Nursing shortage predates pandemic
Virus worsened problem, however
Oklahoma hospitals are again overwhelmed as the spread of COVID-19 is surging through the state, but this time, they’re facing the wave with even further strain on health care workers.
The state has dealt with a nursing shortage for at least two decades, Oklahoma nursing leaders said. But the pandemic has worsened it, with the stresses driving some burned-out nurses out of the industry or to other states, amid greater demands on the health care system.
“The pandemic has brought on some extra stresses that we had no way of predicting, and that has impacted our retention rates enormously,” said Shelly Wells, president of the Oklahoma Nurses Association. “For example, I don’t think that humans were meant to see as much death as our nurses have
seen, personally, in the last 16 months.”
A nurse working in a hospital in normal times might expect to care for a dying patient once a week, Wells said.
“These patients are dying much more frequently,” she said. “There’s no family support, so the nurses are having to double as family and offer that support” on top of caring for the patients themselves.
Adding to the mental burden is how it can be especially troubling to care for someone your age or younger “that you know is probably not going to live,” said Elain Richardson, regional chief nursing officer with SSM Health St. Anthony. This COVID-19 surge has been marked by younger and sicker patients, most of whom are unvaccinated, medical professionals have said.
“In order to care, you need to give some of yourself,” Richardson said. “When you are putting yourself out there, there’s a piece of you that is sick right with those patients, and there’s certainly a piece of you that dies along with them as well. And you can’t just shut that off.”
Across the SSM Health’s Oklahoma region, both the vacancy rate and turnover rate has doubled for its nursing workforce during the pandemic, Richardson said. There are twice as many open positions as usual — over 200 nurses needed, she said.
At OU Health, the reserves that helped nurses weather the earlier surges of the pandemic have been tapped, said Julie Hoff, OU Health interim chief nursing executive and dean of the OU College of Nursing.
“There’s just not the numbers in the wings that we had with the first surge,” Hoff said.
The health system announced this month a number of incentives and strategies to boost and retain its nursing workforce. Across OU Health hospitals, there is a 19% nursing vacancy rate and a turnover rate of 47%,
officials said earlier this month.
What’s behind the shortage?
The reasons for Oklahoma’s long-existing nursing shortage are multifaceted, leaders said. They’re not all unique to the state — there is a shortage of nurses nationwide. And the staffing shortages affect other health care professions too, including respiratory therapists and physical therapists, though nurses make up the largest share of the health care workforce, Oklahoma leaders said.
The state ranks low — 46th — among other states for its ratio of nurses per 100,000 residents, said Wells, of the Oklahoma Nurses Association.
One part of the growing demand for nurses is the state’s aging population, Wells said. There are also education pipeline issues. A limited number of clinical settings for nurses to train is another factor.
“We have a number of people who apply to nursing school who aren’t accepted for a variety of reasons within the pipeline, including a faculty shortage,” Wells said.
In the short-term, hospitals and other health care settings are offering sign-on bonuses and other incentives to try to attract nurses. They’re competing with each other as well as traveling nurse agencies, which often can offer higher salaries for nurses who prefer to work as contractors.
And many facilities are vying for a small pool of traveling nurses, said Richardson, of SSM Health.
“I have seen numbers that say [staffing agencies have] 20,000 requests across the US, and nurses that they have in the pipeline are about 1,000,” Richardson said. “Just because you ask for agency nurses does not mean that you can get them. Quite honestly, a lot of those requests are going unfilled.”
Training the next generation
At Metro Tech, one of Oklahoma’s technology centers where students can get training and education in a number of health care professions, calls come in multiple times a day from health systems, nursing homes and other facilities asking for leads on workers, said Jay Decoteau, an adult education coordinator at Metro Tech.
“The pandemic has really stretched the healthcare system as thin as it could possibly go,” he said.
In an effort to replenish the depleted nursing workforce, Metro Tech has a nurse refresher program in partnership with the OU Health Sciences Center, so retired nurses, those who have completed a nursing program but have yet to take a required test within a certain timeframe, or those who otherwise have let their licenses lapse can get their certification and rejoin the workforce quickly.
“Nurses who have for some reason or another gotten away from the medical field, or nursing field, that is a way for them to get back in,” Decoteau said. The program averages between 30 and 40 students a month, he said.
A new basic nursing program held in the evenings just began this month. For students awaiting a slot in Metro Tech’s practical nursing program, the new program is a chance to complete prerequisite courses and be eligible to get a certified nursing assistant or advanced unlicensed assistant certification, Metro Tech officials said.
Those programs are aimed at quickly training students with the skills they need to join the workforce.
Hoff, of OU Health, said it’s also important to have nurses with advanced education, including at the baccalaureate level. Decades of data shows that the more educated frontline nurses are, the lower mortality rates are within their organizations.
“It’s going to be a critical mass of educated nurses that will change health outcomes in Oklahoma,” Hoff said.
Despite the pressures on the nursing workforce, OU hasn’t seen a decline in nursing applications or of the quality of applicants, Hoff said.
“There’s a level of altruism across nursing programs in this state,” she said.
The only program that’s seen a decrease in enrollment is the school’s RN to BSN (registered nurse to bachelor of science in nursing) program, which was understandable given the strains on practicing nurses in a pandemic, Hoff said.
Long-term solutions
Wells, with the Oklahoma Nurses Association, said there’s an opportunity for state leaders to see health care as a lucrative opportunity for Oklahoma.
“I think we tend to think about energy, and aeronautics. But healthcare is never included in that targeted group,” she said. “If our legislative and executive folks would ... treat (health care) with the same kind of incentives and opportunities that they look at other big industries with, that would be a very positive thing.”
Nursing leaders agreed that investments in nursing education are a way forward.
Shawna Blackburn, director of the Health Careers Center at Metro Tech, said longer-term solutions boil down to three needs: quality programs, space and resources.
“If we have quality programs, space and resources, there are people out there who want to be in health care,” Blackburn said. “I’ve got 200 applicants, but if I don’t have a place to put them, if I don’t have a clinical slot to put them in, and if I don’t have the resources to teach them what they need, and the faculty, I can’t do anything.”
In the meantime, health systems are begging for our help to weather the COVID-19 surge. For weeks, nurses, doctors and other health care workers on the front lines have pleaded for more people to get vaccinated and take other precautions against COVID-19 like wearing a mask.
“We all want to have nurses there to take care of us when we get into a car accident, or we have a heart attack, or God forbid, when we get COVID and are brought in,” said Richardson, of SSM Health. “We’ve got to do everything we can so that everyone can be cared for. And right now, we’re falling a little short of that.”