Story by Dair McNinch
While the healthcare industry was experiencing a nationwide labor shortage well before COVID-19 broke out, the challenges introduced by the pandemic have exponentially exacerbated the issue and forced it into the public eye.
In a survey conducted by Morning Consult in September 2021, nearly 1 in 5 American healthcare workers had quit their jobs since the beginning of the pandemic. More recently, Elsevier Health reported in March that 18% of healthcare workers planned to leave the profession by 2025.
Factors contributing to this exodus of workers range from the pandemic’s strain on the system’s resources, the greater workloads and responsibilities for staff without proportionate compensation, and the emotional burnout that the last few years of these conditions have created.
Across North Carolina, healthcare staff of all types say this combination of factors has created a snowball effect that they’re unsure of how long they’ll be able to withstand.
“There’s been a longstanding shortage of nurses that predates the pandemic, which has been discussed in just about every forum there is,” said Dr. Josie Bowen, an emergency medicine physician in Charlotte. “I think that the pandemic has revealed and uncovered it in a more mainstream way.”
According to the American Association of Colleges of Nursing, nursing schools in the U.S. denied 80,000 qualified applicants from graduate programs in 2019 because of budget constraints and a lack of faculty, classroom space and clinical sites. In addition, the American Health Association found that more than half of all nurses in 2017 were 50 or older, and 30% were 60 or older.
Nurses, however, aren’t alone in this. In 2019, an estimate from the Association of American Medical Colleges reported the U.S. had nearly 20,000 fewer doctors than the country’s healthcare needs required.
Bowen said the effects of the shortage and the pandemic have had dangerous consequences on many hospitals’ efficiency with processing, evaluating, and treating patients.
“If you’re in the emergency department and you already have let’s say 15 nursing vacancies, but now you have three times the volume of patients for what your facility was designed to be able to undertake,” Bowen said. “That could create a situation that could challenge the quality and safety metrics for an emergency department.”
Bowen says the emotional burnout is largely driven by how medical staff are expected to consistently provide the same quality of care under increasingly demanding conditions.
“We went into healthcare to be able to provide compassionate and quality care to our patients with empathy,” Bowen said. “And when we’re consistently stretched thin and inadequately resourced, it just becomes intolerable for some over time and therefore many choose to leave.”
Bowen refers to this concept as “the death of a thousand cuts.”
And not only is the pandemic’s increase in the volume of patients stretching staff thin, it’s also constrained healthcare systems’ resources and their ability to properly compensate and retain workers.
Hospitals have been forced to rely on travel nurses and other contract healthcare workers in order to staff their facilities. But contract work is more expensive and higher-paying than what established employees make, increasing hospital costs and further inhibiting retention efforts.
Melissa Allen, project and operations director at WakeMed’s Cary Hospital, believes that this growing reliance on contract workers in healthcare will be what many hospitals might not be able to survive.
“The expenses around contract staffing, that’s going to be a breaking point for a lot of hospitals,” Allen said. “They’re not going to be able to sustain that and it be reasonable.”
And while the WakeMed Cary Hospital’s Director of Nursing Brigit Piercy believes that all of these issues are impacting recruitment and retainment efforts across the board, she says that anything from the different size and characteristics of the patient population to the levels of resources and support a healthcare facility has leaves them at widely varying levels of risk.
“Take UNC-Chapel Hill, that is a huge health system with a lot of connections from an educational standpoint and from a profit standpoint,” Piercy said. “So what they can offer people from a resource perspective is going to be a lot bigger than some of your smaller hospitals in your outlying areas.”
On the Outer Banks of North Carolina, for example, options are more limited.
With a population that swells dramatically in the summer, the Outer Banks Hospital already depends on hiring high levels of contract staff to meet the demands of the season.
Here, the various issues affecting healthcare workers nationwide are also coupled with the devastating housing crisis the pandemic has brought to the island.
Devereux Grindle, director of quality at the Outer Banks Hospital, said the shift in the market has led to homeowners being able to make large profits from selling long-term rental houses or converting them to AirBnB models. This shift, however, has forced many locals out of their homes with no place to go.
Grindle said that over the course of the pandemic, hospital staff have come together to put feelers out in the community and try to find places to live for employees who have lost their long term rentals. But despite their efforts, they were unsuccessful with many.
These factors have made it increasingly hard for the hospital to recruit and retain staff, which Grindle says has only further extended the season that they’re relying on travel and contract workers to keep their facilities running.
“As far as the pressure and how the healthcare world is changing as a result of the staffing issues goes, I think we’ve just seen the tip of the iceberg,” Grindle said.
