Even prior to the COVID-19 pandemic, the United States was projected to run short of RNs.2 Baby boomers created more demand for health care, and the national move toward health care reform in recent years has meant nursing schools nationwide have had to expand capacity, according to the American Association of Colleges of Nursing. Nearly two years into the pandemic, hospitals across the United States have felt that shortage acutely, particularly in the dwindling numbers of nurses available to staff emergency departments.
According to a recent American Nurses Foundation survey, 21 percent of 9,572 nurses surveyed last fall said they intended to leave their position, with another 29 percent saying they were considering leaving.3 Of those wanting to leave, 47 percent cited the negative effects of work on their health and well-being, and 41 percent cited insufficient staffing.
“I’d be lying if I tell you we’re doing good,” says Maureen Ramos, MSN, RN, speaking of the exhaustion and burnout nurses are still facing during the pandemic. Ramos is director of nursing in the emergency department at Ben Taub Hospital, part of the Harris Health System in Houston. “I think for the past almost two years now, it’s been hard. These clinicians have burdens they carry from their home life, and they’re expected to be 100 percent all of the time they’re here. I’m in awe of the fact that they come in here 100 percent.”
The pandemic combined with nursing shortages has meant longer hours, higher nurse-to-patient ratios, and protocols that have had to be fluid to accommodate things like personal protective equipment shortages and pivoting on best practices based on the latest information. Another nursing challenge is that the pandemic has made it very lucrative for experienced emergency nurses to get contracts to work through outside staffing agencies. Those working for traveling nurse agencies can make as much as $150–$200/hour, which can be up to five times the amount emergency department nurses make when they are on staff at a hospital. On top of this, some traveling nurses are provided with food, lodging, and bonuses.
“It has been a challenge to keep very experienced emergency department nurses because everyone’s just competing for the same exact manpower I want for my team,” Ramos says.
Not only is Ben Taub Hospital competing with traveling nurse agencies, it is also competing with the many health care institutions in the Houston area. Recruiters from these health care facilities have reached out to the hospital’s staff directly in an attempt to lure them away, and administrators at Ben Taub have had to develop strategies to retain their staff, including tuition reimbursement and big retention bonuses as well as sometimes matching inflated pay for a limited time period.
The same thing has been happening at University of Florida Health Jacksonville. “Our CEO, CNO, and CFO have been very impactful, adding increased salaries and bonuses for staff across the house but especially the COVID units or other hard-to-staff areas,” says Dr. Gray-Eurom, adding that the large increase in salary expense is not sustainable at a safety-net hospital, so it is difficult to know what the future will bring.
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