Rural hospitals can’t find nurses to fight COVID
On any given day, Mary Ellen Pratt, CEO of St. James Parish Hospital in rural Lutcher, Louisiana, doesn’t know how she’s going to staff the 25-bed hospital she manages.
With the continued surge of the COVID-19 delta variant, she’s had to redirect resources. Her small team, including managers, has doubled up on duties, shifts and hours to care for intensive care patients, she said.
“We’re having to postpone elective surgeries that require hospitalizations because we can’t take care of those patients in the hospital,” Pratt said. “The staff working in outpatient services have been redeployed to bedside care.”
Since the beginning of the pandemic, Pratt said, she’s lost nurses who decided to retire early. The hospital offered salary bumps for current staff and incentive pay earlier in the pandemic, Pratt said. But with larger hospitals in urban areas offering hefty bonuses to lure workers, it’s difficult to recruit specialists and nurses to Lutcher.
Across the country, thousands of hospitals are overwhelmed with critically ill patients, prompting many overburdened nurses to change careers or retire early. The shortages are particularly dire in rural areas, rural health experts say, because of the aging workforce and population, smaller salaries and intense workload.
Rural health care leaders have begun offering sign-on bonuses and benefit packages to combat shortages during the pandemic. But they’ve found that even those perks aren’t enough to keep or attract skilled health professionals. Instead, they say, the focus needs to shift to boosting nursing school enrollment and getting workers into the field faster.
“It’s just very difficult to compete with some of the size and scale that bigger systems have,” Pratt said.
For decades, hospitals and clinics have struggled to recruit and retain enough doctors, nurses and administrators. The problem is particularly acute in rural areas. The recent delta surge has worsened the shortage, pushing some hospitals into crisis.
State health officials in Nebraska are so desperate they are trying to recruit unvaccinated nurses from other states and from hospitals that require the vaccine.
Some states and hospitals have requested assistance from the federal and state governments to deploy medical teams to alleviate the burden on local hospitals. Oregon Democratic Gov. Kate Brown announced Aug. 25 that up to 500 health care personnel would be placed in the central and southern regions of the state by way of Jogan Health Solutions, a medical staffing company. The state also signed a contract with staffing company AMN Healthcare to fill 60 additional nursing and clinical positions.
Georgia and Kentucky requested help from their states’ National Guard units. Mississippi is paying $8 million per week for 1,100 contract workers for eight weeks, reported Mississippi Today. And Texas hired 2,500 out-ofstate medical professionals to reduce the strain on its hospitals.
In early August, the Louisiana Department of Health said that more than 50 hospitals requested staffing assistance, asking for more than 1,000 additional nurses. Gov. John Bel Edwards, a Democrat, warned that all staff shortages won’t be filled, The Associated Press reported.
Whitney Zahnd, a health researcher and associate professor at the College of Public Health at the University of Iowa, voiced concern that rural hospitals may go unnoticed by government officials who are sending emergency assistance to larger hospitals with more patients.
“We’re seeing that there’s not enough ICU beds for COVID patients in some areas and that’s a reflection for the need of nurses who have that expertise in intensive care,” Zahnd said, “because it’s not just about do these hospitals have physical beds, it’s if you have nurses to staff the beds.”
The University of Arkansas for Medical Sciences, the state’s largest academic medical institution, increased sign-on bonuses from $12,000 before the pandemic to $25,000 for experienced acute care nurses, spokesperson Leslie Taylor told Stateline. The bonus will be paid out over three years.
The health care provider also offered a $10,000 stipend to current staff nurses who commit to work for at least three years. Taylor said few nurses have taken advantage of the offer.
“We wish there could be more, but the nursing shortage is making it hard,” Taylor told Stateline.
In Wisconsin, one health care employer is offering up to $15,000 bonuses to nurses with a year of experience. At Monument Health in South Dakota, officials are providing a $40,000 incentive for ICU nurses to work for two years.
But as federal aid dries up, other health care systems aren’t able to provide extensive bonuses for recruitment.
Her system’s Paycheck Protection Program money has run out, Pratt said. “That’s been used. We’ve used all of our CARES Act money, so there aren’t any additional sources right now.”
Lari Gooding, CEO of Allendale County Hospital in western South Carolina, echoed those concerns. Gooding said he has been working with staffing agencies to hire travel nurses, who≠ are registered nurses employed by independent nursing staffing agencies. They work short-term stints at hospitals, clinics and other health care facilities to fill in during shortages.
“We’ve talked about incentives and we’ve increased our pay a little bit,” Gooding said. “I think the hard part is that a lot of these travel nurses have gone to agencies to work and the agencies are paying a lot more than we can afford, even with incentives. In the long term, it’s not sustainable for us.”