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Managers Struggle to Cover Shifts During Pandemic-Fueled Nursing Shortage

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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. [caption id="attachment_102631" align="alignleft" width="225"]nursing shortage Terry Prowse, RN[/caption] "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

[caption id="attachment_102632" align="alignleft" width="233"]nursing shortage Dawn Molz, RN[/caption] 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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