NURSING SHORTAGE PERSISTS IN ROCHESTER AND ELSEWHERE

BY DEBORAH JEANNE SERGEANT

The current nursing shortage troubling the healthcare industry may seem like yet another outcome of COVID-19. However, it pre-existed the pandemic. COVID-19 only exacerbated it.

“The nursing shortage is not a new theme which we’re seeing,” said physician Hemant Kalia, interventional pain and cancer rehabilitation specialist and managing director for InvisionHealth in the greater Rochester region.

“If you look at the Institute of Medicine Report, they were already reporting significant gaps between supply and demand but COVID-19 acted as a catalyst into that gap which has widened significantly. The total supply of nurses decreased by more than 100,000 between 2020 and 2021. This drop was the largest every observed over the past four decades,” said Kalia. At the time of this interview in December 2022 he was the president-elect of the Monroe County Medical Society.

The pandemic further stretched the already short-staffed nurses because of the increased demand and diminished number of staff members, Kalia said.

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.

“One cause is the nursing school enrollment is not growing at the same rate as projected demand,” Kalia said. “Over the past decade, we’ve seen a significant decrease of nurses falling off the workforce, especially in 20 to 35 age group and 36 to 44 age group. We were anticipating a widening gap with boomers retiring, but we have a double whammy with the nurses in this age group. That’s adding up. Obviously, the nursing school enrollment is not going.”

Many nurses have left hospitals to work for traveling nurse companies for higher wages. These firms 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.

“These are really complex decisions if you increase the base rate, then how do you justify the benchmarks?” Kalia said. “What is the new benchmark? Do we need to define a new benchmark for nursing salaries in accordance to the inflation rate and the demand/supply curve?”

Kalia wants to see greater emphasis on recruiting students to nursing school to fill the gap between supply and demand. Some healthcare organizations like Finger Lakes Health are looking at raising awareness about the nursing profession to young people.

“At Finger Lakes Health we continue to recruit and attend numerous activities in order to engage individuals in nursing as a career starting with high school students,” said Ardelle Bigos, chief nursing officer for Finger Lakes Health. “In addition, we offer generous tuition programs that can be discussed with our human resource department. Our goal is not only to recruit but provide those opportunities needed to be successful so that we can retain our staff as well for an example utilizing shared governance as our model for professional development.”

Recruiting is also important for drawing students to schools to study nursing. Mary Dahl Maher, nursing department chairwoman and director of the public health program at Nazareth College, said that the school has plenty of slots open for nursing students and has been focusing on maintaining diversity, inclusion and equity to encourage people of all races to consider the nursing program, including racial minorities.

“We nurture those students, as we need students who look like the patients they’ll be serving,” Maher said.

Welcoming minorities also taps into a larger labor pool.

Solving the nursing crises also depends upon reducing the demand on nurses at hospitals. This includes efforts to help people stay healthier to avoid acute and chronic health issues if possible. Maher said that this begins with public health nurses and school nurses, who can help educate the public on how to better care for their health and wellbeing.

She believes that many hospitals staff with so many travel nurses because their own staff feel so burned out and do not receive sufficient compensation.

“There needs to be reevaluation of the whole pay structure,” Maher said. “There are floors in local hospitals that are totally travel nurses. There’s no continuity of care.”

In addition to low pay, she thinks that nurses also receive too little respect for their challenges.

“We need to care for our nurses,” she added. “Like Aretha Franklin sang it, they need R-E-S-P-E-C-T as they’re doing their jobs and so much more. The responsibility is way beyond what it used to be; it’s incredible. It’s one of the hardest majors. And nurses are actually doing more than their own jobs because of the pandemic, things like housekeeping and maintenance.”

She referenced a study that states up to 50% of nurses quit the profession after their first year and thinks that part of this issue is a generational shift.

“This generation has not been prepared for this kind of work,” Maher said. “They’re not willing to work 16 hours to not abandon a patient. They want to put in a normal, eight-hour day and go home.”

Consistent eight-hour schedules have become less frequent in an industry chronically understaffed. But until healthcare organizations can hire more employees and specifically more nurses, those long shifts will continue.