MN THE PLAIN DEALER | CLEVELAND.COM SUNDAY, SEPTEMBER 25, 2022 H1
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Where have all the nurses gone? And how do hospitals get them back?
BY GRETCHEN CUDA KROEN | The Plain Dealer
CLEVELAND, OHIO
hen COVID-19 swept the globe, the world took note of the people who were responsible for managing an unprecedented number of critically ill patients. In the early days of the pandemic, stories and images went viral of doctors and, to a larger extent, nurses who went to work, day in and day out, exhausted and emotionally drained, sometimes without proper masks, gowns or gloves. They were praised for bravery and lauded as heroes. And then we moved on. And so did many of them. A large fraction of the nursing workforce quietly disappeared post-COVID-19, leaving hospitals and clinics understaffed, and creating an even greater burden on the nurses that remained. The economics of the shortage are fairly simple: in a field where demand for nurses has been consistently rising for years, more nurses are leaving than entering the profession, creating a deficit. And the gap between demand and supply is getting wider. Why are so many nurses leaving the profession? What is being done to replenish their numbers? And can an already fragile healthcare system cope with the strain until we do? Why are they leaving? There are a number of reasons nurses are leaving, including an aging workforce that is reaching retirement, on-the-job burnout, and a shift from traditional, stable staff jobs at the hospital bedside to telemedicine and a gig-economy of short-term assignment travel nurses, say the experts.
In a field where demand for nurses has been consistently rising for years, more nurses are leaving than entering the profession, creating a deficit.
It would be easy to blame all these changes on the pandemic, but healthcare economists and academics in the nursing profession observed and reported on aspects of the nursing shortage long before COVID-19. The American Association of Colleges of Nursing has put together an entire fact sheet devoted to addressing the nursing shortage, littered with data, reports and predictions of an ever worsening shortage of nurses going back almost two decades. For example, according to the 2020 National Nursing Workforce Survey, the average age of surveyed registered nurses was 52 years old, and 19% of RN’s are 65 years of age or older. About one-fifth of the respondents said they planned to retire in the next five years, leaving the U.S. short an estimated 1.9 million nurses by 2030 . This, in addition, to the growing healthcare demands of a population that is living longer. The pandemic simply took a system that was already failing to keep up, and placed it under extraordinary, and unexpected strain. “Really the biggest thing is the burnout is creating a high turnover,” one ICU nurse at the Cleveland Clinic told cleveland.com, asking not to be identified, for fear her comments might impact her ability to get a job in the future. Burnout she says is driving many nurses she knows to leave the profession entirely, but many others – including her --are simply taking advantage of high salaries paid by travel nurse companies. “The pay is double, triple, quadruple, what we make as staff,” she said. “I mean, why wouldn’t you do that?” continued | pg 2
The impact on hospitals High nursing demand has caused some hospitals to offer extra incentive pay to retain their nurses, and they are making up the staffing differences using travel nurses that they pay many times more than the full-time staff that train them. But even then, some hospitals find that they are having to make some hard decisions. University Hospitals in Cleveland recently decided to close its hospital facilities in Bedford and Richmond Heights. The closures were met with harsh criticism from local area residents and politicians. UH said staffing shortages – in particular nursing shortages— were the primary driver of the decision. “We are committed to making sure that we are providing high-quality, safe care, and a part of our decision making was related to workforce shortages,” said Michelle Hereford, UH’s chief nursing executive. Hereford said 90% of the staff was relocated to another facility where they were needed. “We are quite grateful that those people decided to stay with us and that we are able to spread those employees across other parts of the organization.” Nursing shortages aren’t specific to Cleveland-area hospitals, Ohio hospitals or even American hospitals. In Australia, the country is so desperate for nurses, that Victorian Premier Daniel Andrews recently announced his government would offer free university degrees to over 10,000 nurses and midwives. “To our year 11 and year 12 students - choose nursing,” Andrews told Australian reporters. In the United States there is no such national initiative, but all 50 states offer some form loan forgiveness for nursing students as a means to combat nursing shortages. However, these programs vary widely by state. For example Ohio offers its nursing students $1,620 per year, but neighboring Michigan forgives up to $200,000 in student loans for nurses who work for two years in a federally designated healthcare professional shortage area.