Short staffed

MARY REICHARD, HOST: Coming up next on The World and Everything in It: hospitals brace for more tough times.

Nearly 2,000 workers at Mercy Hospital in Buffalo, New York traded their scrubs for picket signs on Friday. They said an ongoing staffing crisis is endangering patients and making it impossible for them to do their jobs.

And the healthcare worker shortage in the state appears to be getting worse, not better.

NICK EICHER, HOST: A state vaccine mandate is now in effect for all healthcare workers in New York. That means they must now have at least one dose of a COVID-19 vaccine.

The vast majority of healthcare workers got vaccinated long before the governor rolled out the mandate. But not everyone did: Some quit rather than comply. Others have gone out involuntarily: losing their jobs or being placed on unpaid leave.

REICHARD: But New York is not alone. Healthcare systems nationwide are facing staffing shortages, and a federal vaccine mandate for healthcare workers is looming.

Joining us now with more insight is Dr. Bret Nicks. He is director of the Master of Science in Healthcare Leadership program and a professor of emergency medicine at Wake Forest School of Medicine.

Doctor, good morning!

BRET NICKS, GUEST: Good morning. How are you today?

REICHARD: Doing well. I know this varies from state to state and city to city, but give us a snapshot of the staffing situation nationally. How shorthanded are hospitals in the United States at the moment?

NICKS: Yeah, boy, I tell you it is a complex issue. And most hospitals, if they haven't been feeling it for the preceding years, COVID has certainly made it a whole lot worse. From a national perspective, we have to recognize a couple things. This is almost a perfect storm that we could have predicted in the absence of COVID. Back in 2015, there was a study that predicted that over a million nurses would retire between that time and 2030. Here we are in 2020, where we knew that we had a looming deficit of nurses and now we have not just the increased demand because of COVID and the challenges associated with that, we have an increasing number of retirees within the nursing population. You add to that that a lot of hospitals had been dependent on nurse overtime to go ahead and meet ongoing demands and you add in the complexity and stress associated with COVID that we've been dealing with now for well over a year and a half and people are exhausted. They're tired. And so now what you find is we have a complex health system. We have an aging population that requires a greater breadth of nursing care, not just in hospitals but across the paradigm of health. And at the same time, we don't have a nursing windfall coming out of an educational paradigm. And yet those that have been well educated in practicing and nursing retiring and taking with them that knowledge base, we really do face tremendous challenges right now. And I see it every day in our health system. You hear about issues on the inpatient side of massive medical centers that may have upwards of 1,000 beds, only being able to staff 500 or 600 beds because of shortages.

REICHARD: While many states don’t have vaccine mandates, there are plenty of health systems within those states that do—Wellstar Health System in Georgia, for instance. Are the vaccine mandates a significant cause of worker shortages ?

NICKS: I don't think it's a significant shortage issue. I do think that it's interesting. If you look across most health systems on an annual basis, you have vaccine mandates that are fairly common—things like our influenza vaccine, that unless you have a medical reason not to have it, most systems actually require it. So now we're having the issue around COVID vaccinations and immunizations where you have people that would like to be excluded and go through that process. Even in our health system here, we do have a percent of folks that as the mandate moves forward, we will have them leaving their positions and leaving unfilled positions because of it. Will it have an impact on the ability for us to provide care? Absolutely. Is it a critical number? Well, when you are already stretched to the capacity that we are, any additional loss is critical. The percent is small, but the effects of it will certainly be felt.

REICHARD: What are the other drivers of these staffing shortages?

NICKS: A lot of them really come into the fact that healthcare is difficult. Healthcare is a difficult specialty to go into in the sense of what is expected from a work perspective. A lot of it also has to do with the amount of effort required to get into the practice within healthcare and the longevity associated with it. You know, we will find a lot of components of things where, from a health education perspective, the number that go into that are not adequate to replace the number that are retiring or moving into it number one. Number two, as we look at our aging population, which I mentioned briefly before, we have an increasing number of long term care facilities. We have increasing numbers of outpatient facilities to a degree that is even greater than the number that are coming out of an educational pathway. That educational pathway is required for those to fill the medical center and the clinic basis that exists, but as we continue to expand the pathways that require nursing and other types of healthcare professional expertise, we're not meeting the demand as we continue to grow the underlying offerings. And so, really, it's just incredibly spread thin. Right now, the workforce data sets that are there are really saying that we're probably not going to see relief, at least from a nursing perspective, until possibly 2030.

REICHARD: Well, here’s the million dollar question. What’s the answer here? How can health systems fix the staffing crisis?

NICKS: I don't know that there's an easy answer. I think the reality is, within healthcare itself, we have to recognize that healthcare is a supportive team. And that we need to go ahead and elevate the expertise of those that are practicing. At the same time, let them feel that not only are they valued for the expertise that they bring, but really, when I say elevate the capacity for what they can do, it is also to create opportunities for technicians, nursing assistants, integral use and maybe perhaps new use of paramedics in our space, such that they can provide resources that help to backfill in some of these aspects. I work in the emergency department and on a daily basis, we have areas that are closed down, because we don't have enough nurses to cover those spaces. At the same time, more than half of my operational space is occupied by patients that are boarding. And what that means is they need to be admitted to the hospital, but there are no beds in the hospital for them. And it makes it very difficult for a nurse that goes into emergency medicine to say, boy, I love my job, but I'm not taking care of what I signed up for. And so the question is, how do we improve our operations to make capacity? And in doing so, what ways and perhaps what have we done or what should we be doing in the future that we've not done that helped to offload nurses to do just nursing tasks? Many times nurses are tasked to be a secretary or a phlebotomist or a technician because we don't have the secondary staff to support them. Maybe we need to be investing not just in nurses, but the things that allow nurses to do their job in isolation.

REICHARD: Dr. Bret Nicks with the Wake Forest School of Medicine has been our guest. Dr., thank you!

NICKS: Thank you.

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