SHORTAGE OF HEALTHCARE: DOING MORE WITH LESS

Experts say shortage of providers predates COVID-19. The pandemic just made it worse

BY DEBORAH JEANNE SERGEANT

The current nursing shortage troubling the healthcare industry for numerous years may seem like yet another outcome of COVID-19. However, it pre-existed the pandemic. COVID-19 only exposed and worsened it.

“COVID-19 exposed a shortage that has existed for a long while,” said Yuri Pashchuk, chief nursing officer with St. Joseph’s Health. “The nursing shortage is not new, but COVID-19 exacerbated it and brought to light the significant challenges healthcare systems face when we can’t provide a certain number of nurses or level of care using nursing care delivery models. We’re not immune to this and unique; we’re faced with the same challenges.”

The surge of retiring baby boomers swelled during the pandemic as many abruptly decided to retire early or shift to out-patient centers that can offer more predictable working schedules. With fewer nurses available, patients receive less coaching and less attention. This contributes to less-than-ideal outcomes.

“There are significant delays or un- availability of patient care,” Pashchuk said. “It exacerbates disease processes. When they access care, they have much greater needs and more complex care. Doctors are seeing cases of heart disease they haven’t seen in 20 years because there are limits in resources in communities.”

The pandemic further stretched the already short-staffed nurses because of the increased demand and diminished number of staff members. In addition to nurses who were ill during the pandemic, causing temporary shortages, numerous nurses chose early retirement or shifted to other careers. These nurses have not been replaced at the same rate.

“Like all of the hospitals in New York state, we have challenges with staff shortages,” said Matthew Chadderdon, vice president of marketing, public affairs and fund development at Auburn Community Hospital. “Our nurses have been doing an amazing job and we have a number of travel nurses as well that have helped with the challenges.”

The continuing presence of COVID-19 patients and the uptick in flu and RSV at the end of 2022 kept beds full at area hospitals.

Auburn Community Hospital works with SUNY Upstate “on balancing our patient loads so they have rooms for children,” Chadderdon said. “We are also exploring opening a small pediatric area in Auburn Community Hospital to care for local children, but we are not there in terms of the final details.”

Pashchuk said that St. Joseph’s has helped stabilize the workforce by limiting capacity, such as closing units and consolidating resources. Offering incentives to staff picking up extra shifts or working late has helped, as has cross-training staff so they can be moved to areas of greatest need. St. Joseph’s has also used traveling nurses, who work for third party companies that operate in a similar way to employment agencies and their nurses do not work directly for the hospitals. While these traveling nurses provide flexibility to the hospitals to accommodate surges in need wherever they arise in the facility, the wages they receive are sometimes double of directly employed nurses, plus administrative costs their hiring agency charges.

Paying staff nurses more seems a simple alternative to hiring traveling nurses. However, that would require the health system to raise all of the wage rates forever. Working as temporary staff, traveling nurses may be let go or hired as needed.

“Our nursing salaries are set by collective bargaining agreements negotiated by the state,” said Leslie J. Kohman, physician adviser, SUNY distinguished service professor of surgery, chief wellness officer at University Hospital and Wellbeing & Mental Health Resources at SUNY Upstate Medical University. “We did get some salary increases. There will be a healthcare worker bonus the government is distributing for people on duty during the worst of the pandemic. We pay 2.5 times the rate for overtime for nurses, though that may change.”

Kohman also lauded Upstate’s educational benefits, which help nurses enhance their education to a bachelor’s level or obtain another advanced degree. Upstate’s nursing residency program offers nurses mentoring and opportunities for gaining experience, so they feel more confident in their nursing roles.

“We have a lot of options for nursing, from pediatric to psychiatric to critical care—anything you could think of,” Kohman said.

One long-term solution is recruiting more students to nursing school to fill the gap between supply and demand and hire more people take back the extra tasks nurses have had to pick up in their absence.

Pashchuk wants to see more recruitment arrangements that make it less expensive for people to complete an education in nursing with a work commitment for a certain number of years, along with higher insurance reimbursements for healthcare organizations.

“It’s creating a lopsided effect when hospitals are fighting for reimbursement for providing care as opposed to reimbursing hospitals and finding other opportunities for discussions on reimbursements,” Pashchuk said. “We almost have to defend the care we provide.”

New approaches like virtual nursing to support people recovering at home may help lighten nurses’ workload. Pashchuk cited the upswing in virtual mental healthcare during the pandemic as an example of how virtual delivery models can help in some cases.

“Despite the challenges we’ve faced—and I had a unique perspective overseeing COVID-19 units—I’ve never felt prouder of our nursing staff and even with the challenges,” he said. “They come in supporting each other and community. They’re some of the most resilient I’ve ever had the privilege working with. I’ve worked in ER and been deployed to natural disasters all over the world. I’d gladly work hand in hand with them in any situation moving forward. I tell them, ‘You’ve solidified yourselves in the pages of history for caring the most vulnerable when the rest of the world stopped.’”