Early in the COVID-19 pandemic, hospitals worried about not having enough personal protective equipment and ventilators. Now, 18 months into the pandemic, hospitals said a shortage of healthcare workers is as bad as it has ever been.
Turnover has gone up in recent months. Hospitals are struggling to recruit new employees and still retain the ones they have.
"I don't know of any major health care system in North Carolina right now that is not facing triple-digit shortages in terms of nursing personnel," Dennis Taylor, a registered nurse at Wake Forest Baptist Medical Center in Winston-Salem and president of the N.C. Nurses Association, told the News & Observer.
Shortages come as hospitals are pushed to capacity by a surge in COVID-19 patients. Statewide, the number of people hospitalized with the respiratory disease has grown from fewer than 400 in early July to 3,651 on Friday, according to NCDHHS.
Hospitals are hurt by the same labor shortages affecting restaurants, hotels and other businesses.
After a recent spike in departures, the UNC Health system alone has more than 1,000 openings for registered nurses across its 12 hospitals.
"Mentally, physically, emotionally, it's exhausting," nurse Erick Gonzalez said. "It doesn't seem to stop. It just seems like it's progressively getting worse. I think I speak for a lot of us, it can be draining."
In a survey, Nursing Solutions Inc. found that hospital staff turnover nationwide was 17.8% in 2019, then rose to 19.5% in 2020, the first year of the pandemic. Turnover in registered nurses at hospitals rose from 15.9% to 18.7%. And that was before the second wave of COVID-19 hit this year.
CUTBACKS IN CARE
Hospital leaders are making adjustments hour by hour. Some hospitals are postponing non-emergency procedures or temporarily leaving beds empty because they cannot be staffed.
"With the increasing capacity demands because of the COVID surge, we are looking at ways to add more space for inpatients," UNC spokesman Alan Wolf wrote in an email. "That ability to expand is hampered by staffing resources."
NOT A NEW PROBLEM
Hospitals have long struggled to hire enough workers. That's particularly true in the Triangle, where a growing population helps drive up demand for health care. As the big three health systems open up new hospitals and clinics and expand their existing ones they must hire additional workers each year.
"Basically there was a shortage already," Fuchs said. "COVID just complicated it, just made it worse."
MORE 'TRAVELING' NURSES
One complicating factor in the staffing at hospitals is the role of travel nurse agencies, which recruit nurses and temporarily hire them out to hospitals where and when they're needed. As turnover increases, hospitals are leaning more on traveling nurses, said Jeronica Goodwin, WakeMed's senior vice president of human resources.
"We have increased our nurse agency use like everyone across the Triangle has," Goodwin said. "I don't think any hospital across the nation could function right now without travelers."
But traveling nurse agencies also help increase hospital turnover, because they pay so well. Fuchs says Duke lost 100 nurses in three months last winter to travel agencies.
RAISES, BONUSES AND MORE
Duke and UNC are offering up to $25,000 to pay off student loans for new hires, as well as relocation expenses and hiring bonuses. Fuchs said Duke is offering a $15,000 signing bonus for experienced nurses for the first time in 25 years.
Hospitals are also working to hang on to the workers they have. They're offering more flexible hours and assignments and providing more opportunities and bonuses for continuing education and training. Duke stresses its supportive work environment, including adequate staffing levels of nurses and assistants so people don't feel as stressed.
"We really try to focus on having a good environment for people to practice," Fuchs said.