By Deborah Jeanne Sergeant
The pandemic exacerbated the longstanding shortage of bedside nurses. Tougher conditions, supply scarcity, employee illnesses and many sicker patients prompted many hospital nurses to quit the profession or move into a non-hospital role in nursing.
In addition, waves of retiring nurses have also affected the number of hospital nurses, according to Lydia Rotondo, associate dean of education and student affairs at the University of Rochester School of Nursing.
“We have a lot of people aging out,” she said. “Most of our faculty are over 50, so there are fewer educators.”
To properly care for patients, many hospitals temporarily reduced capacity or paused services. Some are still not operating at full capacity, as that would place the patient-to-nurse ratio at unsafe levels. Some also use agencies dispatching travel nurses, which seems to Rotondo a bit like a “shell game,” shifting nurses from working for hospital systems to better-paying traveler positions. Some agencies pay four to five times what regular nurses receive.
“The financial piece is significant,” she said. “Team and culture and expense of orienting people is affected by travel nurses. That’s all part of it.”
A lack of nurses at long-term care facilities further worsens the problem, as sick people who need short-term rehabilitation or long-term care have no place to go and must therefore stay at the hospital longer, filling beds needed by still sicker people.
“We have at any given time 100 ‘boarders,’” Rotondo said. “The lack of ability to get people out of acute care and into LTC over stresses every hospital.”
Rotondo can’t blame people who turn to lucrative travel nursing to pay off school debt. But she added that the tide is beginning to change as students interested in nursing realize that many organizations offer education benefits.
Representing another factor, nursing school applications are down 6 to 7% and Lisa Kitko, dean of the University of Rochester School of Nursing, is not sure why, although she theorizes that the uptick of people applying during the pandemic’s acute period has leveled out once people fully realized the challenges of the work.
She believes that hospital nursing recruitment and retention requires extra creativity.
“Early in the pandemic, we offered a traveling position to our own employees without benefits,” Kitko said. “Salary needs to come down to a happy medium between travelers and the pre-COVID rates.”
Many healthcare organizations are grappling with payrates, as many travelers have been receiving four to five times the rates of non-travelers. But engaging traveling nurses is not ideal for many reasons.
“Right now, obviously, we have to use agencies more than we’d like to,” said Kara Silkiewicz, talent acquisition supervisor and human resources for Finger Lakes Health.
Although they can fill in the gaps, travelers cost more to employ, both through higher administrative overhead and higher wages, and do not tend to contribute to camaraderie and continuity of care with regular nurses. But Silkiewicz said that Finger Lakes Health is working to draw on new nursing program graduates with the lure of tuition reimbursement.
Like many other organizations, Finger Lakes Health also tries to “grow its own” nurses by hiring high school students for entry level nutritional services positions. When they graduate, they can enter the CNA program, then move on to the LPN school and eventually RN education.
Finger Lakes Health also works to hire mid-career job seekers, using social media now more than job fairs, which Silkiewicz said “aren’t as effective anymore. It’s instant now. People want to click and apply and converse through text message.”
Kathy Mills, dean of the college of nursing at Finger Lakes Health College of Nursing & Health Sciences, wants to see New York State allow simulation hours to account for one-third of RNs’ 600 required clinical hours.
“That will open up clinical spots to get students in,” she said. “Right now, it’s bottlenecked. I can only put so many students through. More nurses will be able to be accepted into a program this way.”