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Nurse Shortage Plaguing Hospitals in Post-COVID Recovery

"It never was a challenge before," said Jessica Holden, a registered nurse. "It's a dilemma. Why is it that we are not getting the number of applicants that we got before. There used to be waiting lists. We are not seeing those anymore."

The primary reasons for the nurse shortage have to do with the economy, says Peter McMenamin, a senior policy fellow at the American Nursing Association. (Photo: AP/Steven Senne)
(TNS) - Westfield State University has 130 students in its pre-licensure nursing program but could double that to 260, much to the relief of staff-starved hospitals in the Pioneer Valley and across the state.

If only it had the students signing up for courses that lead, upon graduation, to jobs paying at least $60,000 a year with benefits. Salary and benefits, including tuition reimbursement, are constantly sweetened by hospital administrators looking to fill wanting shifts.

"It never was a challenge before," said Jessica Holden, a registered nurse with a doctorate in the subject who is Westfield State's executive director of nursing and allied health. "It's a dilemma. Why is it that we are not getting the number of applicants that we got before. There used to be waiting lists. We are not seeing those anymore."

The answer is burnout, say hospital administrators. Burnout and generational change as Baby Boomers continue to retire from the workforce, escalating a growing shortage of workers in health care.

"There's this giant staffing problem running across the (health care) system, but that staffing problem is doing significant damage to the normal process by which the system works," Gov. Charlie Baker told a Massachusetts Association of Health Plans conference 10 days ago in Boston. "People really need to think differently about how all the pieces of the system are organized."

Holden and Westfield State University president Linda Thompson, whose professional and academic background is in nursing and nursing education, met with 70 key health care stakeholders across the Pioneer Valley searching for solutions.

"The nursing profession, on many levels, is not likely to be the same after the strains and stresses of the COVID-19 pandemic," Thompson wrote in an op-ed submitted to The Republican. "To rebuild and replenish the ranks of professional nursing, we must examine and evaluate all processes to determine how to cultivate and nurture interest in science and working with others."

Westfield State is working to improve pathways to nursing through the local community colleges and has posted a hiring notice for a new job if its own, a health care career navigator who will spread the word about thesis careers in high schools and middle schools.

Massachusetts Healthcare Collaborative has a $55 million in grant money funding programs that bring people into nursing training.

"Nursing is not easy," Holden said.

The more difficult hiring environment started even before COVID 19, according to Kristin Morales-Lemieux, senior vice president and chief human resources officer at Baystate Health.

"We were feeling the squeeze," she said. "With less available labor in the marketplace, then the pandemic, a lot of what was happening pre-pandemic has accelerated. That happened faster than we had anticipated."

Baystate, one of the region's largest employers, has around 13,500 employees, up from 12,000 pre-pandemic, according to Morales-Lemieux. But there are 1,600 openings.

Pre-pandemic the high water mark for open positions was 700. "We would start freaking out at 700 openings," she said.

Statewide data shows an estimated 19,000 total full-time job vacancies across Massachusetts, according to the Massachusetts Health & Hospital Association, a statewide trade group. The vacancy rate for licensed practical nurses is 56%, according to the association

And at any given time, more than 1,500 patients are stuck in acute hospital beds as they await placement to a specialized behavioral health bed or post-acute care.

Cooley Dickinson Hospital in Northampton said the shortages continue as patient traffic surges.

Cooley Dickinson Hospital in Northampton said the shortages continue as patient traffic surges.

"We have open positions in a variety of areas. At the same time, we are seeing a high volume of patients, which is putting increased demand on staff and services," said Jeff Harness, chief community relations and communications officer at Cooley Dickinson in Northampton. "Our Emergency Department is seeing a higher than traditional number of patients and wait times for non-urgent patients have increased on some days. Staff recruitment and retention remain priorities and we are starting to notice less staff turnover and are hopeful the staffing challenges will begin to ease. We are very appreciative of all of our staff across the organization who continue to make caring for the patients in our community a priority."

In his remarks, Baker cautioned that the staffing situation is having fallout across the system, affecting health care payments among other things.

Rehabilitation and long-term care facilities that are understaffed are unable to take in new patients from hospitals, leading to patients staying longer in hospital beds waiting for a spot in their next treatment facility to open up, the governor said.

"If you look at the average time to stay in a hospital right now, not just in Massachusetts, or many places around the country, it's about a day and a half longer than it used to be," Baker said. "So now you have a situation where hospitals are providing a lot of care for which they are not being paid."

Spiros Hatiras, president and chief executive officer of Valley Health Systems, said Holyoke Medical Center is still using temporary fill-ins and traveling nurses to meet its gaps in staffing. It's a situation he hopes won't continue for long.

"We think in another six months or so we should be able to get there," Hatiras said, "although it is a moving target."

Holyoke Medical Center has 1,900 total employees, and 400 to 450 of those are nurses. There are vacancies, Hatiras won't say how many in various staff roles. But for a hospital, a lack of nurses hurts the most, it's difficult to slide others into those tasks.

"There is not much you can do without nurses," Hatira said. Holyoke has hired 40 nurses in the last six months. "Most of them are already up on the floors working," he said.

The hospital's highest tuition reimbursement rate is $7,000 a year, money for employees to get another degree.

For new grads, Holyoke offers up to $50,000 in student debt reimbursement if a nurse stays for five years. "So that's a retention and recruiting tool," Hatiras said.

At Baystate, there has been an ongoing review of nursing salaries over the past three years, keeping them in line with competition, Morales-Lemieux said. The result is raises of 9.5% to as much as 33%.

The higher number would include not only market-driven raises, but salary bumps for longevity and performance and for being promoted to a job with more responsibility, she said.

Baystate also completed an employee engagement survey over the summer which shared some of the fallout from the staffing situation.

"People are feeling depleted," Morales-Lemieux said, noting reports of escalating tension and stress. She said COVID escalated a trend of people behaving poorly toward health care workers.

Hatiras said hospitals have to act with more compassion towards employees, especially those on the front lines.

"It used to be that money was the biggest factor," he said. "It's not just money anymore. Will you be flexible with me, (employees are asking)."

Holyoke Medical Center monitors workloads carefully to address such concerns he said. "We don't want to hire people and then burn them out," Hatiras said

Holyoke is trying other things, as well. Starting this month there is a new benefit called "grandparent days." Employees can take as many as two days off a year for the birth of a grandchild without burning personal or vacation time.

Also, for the past few weeks Holyoke Medical Center has had an emergency room doctor doing triage. The idea is that the doctor might be able to identify an issue — like a sore throat — and write a prescription or devise a treatment in the triage process. That's instead of a nurse doing the triage and then the person having to wait for a doctor. The idea is to cut down on the people who leave the emergency room without getting any treatment, Hatiras said.

As part of rethinking what health care looks like in Massachusetts, Baker said there is opportunity to reimagine public health care plans. The governor said the current federal Medicare reimbursement model isn't designed for increased chronic care needs that come with addiction and mental health crises that have risen in the country.

A recently approved waiver deal that pledges $67 billion to tailor public health insurance programs to specific state preferences "sets the table for a very significant change in the way, over time, MassHealth and Medicaid pay for stuff," Baker said.

The Centers for Medicare and Medicaid Services approved the Section 1115 demonstration waiver in September, allowing the state to invest tens of millions of dollars into primary and mental health care workforce development and offer continuous Medicaid eligibility for some vulnerable populations. It took effect on Oct. 1 and stretches until December 2027, well beyond Baker's time in office.

It will allow the state to "expand both service delivery and capacity," Baker said in September, highlighting mental health care as an area particularly bolstered by the agreement that represents federal support to move beyond the basic contours of Medicaid requirements.

"The biggest thing people need to do generally is to recognize and understand that some of the after-effects of COVID are probably not temporary, and you need to think about them as part of the way you manage and organize ... going forward," Baker said.

Material from State House News Service was used in this story.


©2022 The Republican, Springfield, Mass.