Which hospitals to blame for the nursing shortage in the event of a pandemic? It is complicated

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National Nurses United (NNU), a California-based union with 175,000 members, blames hospitals for nursing shortages that occurred during the COVID-19 pandemic.

In a press release last Thursday, the NNU said chronically understaffed hospitals had driven out many nurses who “did not want to risk their licenses or the safety of their patients by working in unsafe conditions in hospitals.” .

The union says there is no shortage of nurses in the United States as a whole, citing a 2017 report from the United States Department of Health and Human Services (HHS) which found there would be enough nurses to meet the country’s health needs until 2030.

The NNU admits, however, that nurses are unevenly distributed across the country and that there are shortages in some areas.

The insufficient supply of nurses in some states, the union says, is a direct result of hospital treatment of frontline nurses. Even before the COVID crisis, NNU alleges hospitals were understaffed in every unit and shift to maximize profits and “excess revenue.”

Hospitals also failed to maintain “a solid nursery pool to draw on when planning shifts,” says NNU.

During the COVID pandemic, the union adds, “hospitals have rejected advice from nurses to prepare and plan for foreseeable staffing needs, including hiring and training more nurses, and cross-training of existing staff nurses to work in intensive care units. Instead, hospitals have cut it and put it in place. staff from units that had temporarily low patient numbers and canceled IA travelers’ contracts. “

The UN declaration ends with a call for hospitals to “immediately staff each unit and create a safe and sustainable working environment where nurses can be confident in their ability to provide the best possible nursing care to their patients.” .

Some states are worse off

In response to the union’s accusations, Robyn Begley, DNP, RN, senior vice president and chief nurse of the American Hospital Association, told Medscape Medical News: “Shortages of critical healthcare workers were predicted long before the start of the pandemic. have used a variety of approaches to recruit, retain and support their workforce. “

One of those approaches is to offer unprecedented reimbursement to some nurses, especially in areas hardest hit by COVID-19. According to a recent report by Becker’s Hospital Review, the weekly salary of traveling nurses has more than doubled to $ 3,500 per week, and some positions pay up to $ 8,000 per week for a 3-month assignment. By comparison, RNs earned an average of $ 63,000 in 2017, according to the National Nursing Workforce Survey for that year.

A recent McKinsey survey of large hospitals found that 84% of respondents reported ongoing issues with nursing workforce coverage. Nursing sales have grown 4 to 5 percentage points in the past 12 months, McKinsey found.

According to the report, the main tactics used by hospitals to retain their nurses include salary increases (31%), recruiting increases (30%), one-time bonuses (16%) and general purpose / development nurses ( ten%).

None of this has benefited hospitals in states where COVID is reaching new heights. In Mississippi, for example, nearly 1,000 hospital beds are unstaffed due to a shortage of healthcare workers, according to an AP article. Since the start of the pandemic, the state has lost nearly 2,000 nurses.

Florida is also struggling with a shortage of nurses at 70 percent of its hospitals, an NPR article noted. According to the article, “Miami’s Jackson Memorial Health System, Florida’s largest medical provider, has lost nurses to staffing agencies, other hospitals and pandemic exhaustion.”

Gerard Brogan, RN, director of nursing practice for NNU, told Medscape Medical News that Florida is a prime example of what the union is talking about. “The HHS predicted an overabundance of nurses in Florida of 55,000 from 2017 to 2030,” he notes. “So why are we seeing this massive shortage of nurses in Florida? It’s because Florida has such a bad reputation among nurses.”

For example, Brogan said, some nurses in Florida have told him they work in intensive care units “which only have one nurse for every five patients.” It is dangerous and irresponsible. patients that a nurse can take care of in an intensive care unit, and that makes two patients.

“There is a dearth of nurses in Florida who are prepared to deal with these extreme working conditions. Some nurses nearing retirement are leaving.”

Critical care shortages

Critical care nurse shortages in the United States are the most worrying aspect of the workforce situation as the Delta variant continues to rampage, Peter Buerhaus, PhD, told Medscape Medical News. RN, professor of nursing at Montana State University at Bozeman.

In areas ravaged by COVID, he said, the local supply of intensive care nurses is already exhausted. While there are also shortages in medico-surgical units, he says, “there’s no way we have an available supply of these highly skilled nurses sitting down, ready to jump into the ER and intensive care. And these shortages are likely to continue. It takes several years for these nurses to get up to speed and function in these areas. “

Additionally, while some hospitals have tried to train other types of nurses to provide intensive care, he said, only some of those nurses are able to make the transition.

Buerhaus disagrees with the union’s claim that the global nursing shortage was caused by hospitals. Even before COVID-19 arrived, he said, other factors combined to create conditions of scarcity. First, he noted, there are still “background shortages” in hospitals resulting from temporary changes in local supply and demand.

Second, the 1.2 million baby boomer nurses have made up a large chunk of the workforce for decades, he said. Around 2010, they started to retire. Initially, around 60,000 retirees per year; by 2019, the number had grown to 70,000. Many of those nurses were very experienced and skilled clinicians, and some had intensive care experience, he explained.

Third, an increasing number of nurses have enrolled in advanced practice programs since 2012. “We feel that has reduced the number of nurses in the workforce. [will decrease] 80,000 a year, ”Buerhaus said. “So you have 80,000 nurses leaving patient care for this reason and 70,000 retiring, and some hospitals have periodic shortages. And when you are understaffed, you have nurses who work harder, and they are unhappy. “

Bad actors

Buerhaus does not deny that “there are bad players in the hospital world” who simply want to cut costs by keeping their nurses to a bare minimum.

“However, I don’t recall hearing a nurse say directly or in a survey, ‘We have adequate staff.’ Nurses always say we need more staff regardless of other factors, the cost of that, or what you trade off by acquiring more staff. The profession adopts this position by reflex, and some unions have exploited this. “

Brogan retorts that, in his opinion, most hospitals are understaffed in their nursing units. “We have to fight tooth and nail with every hospital where we represent nurses. I cannot stress enough the difficult working conditions for nurses across this country. And the pandemic was the last straw. Nurses try to get away from the bedside. The role of nurse practitioner offers more pay, more respect and more autonomy. due to lack of staff [in the hospital]. ‘”

Brogan said he is meeting more and more nurses ready to throw in the towel. He quotes a seasoned nurse in Fresno, Calif., Who told him, “I’m not sure I can continue. I just breastfed a pregnant woman who has COVID, and we have a 19 year old on a ventilator.

The real reasons for the nursing shortage, Buerhaus said, likely lie somewhere between what the union claims and what the numbers show. “Between retirement and all the folks leaving to become nurse practitioners, the supply wasn’t going in the direction we needed when COVID hit. And some of the bad actor hospitals were hit even more because they didn’t didn’t have enough personal to begin with.

“It’s a little scary, because if we saw a big increase in retirements, we would lose a lot of people with valuable experience and skills. I don’t know what hospitals will be able to do about it. “

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