Around the world, community hospitals are facing critical nursing shortages.
According to the Sigma Theta Tau International Honor Society of Nursing, in the United States alone, 126,000 nursing positions remain unfilled and by 2020, there will be at least 400,000 fewer nurses available to provide care than will be needed.
There are many reasons for the shortage, but one factor stands out — age; that is, an aging population in need of services and an aging nursing workforce.
Issued in May 2014, the U.S. Census Bureau report on “An Aging Nation: The Older Population in the United States” found that by 2050, the number of U.S. residents age 65 and over is projected to be 83.7 million, almost double its estimated population of 43.1 million in 2012, stated the the American Association of Colleges of Nursing. “With larger numbers of older adults, there will be an increased need for geriatric care, including care for individuals with chronic diseases … Insufficient staffing is raising the stress level of nurses, impacting job satisfaction, and driving many nurses to leave the profession.”
And according to a 2013 survey conducted by the National Council of State Boards of Nursing and The Forum of State Nursing Workforce Centers, 55 percent of the registered nurse workforce is age 50 or older.
“These issues are occurring just as the majority of nurses are retiring and job opportunities within health care are expanding,” notes Sigma Theta Tau. “The result: Hospitals and other institutions need more nurses, especially those who deliver specialized care.”
Health care organizations in Windham County, though not in such a dire situation as indicated by Sigma Theta Tau and AACN, are also struggling to hire and retain registered nurses.
“As people retire, we have to be able to keep up,” said Jodi B. Stack, chief nursing officer at Brattleboro Memorial Hospital. “We probably have 10 to 15 open positions at any given time.”
Across Brattleboro Memorial Hospital and its clinics, the organization employs between 140 and 150 nurses.
While the shortage BMH is facing doesn’t impair its mission, as at other hospitals around the nation, said Stack, it does affect the budget and it means that many nurses are working overtime shifts, which can lead to occupational burnout. To fill in the gaps, BMH relies on an outside contractor to provide temporary nurses.
“It is certainly challenging” said Stack, “and our relationships with local schools is important as we look to the future.”
BMH and Grace Cottage Hospital in Townshend are working with Greenfield Community College, in Massachusetts, and Vermont Technical College to develop a pipeline for nursing students. As part of their curriculum, student nurses spend one to two semesters at the hospital, participating in patient care in collaboration with BMH nurses and under the supervision of their instructor.
“We have quite a few nursing students that end up taking positions here,” said Stack. “They tell us they like the small community feel of BMH.”
Brattleboro Memorial Hospital is also working collaboratively with Windham Southeast Supervisory Union and Windham Regional Career Center. As part of its health sciences track, students will now be able to become licensed nursing assistants during their senior year. BMH plans to host its first clinical rotation for this program in the spring.
“The licensed nursing assistant position is a key part of Nursing Services at BMH,” said Stack. “Under supervision of the registered nurses, the LNAs assist with different aspects of patient care. The LNAs are a valued member of the nursing team, and I am looking forward to this new collaboration with the high school.”
Recently, noted Stack, BMH has had some staffing challenges in the Progressive Care Unit. “There have been some internal transfers and we have had a few nurses who have moved out of the area.”
Although BMH has people in a training pipeline, they won’t be available until the beginning of 2019, so BMH is filling in the gaps with contractors, she said. But there are challenges, even working with temporary staffing agencies. Recently, said Stack, the hospital put out a bid request for temporary nurses and was unable to fill the positions immediately, likely due to the holiday season. “Travel nurses can pick and choose assignments,” she said, “and they don’t necessarily want to pick up a new assignment during the holiday season.”
Stack and the nursing team had to think of a creative way to address the immediate staffing need on the PCU, mulling different options.
“The one we came up with was combining the second floor surgical inpatient unit and the PCU for a short period of nine weeks,” said Stack. “In addition to solving the short-term inpatient staffing issues, it will also give us an opportunity to perform upgrades and renovations to the second floor, including installing a nurse call system.”
The second floor department is open five days a week and is available to patients in post-operation recovery. The Progressive Care Unit, which has space for up to 25 patients on the third floor, is open seven days a week and is available to inpatients for general medical care and surgery-related care.
“We are doing everything we can to manage beds so that there are no space issues” said Stack. “We have special rooms we have allocated for our surgical patients and are communicating constantly as a team to ensure this goes smoothly.”
The hospital is committed to reopening the second floor surgical unit the first week in January, said Stack.
Nurses often change roles within the organization, too, which creates vacancies in the departments they are leaving, said Stack.
“We’ve had quite a few nurses transition from medical-surgical nursing to other specialties such as emergency department, post-anesthesia care, or as a care coordination,” she said.
Stack said BMH supports nurses who want to change roles within the organization. “That’s one of the benefits of working as a nurse, and we want to support those opportunities for professional development”
Stack, who has a team of nursing directors that oversee different departments, said she works closely with them to support the advancement of all the nurses on staff, even if that means creating a temporary shortage in one department or another.
Stack said that staffing can be especially challenging in smaller, highly specialized departments such as the Birthing Center. “Not everyone can do what they do, which means when census is high, nurses in the Birthing Center will work overtime.”
Stack emphasized that birth rates fluctuate, and they appear to be trending down everywhere. Brattleboro is experiencing the same trend, she said. “Our birth numbers were down a bit last year, but seem to be trending back up as of the first of the year.”
BMH continues to make investments in this area, including hiring a new physician OB/GYN and new nurse midwife.
“BMH is very involved in initiatives that improve the health of women, children, and families in our community, and I am proud of the work these nurses do,” said Stack.
The Birthing Center, which is also on the second floor, will also be receiving upgrades, including the installation of the call system and updates to the C-section room.
Along with the traditional demands placed upon nurses, said Stack, more and more each day these nurses are being called upon to step outside of their traditional roles and respond to issues such as substance misuse, mental health, homelessness and food insecurity. BMH is working with other community organizations such as HCRS, Groundworks Collaborative, the Women’s Freedom Center,the Brattleboro Retreat and Turning Point to insure those on the front line have the resources and support they need to help their patients.
“The needs of our patients and our community change over time,” said Stack, “and I am proud of our nurses for everything they do to meet these needs and deliver quality care with compassion and respect.”
At Grace Cottage Hospital, Chief Nursing Officer Lisa Eaton has a much smaller nursing staff than BMH, but has the same concerns about finding qualified nurses to fill positions.
“We’ve been pretty lucky,” said Eaton. Her staff of slightly more than 40 nurses has not needed to be supplemented by contract nurses, she said, though they do have per diem nurses who fill in when needed, such as covering for vacations or sick days.
“That per diem pool helps us absorb some of the slack due to changes, such as someone leaving the job,” said Eaton.
As at BMH, she said, Grace Cottage’s partnership with Greenfield Community College and Vermont Technical College helps to funnel nurses into the hospital’s halls and rooms.
“We have hired a number of employees who performed onsite work here as students,” said Eaton.
To assist in the emergency department, Grace Cottage has hired EMTs and paramedics, many of whom have shown an interest in continuing their education and eventually becoming nurses. Grace Cottage offers reimbursements for educational expenses to those who earn certification and take jobs there.
“We’ve been voted the best place to work in Windham County,” said Eaton, and that helps in recruitment and retention.
“People enjoy working in this team environment,” she said. “And we have a great leadership team here that encourages initiatives designed to take care of our patients and keep our staff engaged. Our job is to support the people in our community, and that includes our employees.”
Eaton also believes nursing can be an incredibly rewarding career.
“There are so many things you can do with a nursing degree,” said said. “You can work in a community hospital, a doctor’s office or a community clinic. There are many avenues to choose from.”
With more than 140 nurses on staff, the Brattleboro Retreat faces the same challenges with a slightly different skill set, said Meghan Baston, chief nursing officer and senior vice president of Patient Care Services.
“The challenge for a specialty hospital like ours comes from the inherent need of the training specific to our specialty,” she said. “All of our nurses are trained in psychology.”
While a registered nurse trained in a typical hospital setting might consider a career at a facility such as the Retreat, said Baston, they need to be trained to respond to patients with mental health issues.
“It’s nice when we get psychiatrically trained nurses, but they are very difficult to find,” she said.
To make up for that lack, said Baston, “we have a quite robust clinical education department providing didactic training.”
And recognizing that the Retreat needs to do more outreach in encouraging qualified nurses to come to or stay in Brattleboro, the Retreat recently hired a recruitment and retention specialist specific to registered nurses.
Baston said that person will be responsible for getting out into the community, promoting the culture of nursing at the Brattleboro Retreat and with creating a residency program.
The Retreat also works with regional nursing colleges.
“We are a robust clinical site for psychiatric nursing in this part of Vermont,” said Baston. “We have upwards of 10 nursing colleges who send students to our site.”
Many of those students end up coming to work at the Retreat, not only because they find its mission rewarding, but also because it provides support to nurses who are interested in their own professional development, she said.
“We work very diligently to insure our staffers have the tools they need to be successful and do their jobs safely and appropriately,” said Baston. “It’s about knowledge and being empowered to think critically and make patient care and clinical decisions.”
The more than 500 Retreat employees represented by the United Nurses and Allied Professionals Local 5086 recently signed a new one-year contract. The agreement includes wages that are above local markets in Vermont and New Hampshire and are competitive with western Massachusetts, said Baston.
“I have been here a year,” said Baston, “and this is the most dedicated staff I have encountered in my 15-year career. They are dedicated to the mission in a way you don’t see very often. They come here every day and they really care about this population and want to advocate for them and do well by them. It felt like such a win to pay them at a wage that is reflective of their value.”
“In many ways this new contract is an historic step forward for the Retreat,” said Daniel Watson, co-president of UNAP Local 5086. “It lays the foundation to address many important issues faced by current staff, while establishing competitive wages to attract much needed new front-line employees. It is a victory for the Retreat, the union, and especially for the patients.”
Adding to the wage increases, the new contract includes provisions to enhance work/life balance particularly around staff scheduling and vacation time.
“We’ve now established wages at or above the regional healthcare labor market for RNs, and our mental health workers will all be earning a minimum of $15 an hour,” added Baston. “We simply feel we’re doing right by the people who do the profoundly meaningful work of caring for our patients, while also re-establishing the Brattleboro Retreat as a highly attractive employer in both local and regional markets.”
Even with the new contract, she said, the Retreat, like other health care providers around the country, is continuously in the market for nurses. But Baston emphasized the collaborative nature of the work the nurses do at the Retreat.
“We are providing true patient-centered care,” she said. “We help folks advocate for themselves in arenas where they can’t do it on their own. That really impacts the outcomes.”
Source: The Associated Press