Managers Struggle to Cover Shifts During Pandemic-Fueled Nursing Shortage

By | 2022-10-11T13:39:38-04:00 October 19th, 2021|17 Comments

Terry Prowse, MSN, RN, a Clinical Services Manager at the University of Arkansas Medical Center (UAMC), was relieved when most of the nurses on his units continued working throughout the first and second waves of the pandemic, but that trend began changing in 2021.

Resignations surged as nurses received offers from travel agencies for more than double their current hourly rates. Others who were exhausted and overwhelmed started leaving the bedside for roles in employee health, school nursing, and endoscopy.

nursing shortage

Terry Prowse, RN

“When hospitalizations increased due to the Delta variant, we had five resignations in one week and no new applicants in the pipeline,” Prowse said. “It’s stressful trying to fill the gaps in staffing.”

There are eight vacancies among the 54 nursing positions in Prowse’s units, which includes a COVID-19 unit and medical-surgical unit. After work, he is frequently scrambling to fill vacant shifts by offering overtime or asking other managers if they can spare a nurse for a day or night.

Nurse managers throughout the country are reporting similar stories of nursing staff shortages, and results from a national survey of 1,000 nurses suggest numbers may continue to dwindle. Two-thirds of the respondents reported feelings of depression and a decline in physical health since the pandemic began, and nearly half felt less committed to the profession than before the pandemic.

The decrease in commitment was most pronounced among nurses under 40. Organizations such as the American Nurses Association (ANA) warn that that the severe lack of nursing staff could have long-term repercussions for the profession and the health of the nation.

In a recent letter to the Department of Health and Human Services, the ANA urged the administration to declare the nursing shortage in the United States a national crisis and take steps to address the problem.

At UAMC, the nursing shortage has been exacerbated by the loss of staff who support registered nurses, such as patient care technicians, nursing assistants, and environmental services staff — many of whom left the hospital to pursue jobs at employers such as Amazon and Costco that offered higher pay and lower risk of contracting COVID-19, according to Prowse.

“Instead of focusing primarily on clinical decisions and tasks, nurses are also emptying urinals and trash cans, feeding patients, and getting patients to the bathroom,” he said.

To better support nurses who are working under these conditions, Prowse has increased the frequency of communication with the people he manages. “Nurses need to know what we are doing and why,” he said.

He holds staff meetings more often to answer questions and sends email updates regularly. Additionally, the hospital recently started offering $10,000 retention bonuses to nurses who had at least three years of full-time experience at the facility. Nurses who worked extra shifts received overtime rates as well as incentive pay.

One of the Unexpected Effects of Nursing Shortage

The lure of high-paying travel positions also has increased the nurse vacancy rate at Covenant Health in Lubbock, Texas, said Connie Gonzales, MSN, RN, CCRN, Director of Nursing for Perioperative Services at Covenant Health.

“Nurses are moving to places like Washington State, New York, and Hawaii for travel positions,” Gonzales said. “But we are appealing to nurses to stay here and take care of our region.”

Many of the highly experienced nurses at Covenant Heath have worked within the system for decades, and some decided to retire early to avoid the stress and uncertainty ushered in by the pandemic. “It was devastating when they left and took years of knowledge and skills with them,” Gonzales said.

When hospital admissions soared in August, administrators like Gonzales started working at the bedside to cover gaps in staffing. After finishing her administrative duties on Friday, she would don scrubs and PPE to work 12-hour shifts on Saturday and Sunday before she returned to her desk on Monday.

“There are days when every single management person — including nurse educators, managers, and directors — is working the bedside, working transportation, helping to clean rooms,” said Susan Harlan, MSN, RN, Nurse Manager of the Post-Operative Unit and Palliative Care Units at Covenant Medical Center.

The hospital, which is a Level II trauma center, can provide a higher level of care than the small community-based hospitals in the area. “We’ve gotten calls from Houston to Kansas City to Oklahoma City from providers trying to find beds for their patients,” said Harlan.

Advocating for Nursing Shortage Solutions

nursing shortage

Dawn Molz, RN

The combination of a worsening nursing shortage and increased COVID-19 hospitalizations meant that August was one of the worst months yet during the pandemic, said Dawn Molz, MSN, RN, Patient Care Manager of the Intensive Care Unit at Singing River Gulfport hospital in Mississippi. “Patients were sicker, younger, and less likely to recover,” Molz said. “We were begging people to work extra shifts,” she said.

Former ICU nurses in non-direct care roles, such as quality coordinators and risk managers, agreed to work the bedside for several weeks, and the hospital began hiring more new graduates for acute care roles because fewer experienced nurses were applying for these jobs.

The hospital’s CEO, Lee Bond, also asked state legislators to allocate 25% of the $1.8 billion received from the American Rescue Plan to retain frontline healthcare workers. Molz hopes lawmakers will see the importance of dedicating resources to recruit and retain nurses who are needed more than ever to care for patients.

“Our staff nurses get frustrated when they get calls and emails from travel agencies or other hospitals offering so much money,” said Molz. “They want to know what they get for staying, and we need to have a better answer to that question.”

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About the Author:

Heather Stringer
Heather Stringer is a health and science freelance writer based in San Jose, Calif. She has 20 years of writing experience and her work has appeared in publications such as Scientific American, Discover, Proto, Cure, Women and the Monitor on Psychology.


  1. Avatar
    Kim October 24, 2021 at 10:13 am - Reply

    I find it odd the effects of the vaccine mandate weren’t mentioned? It’s HUGE loss of experienced staff.

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    Dave October 24, 2021 at 10:31 am - Reply

    Unfortunately the governmental and facility vaccine mandates have also exacerbated this problem. Nurses worked all through the pandemic in 2020 with limited or absent PPE, doing what had to be done. Some got sick with C-19 and some even died because of it. Some of those same nurses who last year were called heroes are now today’s zero’s. If hospitals want to retain staff, they need to urge the government to back off of these draconian mandates and allow liberty to those that want to continue to help others but have a strong opinion about not being coerced into being vaccinated or losing their job.

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    Dora Luz Brown October 24, 2021 at 10:49 am - Reply

    Y’all think it’s bad now, wait until MORE nurses start getting fired or walking away for refusing to get vaccinated. My employer still hasn’t said anything definitive but it may be coming and when it does, I’m definitely walking away. I’ll take my skills somewhere else, somewhere where my personal medical choices are respected. Stay strong everyone, they need US more than we need will ever need them, and this article proves it. Good luck.

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    Julie Tarrant October 24, 2021 at 12:13 pm - Reply

    This article fails to mention vaccine mandates as a reason for nursing staff shortage and the reason so many nurses are compelled to take travel nursing jobs to areas where there are severe nursing shortages due to the vaccine mandate and the freedom of personal health choices that are being ripped from nurses and other healthcare professionals.

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    Wendy Barbier October 24, 2021 at 3:40 pm - Reply

    It doesn’t take research or rocket science to understand why RNs are leaving. We are taught that care is delivered by EBP. Yet the CEOs havent gotten that memo and make hundreds of thousands dollars more than a floor RN. Research has shown the higher the nurse-pt ratio the higher the risk of falls and mortality. The hospital I’m at currently has no phlebotomist, the carry over HCA attitude prevalent and the EHR is out of date at best. In general hospital CNAs are overworked and underpaid. The good ones are worth their weight in gold.

    RNs leave if they are going to be overworked and underpaid. Why not at least be paid while being overworked?

    For me personally I left full-time floor after basically no pay raise in 3 years. And if you were honest with the CEO it got you into trouble. Personally I haven’t met a nurse who believes the “how are we doing” surveys to be anonymous no matter what management says.

    From the top down, ratios for RNs and CNAs, pay worth staying, telling JCAHO that, yes, our nurses will be allowed to stay hydrated and fed, equipment that works, ancillary staff that allows nurses to be nurses, and eliminating most of the Healthstream requirements that most of us don’t remember anyway. I suspect it only fills the hospital legal checklist.
    Insurance, money driven corporations, lawsuits are now driving a checklist/to do driven nursing world.

    So why not travel and make good money?

  6. Avatar
    Linda L McCarthy October 24, 2021 at 4:03 pm - Reply

    The nursing shortage has existed for decades and our system of healthcare and DRG reimbursement exacerbates it. The “nonprofit” insurance co’s. (making huge profits on our premiums) have driven our healthcare system into an assembly line of hospital care. Hurry up and get them in then hurry and get them out. That’s how the system is set up, so money is made by volume of patients admitted. If your length of stay in the hospital is too long the hospital losses $$. If you are discharged sooner than expected, even if that discharge is your death, money is made. The more patients a hospital can make a nurses take care of, the cheaper their labor costs. Nursing assistants and ancillary help a luxury, and often cut out to save money. Nurses were burnt out before the pandemic. This was a predictable outcome regardless of pandemic, or other health catastrophes.

    Healthcare is a business model in this country. Only the military had backup supplies of gowns, gloves etc. Our tax dollars funded the big scramble to get more PPE (personal protective equipment), etc. Despite the pandemic in 2020 several healthcare systems, here in my area, made significant profits. Here in Pennsylvania, nurses are advocating for safe patient to nurse ratio legislation, similar to Calif. I hope we are not too late. I retired from nursing just this May after 45 years a nurse. I could go back, as my health is good, but I won’t work in the conditions that hospital administrations and 3rd party payers have created. Universal healthcare, single payer, would save a tons of money, and I believe lives as well. Thanks for your article.

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    Dorothy Diana October 24, 2021 at 4:06 pm - Reply

    As an ICU nurse and a geriatric nurse practitioner with an extended social network, I’m surprised/not surprised that you’re leaving out the main reason hospitals and clinics have shortages right now – vaccine mandates. We nurses have spent years and years working long hours with little to no breaks depending on the unit and the time of year. Nurses don’t quit because they are overwhelmed from being busy, which isn’t the case right now either as our ERs and ICUs are seeing little of patients that are unvaccinated. We are seeing an alarming amount of admissions of the vaccinated which is why August has been so busy obviously.

    Coercing nurses into taking an experimental injection which now has over 17,000 deaths directly attributed to it, per our government database, is unethical and illegal and a shocking breach of informed consent. The fact that you’re not mentioning that in your article tells me you are not for truth, health or wellness. I will cancel my subscription.

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    Margaret October 24, 2021 at 6:46 pm - Reply

    I would also look into how the vaccine mandates are impacting staffing – a lot of the nurses I work with are losing jobs over that… current government overreach is absolutely contributing to the health care crisis..

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    Naomi West October 24, 2021 at 7:58 pm - Reply

    And of course nurses leaving hospitals and clinics due to mandatory vaccine requirements are not mentioned. I personally know at least 25 nurses who have left their hospital positions because they believe in autonomy, the right to choose their own healthcare practices. Why wasn’t that mentioned?

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    Sarah Fischer October 24, 2021 at 10:11 pm - Reply

    What you failed to mention is some of the nursing shortage is due to clinicians refusing to get an experimental vaccine and quitting to avoid being forced to get it. Shame on you.

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    Vikki Montoya October 24, 2021 at 10:26 pm - Reply

    There is no mention of the numerous nurses leaving during to vaccine mandates.

    While FDA approves vaccines generally prophylactically given to prevent a viral infection, the Civil vaccine is much more like a flu shot in that it will only prevent very specific viral make up and may lessen the effects of other strains. However, those that have had COVID have a far less chance of being reinfected. We learn this is school. Why are we pretending natural immunity doesn’t exist. Nurses and many other Healthcare workers and first responders often do not see the need to be mandated to take a vaccine that very vaguely provides protection. If it prevented infection we would likely be all in.

    • Avatar
      Marilyn Fioravanti October 27, 2021 at 3:58 am - Reply

      So-called natural immunity is uneven and not reliable. As is immunity after having had Covid, The Covid vaccine does not just “vaguely provides protection.” It is over 90% effective. I am not sure why there are so many protests against the vaccine in this comment section.

      Nor is the vaccine, as the comment prior to this one says, still experimental. After the experimental phase, millions of doses have been given.

      As a nure in TeleICU, I can tell you the very sick patients in our ICUs now, and in their 40s-60s, are all unvaccinated.

      So if, as you say, you would likely all be in if vaccine prevented infection, then you will do well to be “all in.” Except for the predicted small percentage of breakthrough cases, this vaccine is more effective than most. And this is a deadly disease with often horrible long haul sequelae.

  12. Avatar
    Lynn Davis October 25, 2021 at 1:14 am - Reply

    I have no sympathy for facilities who are suffering the consequences of the nursing shortage. For years, bedside nurses have complained about low wages, lousy benefits, unsafe patient ratios, etc and voices were ignored. I am one of those ignored voices and I am one of the RNs who know what my knowledge and skills are worth and chose to walk away from my facility straight to a high pay travel agency, where I am compensated for my skills. I will NEVER apologize for that. Ever.

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    S. Crawford October 25, 2021 at 1:58 am - Reply

    It’s sad that it took a pandemic for the “nursing shortage” to finally get wide spread recognition! I’ve been a nurse since 1986 and have experienced a “shortage” in every environment I’ve worked! I have already covered shifts as a manager prior to the pandemic! I am sure the amount of shifts needed to be covered by a manager has increased, but covering shifts is nothing new to a manager! I also believe this article neglected to mention the lack of new grads and how many nurses have left due to vaccine mandates! Some of us have gone from ‘heroes’ to ‘zeros’!

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    Laurie October 25, 2021 at 10:18 am - Reply

    Can we also address hospitals have staffing shortages because of the horrible way the hospitals are ran? I left hospital nursing because I got sick of being asked to work every weekend, but then I was forced to low census on other days when I was already scheduled. Also, being put on call as I was walking in the door for my night shift after sleeping all day? This never used to happen when I started nursing. Now it’s all about saving money at the expense of us nurses. With the vaccine mandate where we are losing great employees because they don’t want to be forced, being asked to constantly work in unsafe conditions, etc. I’ll never look back.

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    Wendy October 26, 2021 at 8:41 pm - Reply

    Well said, everyone! I agree with most that’s said. I’ve been a RN for 34 yrs and would have retired if I could have, but cared for covid patients throughout this. And admin pushed us harder, no recognition. My husband got it after I did, reusing masks, no wonder! Sad, sad place and desperately needs some big improvements made to value the work we do from our hearts!

  16. Avatar
    Pooja Patel November 16, 2021 at 7:26 pm - Reply

    The nursing shortage is such a sad reality in the nursing profession. Needs so much improvement and we need to prioritize protecting our NURSES and not treat them like they’re replaceable! Nurses are also leaving because of toxic work environments and it’s just far too common.

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