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.
A new link has been added to the Nurse Licensure Compact. In February 2022, Vermont will become the 35th state to allow nurses from other states to practice and treat patients without re-licensure. State legislators are also seeking other ways to reduce Vermont’s nursing shortage, and other measures under consideration include nursing school loan forgiveness and allowing nursing students to perform more clinical duties.
Vermont nurses are not universally applauding the law’s passage. The Vermont Federation of Nurses and Health Professionals expressed concern that the Licensure Compact will increase the flow of nurses departing from Vermont to seek higher-paying positions in states with a lower cost of living. However, this is a universal issue in states with substantial rural areas, and states like Oregon and Montana have been setting the pace with retention programs offering NPs and other healthcare providers tax credits and insurance incentives as well as school loan repayment and forgiveness, and Vermont appears to be pursuing a similar game plan.
Vermont Secretary of State Jim Condos praised the new law, commenting that the Nurse Licensure Compact bill “will ensure that qualified nurses from other states in the compact do not have to jump through hoops to practice in Vermont. COVID-19 showed how important it is to be able to quickly and efficiently license those qualified to care for Vermont patients in times of need.”
Office of Professional Regulation Director Lauren Hibbert chimed in, saying, that the bill “ensures quality care for Vermonters while providing mobility to Vermont nurses and nurses across the nation who wish to practice in the Green Mountain State. Our mission at the Office of Professional Regulation is to ensure the public’s safety and protect Vermonters from professional misconduct while making sure that qualified professionals who want to practice in Vermont do not face burdensome barriers to licensure.”
A dozen states are reporting drops of 25% or more in new covid-19 cases and more than 1,200 counties have seen the same, federal data released Wednesday (January 27) shows. Experts say the plunge may relate to growing fear of the virus after it reached record-high levels, as well as soaring hopes of getting vaccinated soon.
Nationally, new cases have dropped 21% from the prior week, according to Department of Health and Human Services data, reflecting slightly more than 3,000 counties. Corresponding declines in hospitalization and death may take days or weeks to arrive, and the battle against the deadly virus rages on at record levels in many places.
Health officials, data modeling experts and epidemiologists agreed it’s too early to see a bump from the vaccine rollout that started with health care workers in late December and has, in many states, moved on to include older Americans.
Instead, they said, the factors involved are more likely behavior-driven, with people settling back home after the holidays, or reacting to news of hospital beds running out in places like Los Angeles. Others are finding the resolve to wear masks and physically distance with the prospect of a vaccine becoming more immediate.
A single reason is hard to pinpoint, said Adriane Casalotti, chief of government and public affairs for the National Association of County and City Health Officials. She said it may be due in part to people hoping to avoid the new, more contagious variants of the virus, which some experts say appear to be deadlier as well.
She also said so many people got sick in the last surge that more people may be taking precautions: “There’s a better chance you know someone who had it,” Casalotti said.
Dropping in California, but it’s “An Unstable Equilibrium”
Eva Lee, a mathematician and engineering professor at the Georgia Institute of Technology, works on models predicting covid patterns. She said in an email that the decline reflects the natural course of the virus as it infects a social web of people, exhausts that cluster, dies down and then emerges in new groups.
She also said the national trend, with even steeper drops in California, also reflects restrictions in that state, which included closing indoor dining and a 10 p.m. curfew in hard-hit regions. She said those measures take a few weeks to show up in new-case data.
“It is a very unstable equilibrium at the moment,” Lee wrote in the email. “So any premature celebration would lead to another spike, as we have seen it time and again in the US.”
Four California counties were among the five large U.S. counties seeing the steepest case drops, including Los Angeles County, where new cases declined nearly 40% in the week ending Jan. 25, compared with the week before.
Dr. Karin Michels, chair of epidemiology at the UCLA Fielding School of Public Health, said the lower numbers in L.A. after the virus infected 1 in 8 county residents likely mirror what happened after New York City’s surge: People got very scared and changed their behavior.
“People are beginning to understand we really need to get our act together in L.A., so that helps,” she said. “The big fear [now] is ‘Is it really going in this direction, is it plateauing, or where is it going to go?’ We need to go further down, because it is really high.”
Michels said herd immunity would not explain the declines, since we’re nowhere near the level of 70% of the population having had the disease or been vaccinated. She said the declines may also reflect a drop in testing, as Dodger Stadium has been converted from a mass testing site to a mass vaccination center.
Officials with the California Department of Public Health acknowledged that testing has fallen off, but overall rates of positive covid tests are falling, suggesting the change is real.
Covid Cases Dropping in Other Western States
New cases also fell significantly in Wyoming, Oregon, South Dakota and Utah, with each state recording at least 30% fewer new cases. Each of those states reported having vaccinated 8% or more of their adult population by Tuesday, putting them among the top 20 states in terms of vaccination rate.
Alaska leads the states currently, at nearly 15%, according to HHS. It’s also logged a new-case drop of 24% in recent days.
Yet experts aren’t willing to say yet that the vaccines are driving cases down.
“Most people in public health don’t think we’ll see the benefit of the vaccine until a few months from now,” said Dr. Marcus Plescia, chief medical officer of the Association of State and Territorial Health Officials.
The number of deaths continues to remain high weeks after high case rates as the virus variably attacks the heart, kidneys, lungs and nervous system. Many patients remain unconscious and on a ventilator for weeks as doctors search for signs of improvement.
The death rate fell by only 5% in the data posted Wednesday, reflecting 21,790 patients who died of the virus Jan. 19-25.
Anxiety about new strains of the virus from the U.K., Brazil and South Africa remains high in Portland’s Multnomah County, Oregon, which saw a drastic 43% new-case decline in recent days.
“The concern is that everything could change,” said Kate Yeiser, spokesperson for the Multnomah County Health Department.
Shoshana Dubnow contributed to this story.
Published courtesy of KHN (Kaiser Health News), a nonprofit news service covering health issues. It is an editorially independent program of KFF (Kaiser Family Foundation), which is not affiliated with Kaiser Permanente.
Nurse of the Week Ben Busey is no stranger to crises. In addition to working as an Urgent Care Nurse Manager at the Roseburg VA Medical Center in Oregon, Busey is also a part of the VA’s Disaster Emergency Medical Personnel System (DEMPS), which deployed him in Puerto Rico after Hurricane Maria struck. So, he was ready to serve when COVID-19 started to spread in beleaguered New Orleans.
The 34-year-old Busey spent two weeks at the VA in New Orleans at the height of the pandemic, and says, “The first day I walked in there, two people died within the first two hours of me arriving. They had just run out of body bags, the ICU.” In addition to coping with the strained hospital resources, like most frontline nurses he did all he could to maintain connections between isolated patients and their loved ones: “I would end up calling them in the middle of the night to give them updates on a small improvement on my patient, just because I knew that they couldn’t see their family member and they weren’t allowed to be on the unit with them, and they were probably just worrying all the time about how their family member was doing.”
Warned of the PPE shortage in advance, he packed N95 masks for his trip, and used his small supply sparingly, often wearing the same mask for as many as five shifts in a row. Upon his arrival, he quickly learned that it is unwise to make assumptions merely because your age and health place you in a fairly low-risk group. As Busey recalls, “The person who oriented me for a couple of hours that first day when I arrived, he had just come back from being ill with COVID and he was 31. The way he described it, he said every day he sat in his room and he wondered am I dying, because he felt so sick and short of breath…” Fortunately, Busey himself returned unscathed; his test results after his return to Oregon proved negative.
Busey worked night shifts, and provided strong, capable support during his two weeks in New Orleans. When he came back to the Roseburg VA Medical Center, the Center presented him with official recognition for his work during the crisis.
For more on Dan Busey’s experience in New Orleans, visit here.
Counties across Oregon are suffering from a shortage of primary care Nurse Practitioners (PCNPs), according to a 2019 survey. A recent study from the Oregon Center for Nursing found that despite the promising national statistics reported by the American Association of Nurse Practitioners (AANP), which estimates that over 75% of NPs are practicing in primary care settings, the distribution of these NPs is severely lacking in Oregon.
As PCNPs are vitally needed to compensate for the shortage of physicians, their unavailability is severely felt in parts of Oregon, which is one of the 22 “full practice” states in the US. In contrast to the AANP’s national figures, a state-specific study of Oregon indicates that only one third of practicing NPs (35%) are working in primary care, with another 22% focusing on a combination of specialty and primary care. Of the 22% with combined practices, 62% spend less than half their time on primary care.
Surprisingly, the shortage of primary care NPs tends to be more evident in urban counties, whereas rural counties appear to be better served. Although there are fewer PCNPs by number in rural counties, the proportion of PCNPs is actually higher in rural areas when measured against per capita population figures.
The Oregon Center for Nursing makes three recommendations:
Communities should promote incentives such as student loan repayment programs and grants to attract PCNPs to practice in their areas. In addition, incentives could be devised to encourage primary care physician groups to hire NPs and include them in their existing practices.
The education system in Oregon should examine ways to increase the number of PCNP graduates. Currently, some 70% of the PCNPs practicing in Oregon received their degrees in out-of-state schools. This indicates that the facilities within Oregon are not able to meet present needs for the education of PCNPs, and until the state expands educational opportunities for PCNPs, it will be necessary to fill the gap with graduates from other states.
Community leaders and health officials should explore the reasons that affect NP decisions to focus on primary care. In addition to considering the question of why PCNPs are being drawn more to rural areas in Oregon than urban counties, these officials should ask “Why do NPs choose to work in non-primary care roles? What incentives might change their minds? Once these underlying reasons are understood, communities can use this knowledge to attract NPs to provide primary care in their communities.”
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