themselves. As 2020 raised the curtain on the Year of the Nurse, though, no one could have anticipated it would be a watershed year in which nurses became global icons of hope and courage.
Whether You’re a Hero, or Merely Awesome, Take a Bow…
The public has long admired nurses, but this year, the world has watched nurses brave the pandemic to work in seemingly impossible conditions, act as stand-ins for patients’ absent families, and leave home to speed to the relief of overwhelmed hospitals all over the US.
Nonetheless, many of our 2020 Nurses of the Week (NotW) eschewed the word “hero.” If you glance at remarks from our 2020 Nurses of the Week, you might note that while they take pride in their work, few sound like they are ready to accessorize their mask with a Superman cape. Naturally, they are happy to see their work recognized, but nurses constantly go out of their way to make patients feel less frightened and alone. As frontliner Tabatha Kentner said, “This is what we do. This is why we’re here.” Nurses save lives—and when they cannot, they comfort patients in their final hours and console distraught families. It’s not an occasional phenomenon; it is an everyday occurrence. The name and photo in Wednesday’s NotW feature could easily be your own because your expertise and empathy make you a Nurse of the Week every day of the year.
On the last Wednesday of 2020, DailyNurse salutes the Nurses of the Week who made their mark during the Year of the Nurse!
Great (and Caring) Communicators
A recurring theme is nurses who use their unique talents to raise patients’ and staff members’ spirits. Some, like Marc Perreault and Lori Marie Kay, shared their musical gifts. At Lenox Hill Hospital during the height of the New York City outbreak, Emily Fawcett helped boost morale in her ICU by meeting with staff for positive-thinking “hope huddles” before starting their shifts.
Danielle Fenn applied her language skills to comfort non-English speaking Covid patients. Others, like Tabatha Kentner, have been acting as “angels” (the word angel comes from the Greek angelos, which means “messenger”) and facilitating virtual visits so patients and their loved ones can commune even in isolation (and when necessary, say their final goodbyes).
Advocates and Public Servants
2020 was a year in which nurses stepped forward, spoke up, and got involved in public and civic health. Expect to see more of this in 2021 and years to come (we hope!). Metastatic breast cancer survivor Stephanie Walker is tirelessly advocating for cancer patients and patient education in North Carolina. Another indefatigable advocate, Andrea Dalzell, is on a mission to invite wheelchair-bound people to enter the nursing profession.
NYPD’s new Special Victims Unit head Michael King is a veteran SANE—and he is determined to improve the treatment of rape victims by police and other first responders. American Academy of Nursing (AAN) “Living Legend” Mary Wakefield is sharing her public health expertise and experience in the Obama administration with the Biden-Harris transition team.
Another AAN “Living Legend,” 85-year-old Marie Manthey, is promoting frank, open dialogues between Black and White nurses, and calling upon all White allies to combat structural racism and unconscious bias.
Tens of thousands of nurses this year packed their bags and took off to lend a hand in the nation’s hotspots. Reports on horrific conditions in hard-hit city hospitals were a virtual Bat-Signal for many nurses. They stashed extra masks in their suitcases, said goodbye to their loved ones, and flew to the most dangerous hotspots in the country (even nurses who had never been on a plane before!).
Texas nurse Anna Slayton, who parted from her family to spend 77 days on the New York frontlines, felt compelled to help, telling DailyNurse, “I ultimately knew it was my duty.” And in April, after flying from Tennessee to a desolate—but noisily grateful—NYC, ED nurse Kirsten Flanery declared, “I made the right decision on coming up here. I’m ready to make a difference!”
Difficult Takes a Day, Impossible Takes a Week
Many nurses combine massive multitasking efforts with hard work to pursue their studies, and some fight to overcome dire health and financial obstacles in their quest to start a nursing career. Felicia Shaner was so drawn to the profession that she embarked on her nursing studies while living in a homeless shelter… with a toddler and a baby on board! degrees while working as hospital custodians. Rebel NurseJalil Johnson (of Show me Your Stethoscope fame) had spent his last $5 when he enrolled in an LPN program. And Brianna Fogelman had a lung transplant in her junior year of nursing school and took her nursing finals with a tube in her chest.
Is There a Nurse in the House?
2020 was also a year in which nurses acted as first responders in unexpected times and places. Pamela Zeinoun saved the lives of three premature infants after the devastating August 4 explosions in Beirut. Indiana trauma nurse Colby Snyder rushed to the assistance of two people who collapsed in public within a 3-week period: the first had a seizure at her grocery store, and the second fell while Snyder was volunteering at the polls on Election Day.
Former CCN/cardiac care nurse Hollyanne Miley (whose husband is Joint Chiefs of Staff Chairman Mark Milley) is also a good person to have at hand when out-of-the-blue seizures occur. And VA nurse Maria VanHart impressed “official” first responders by her swift, efficient, and empathic treatment of survivors at the scene of a fatal highway accident.
DailyNurse salutes all of its readers, and all nurses. If you know of someone who warrants a Nurse of the Week nod, send your suggestion to email@example.com. Best wishes for a happier, healthier, evidence-based New Year!
In addition to her dedication to helping others as a surgical trauma nurse at Indianapolis University Health Methodist Hospital, Nurse of the Week Colby Snyder believes in being a good citizen. “It’s really on us, the younger generation, to push for change…” she says, so in addition to helping people register to vote this year, Snyder volunteered at one of Indianapolis’ polling places during the general election. The mounting pandemic spurred a special call for younger poll volunteers, and she quickly stepped forward: “There was a huge push for younger people to work this year, just to help protect that [elderly] age group.” She reflected, “I don’t know, I just wanted to help wherever I could.”
Snyder’s professional and civic duties ended up coinciding during her shift at the polls, though, when a voter collapsed while waiting on line. “I heard a little bit of commotion but didn’t think anything of it,” she says, “and then I turned and saw someone sitting on the floor.” The person on the floor was a female voter. When Snyder came over and asked how she was doing, the voter said that she had not eaten all day and felt light-headed. After Snyder brought her some apple sauce, she recounted, the voter “[said] she wanted to lay down and was pretty shaky… as soon as she went to lay back she went limp.” The poll volunteer-slash-trauma nurse tended to her unexpected patient until the EMS team arrived.
The incident at the polls was Snyder’s second recent foray into nursing outside her usual 12-hour shifts at the hospital. She says, “This happened to me two weeks ago in Kroger!” As she was grocery shopping, Snyder heard someone calling for help and saw a fellow customer laying in the aisle. “He had labored breathing at first and then it stopped,” she recalls. Snyder gave the man chest compressions while they waited for the EMTs: “As soon as EMS was called, I knew they’d be there soon. But prior to them arriving, he started to breathe again.”
Since her experience at the polls, Snyder has been fielding calls from reporters, friends and co-workers, but she says that she simply did what came naturally to her. “It’s strange to be getting all this acknowledgment because you don’t think you did anything special really,” she remarked.
To see a video interview with Colby Snyder, click here.
In March, when New York City staggered under the weight of the COVID-19 outbreak, the images of refrigerator trucks, overwhelmed hospitals, and outdoor triage centers set Amy Kinder’s caregiving instincts afire. On April 5, 2020, the ER nurse left her home in Kokomo, Indiana and joined the thousands of dedicated nurses who came to work on the city’s frontlines. During her 21 days at Coney Island Hospital in Brooklyn, Kinder formed a tight bond with eight colleagues. Now, the nine nurses have described their experience in a new book, COVID-19 Frontliners.
“I remember my first night in the emergency department I was stopped abruptly in my tracks as I was racing down the hallway. My eyes caught movement in one of my rooms. I stopped to ensure what I was seeing. I had a patient actively dying and the patient next to her reached through the rails of the cot and held her hand trying to comfort her. I felt anguish for these patients. They did not know each other, but they were all alone. They had no one but the stranger beside them.” –Amy Kinder, COVID-19 Frontliners
In an interview with the Kokomo Perspective, Kinder said, “We felt like it was important to get the truth out there because you see on the news so many conflicting stories of what’s really happening or what was going on. So we just felt like it was important to get our frontline experience out there so other people really could see and understand what it really was like—because when I was out in New York, [it seemed] like the news sugarcoated what was really going on.”
As they attempted to communicate with non-English speaking patients, Kinder and the other nurses tried to find their footing amid scenes of chaos: “There were patients everywhere, double and triple stacked in rooms, lining the hallways, right up to the nurses’ station.” She added, “I could not believe what I was seeing. How could this be possible? Where did all of these patients come from? I thought to myself, ‘Damn, this is way worse than what I saw on the news.’”
In addition to dealing with the overcrowding and insufficient PPE supplies, Kinder and her colleagues struggled with a shocking volume of mortalities that sometimes included co-workers: “During the hardest time, we learned how to cope in ways we never had before. Not only were we seeing death in our patients but within our own healthcare family. We lost an agency nurse one night at shift change. She was found down in the bathroom. My heart still hurts for this individual’s family.”
When Kinder returned to Kokomo, she found that the experience had left marks on her psyche. Back on duty at the Ascension St. Vincent ER, “Alarms go off, and I flash back to the horror in NYC. I begin to hyperventilate worrying that we are running out of oxygen again or that a patient is in crisis. I have to talk myself down and remind myself of where I am and that I’m no longer in NYC.”
Her 21 days in New York also left Kinder with a sobering awareness of the realities of COVID. “I knew that it was a big deal, but at the same time I wasn’t really sure how big of a deal it was. There’s so much unknown about this dang virus, so I even was on the fence. But then I come home and people are mouthing, and until you’ve been out there and lived it, it hurts to hear people talk like that…”