‘It’s exhausting.’ Second wave of COVID causes nursing shortage at Triangle hospitals
Early in the coronavirus pandemic, hospitals worried about not having enough ventilators, personal protective equipment and other tools to treat COVID-19 patients. The N.C. Department of Health and Human Services still tracks the number of hospital beds available in the state each day on its COVID-19 website.
But in time, hospital leaders said their bigger concern was having enough trained nurses, therapists and other workers to care for the patients in those beds.
Now, 18 months into the COVID-19 pandemic, hospitals say the shortage of health care workers is as bad as it’s ever been. Turnover among a beleaguered workforce has gone up in recent months, and hospitals are struggling to recruit new employees and retain the ones they have.
“I don’t know of any major health care system in North Carolina right now that is not facing triple-digit shortages in terms of nursing personnel,” said Dennis Taylor, a registered nurse at Wake Forest Baptist Medical Center in Winston-Salem and president of the N.C. Nurses Association.
The shortages come as hospitals are pushed to capacity by a surge in COVID-19 patients. Statewide, the number of people hospitalized with the respiratory disease has grown from fewer than 400 in early July to 3,651 on Friday, according to DHHS.
Some hospitals report having to temporarily leave beds empty or postpone surgical procedures because they don’t have enough staff. Others say they’d like to add beds to keep up with demand but don’t have the workers to do it.
“You keep running into the staffing issue,” said Dr. Seth Brody, chief physician executive at WakeMed Health and Hospitals. “We can create all kinds of new space, but we have to have the staff that’s adequately trained to take care of these critically ill patients.”
Hospitals are also hurt by the same labor shortages affecting restaurants, hotels and a host of other businesses; some hospitals say they’re having trouble finding enough people to make and serve food and clean patient rooms.
But the shortages are most acute in nurses, nursing assistants and respiratory therapists. Hospital leaders say turnover in those jobs has gotten worse as the pandemic has intensified in its second year. After a recent spike in departures, the UNC Health system alone has more than 1,000 openings for registered nurses across its 12 hospitals.
Hospital workers say they’re tired, frustrated and dismayed by this summer’s resurgence of a disease they thought would fade with the arrival of vaccines. Erick Gonzalez, a registered nurse, started working in an intensive care unit at UNC Medical Center in Chapel Hill right out of school a year ago.
“Mentally, physically, emotionally, it’s exhausting,” Gonzalez said. “It doesn’t seem to stop. It just seems like it’s progressively getting worse. I think I speak for a lot of us, it can be draining.”
Lee Stikeleather, a registered nurse who manages the emergency department at UNC’s hospital in Clayton, said the stress of caring for people who are very sick with a contagious disease prompted many nurses to leave bedside jobs to work in telemedicine or for clinics, doctors offices or insurance companies. Stikeleather said others, including his wife, a registered nurse at Rex hospital in Raleigh, simply retired.
“People that could get out of it got out of it,” he said.
Turnover in health care is a national problem. In a survey, Nursing Solutions Inc. found that hospital staff turnover nationwide was 17.8% in 2019, then rose to 19.5% in 2020, the first year of the pandemic. Turnover in registered nurses at hospitals rose from 15.9% to 18.7%. And that was before the second wave of COVID-19 hit this year.
Shortages lead to cutbacks in care
Hospital leaders say they are constantly reassessing their staffing needs and making adjustments hour by hour. At Duke Health’s three Triangle hospitals, that means sometimes temporarily leaving beds unused or postponing non-emergency procedures to shift staff elsewhere, said Mary Ann Fuchs, the system’s top nurse executive.
“You balance what the patients need with the staff you have,” Fuchs said. “You may close down or temporarily close some areas to be able to provide staffing where you need it.”
UNC Medical Center in Chapel Hill also kept some beds empty this week because it couldn’t staff them, said spokesman Alan Wolf.
“With the increasing capacity demands because of the COVID surge, we are looking at ways to add more space for inpatients,” Wolf wrote in an email. “That ability to expand is hampered by staffing resources.”
UNC Medical Center hired 744 health care workers in April, May and June, up from 427 hires during a three-month period last summer, said Scott Doak, the chief human resources officer. But with higher turnover, the medical center still had 321 fewer workers at the end of June than it did last summer, dropping to 8,525 employees.
The most common reason departing workers give for leaving is “other employment,” Doak said, followed a distant second by “personal reasons.” During exit interviews, UNC Health managers hear over and over from workers who are just worn out after 18 months of COVID-19, said Dr. Wesley Burks, the CEO.
“And to add another spike like we’re seeing on top of where we were, we’re not rested like we were a year ago when the first major peak started,” Burks said. “So people are in a really different place. They’re really tired.”
Nursing shortage not a new problem
Hospitals have long struggled to hire enough workers. That’s particularly true in the Triangle, where a growing population helps drive up demand for health care. As the big three health systems open up new hospitals and clinics and expand their existing ones they must hire additional workers each year.
“Basically there was a shortage already,” Fuchs said. “COVID just complicated it, just made it worse.”
Duke hired 1,800 nurses in the past year, and lost 1,200, for a net gain of 600, Fuchs said. But it still has 650 positions that it’s trying to fill, she said.
Nursing shortages are baked into the system in North Carolina, said Taylor, president of the nurses association. Nursing programs at the state’s four-year and community colleges produce 5,000 to 6,000 nursing graduates a year, Taylor said, but the health care industry needs between 7,000 and 8,000 a year.
“So when you look at it, even if we filled every seat that we could in the nursing programs in North Carolina, we’re still short,” he said.
One problem is that nursing education programs can’t expand because they can’t find enough faculty, Taylor said. In 2004, a task force on the nursing workforce predicted a shortage of nurses if the state didn’t increase pay for faculty, who can often make more money as practicing nurses.
“So it’s not like we didn’t see this coming,” Taylor said. “We saw it coming as much as 16 or 17 years ago.”
But the pandemic has made everything worse. In addition to the long hours and constant donning and doffing of face shields and respirators, workers are worried about bringing the virus home to their families, Taylor said. And they’re weary from watching people suffer with COVID-19; more than 14,300 people have died of the disease, most of them in hospitals.
“Because there are such restrictions on families visiting COVID-positive patients, often times that nurse is the only one that’s going to be sitting there holding that patient’s hand, when they take their last breath,” Taylor said. “So I think it’s the emotional stress. It’s the professional stress.”
More nurses are ‘traveling’ now
One complicating factor in the staffing at hospitals is the role of travel nurse agencies, which recruit nurses and temporarily hire them out to hospitals where and when they’re needed. As turnover increases, hospitals are leaning more on traveling nurses, said Jeronica Goodwin, WakeMed’s senior vice president of human resources.
“We have increased our nurse agency use like everyone across the Triangle has,” Goodwin said. “I don’t think any hospital across the nation could function right now without travelers.”
But traveling nurse agencies also help increase hospital turnover, because they pay so well. Fuchs says Duke lost 100 nurses in three months last winter to travel agencies.
“Many of our nurses, our younger nurses especially, they choose travel nursing, and it’s because they can make $4,000, $5,000, $6,000, $7,000 a week for being able to care for patients,” she said. “Now what that’s doing for hospitals is putting them in a really tough situation financially.”
As the name implies, nurses who sign on to travel agencies usually go to another part of the country, where the need is greatest. But with everyone in need, nurses find they can work for a travel agency without leaving home.
Taylor says he knows of at least 10 nurses who have left their regular full-time jobs in recent months to become travel nurses.
“I’m talking about still working here in North Carolina, not having to relocate anywhere,” he said. “They’re signing some of these short-term contracts that sometimes can be up to $6,000 or $7,000 a week that they’re being paid, which is sometimes significantly more than what they would be making if they remained in their current full-time position.”
Hospitals offer raises, bonuses and more
Hospitals are trying all sorts of strategies to bring on more nurses and other health care workers. WakeMed has hired more recruiters and streamlined the hiring process and is holding more job fairs, Goodwin said.
Duke and UNC are offering up to $25,000 to pay off student loans for new hires, as well as relocation expenses and hiring bonuses. Fuchs said Duke is offering a $15,000 signing bonus for experienced nurses for the first time in 25 years.
Hospitals are also working to hang on to the workers they have. They’re offering more flexible hours and assignments and providing more opportunities and bonuses for continuing education and training. Duke stresses its supportive work environment, including adequate staffing levels of nurses and assistants so people don’t feel as stressed.
“We really try to focus on having a good environment for people to practice,” Fuchs said.
All Triangle hospitals have increased pay during the pandemic and given employees opportunities to earn more by taking on extra shifts. The UNC Health board recently approved a 2.5% across-the-board raise to take effect in January, the second in a year.
Looming ahead, all three Triangle hospital systems are requiring employees to get vaccinated against COVID-19 to keep their jobs. As of now, as many as 25% of workers in some hospitals remain unvaccinated, and hospitals are working hard to persuade them to get their shots by Sept. 21 at UNC and Duke and Nov. 12 at WakeMed.
Brody at WakeMed said hospitals in other parts of the country that have required vaccination have in the end had few workers leave over it.
“But if your staffing is short and you’re struggling with that already, you really don’t want to lose any great front-line worker at all,” he said. “We hope no one leaves.”
This story was originally published August 27, 2021 at 3:55 PM with the headline "‘It’s exhausting.’ Second wave of COVID causes nursing shortage at Triangle hospitals."
