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Industries across the board are being slammed by labor shortages in the wake of the COVID-19 pandemic, but healthcare facilities across the country are facing a more long-term problem: a nursing shortage.
As of 2018, the most recent year for which statewide data is available, North Carolina employed 120,600 nurses to serve its 10.48 million residents, according to a study by NurseJournal. That breaks down to about 11.5 nurses per 1,000 residents — just below the national average of 11.7.
As of May 2020, 980 registered nurses worked in the Burlington metro area, according to the Bureau of Labor Statistics. For a population of 171,415 people, that's about 5.7 nurses per 1,000 residents.
Contributing factors
Healthcare facilities in the area say this is not enough.
"The nursing shortages ... is a cyclical thing and it comes and goes," said Kenneth Rempher, the chief nurse executive at Alamance Regional Medical Center, said. "We're at a very critical point at this time and I think it's only been exacerbated by the conditions surrounding the pandemic."
The American Association of Colleges of Nursing has identified five main causes for the shortage:
Nursing school enrollment is not keeping up with the demand for nurses;
There are not enough nursing school faculty members to teach future nurses;
The retirement rate for nurses is growing rapidly and over half of the registered nurse workforce is over 50 years old;
An aging U.S. population is creating more demand for nurses than ever before; and,
Insufficient staffing is causing increased stress and burnout for nurses.
Rempher added that Alamance County facilities have an additional challenge posed by the number of academic medical centers in the area creating increased competition for staff.
While ARMC and other Cone Health facilities in the area have "significant pipelines to keep (the hospital) adequately staffed" as well as retention programs for currently-employed nurses, Rempher said vacancy rates still remain a concern.
Kenneth Rempher
Times-News
Cone Health
As of Aug. 20, ARMC had 27 immediate openings for nurses.
"When we talk about the shortage in this area, we're talking about vacancy rates that are a little bit higher than normal. Right now, we're at about a 10% vacancy rate," he said.
The vacancy rate describes the number of vacant job positions.
"It is something that we are dealing with on a daily basis and we have some creative strategies and tactics in place helping us deal with it," he added.
Hospitals are not alone in the shortage, however.
Ed Weeks, executive director of Blakey Hall, an assisted living facility in Elon, said his nursing staff is down about 20%.
"We actually have weathered the storm a little bit better than most," he said. "We're down about 20% ... but I know that a lot of people at a lot of facilities that I talked to were in a lot worse shape than we are."
Nursing homes and assisted living facilities are feeling the same strains as larger healthcare facilities like the hospitals.
"I've talked to people (in the western part of the state) who usually have about 35 employees and they're down to like seven," he said.
The impacts
When healthcare facilities are short staffed on nurses, patient care becomes more difficult or even limited.
"When we don't have enough nurses in a facility, it really does hinder our ability to maximize our inpatient occupancy," Rempher explained. "So if you are short nurses for a particular unit, that means in order to keep our ratio safe and (keep) our nurses at ratios that allow them to produce the highest quality care, we may have to close a few beds."
Patients may also end up waiting longer in the emergency department to be admitted, Rempher added.
"There can be some inconveniences to patients as a result of the shortage," he said.
For Jack Dougherty, a registered nurse in ARMC's general surgery unit, a short nursing staff means more "hustle."
"It's really a matter of having to maybe hustle a little but harder to get things done at the right time," he said.
Regardless of how many patients he is caring for, his shift is only about 12 hours long so he needs to care for all of them within that time frame. This creates busier days and less break time for staff.
"I think the day-to-day sometimes can be more stressful when we have less nurses on the floor," he added. "I can say for sure that me and my colleagues are never going to sacrifice the quality of our care (but) sometimes we have to hustle a bit harder to make things happen for our patients."
At Blakey Hall, the nursing shortage means "plugging holes" to fill gaps and maintain patient care.
"We've actually not been understaffed at all, but it's been close from time to time," Weeks said. "My management team has had to come in and work a shift to cover where they couldn't find somebody to fill that spot or something like that. We've had to do that a lot."
Pandemic pressures
The COVID-19 pandemic has only exacerbated the nursing shortage, Rempher said, contributing to more stress and burnout for nursing staff.
"In some cases, it's energized folks ... but it's also created a great deal of stress for some nurses and I think it's really exacerbated burnout," he said. "For nurses that were stressed before, for some of them COVID has been a really difficult experience and has caused some of them to rethink their career choices."
"We do have nurses across the system that have decided to leave the bedside," he added.
Doughtery said concern over bringing COVID-19 home to his family also added to the stress.
"It's just stressful to worry about it. I'm fortunate (that) we've always had the supplies to keep us protected, but even with your full PPE and vaccination and everything, you can't help but worry," he said.
"I think my overall anxiety level for the past year or so has been higher," he added.
Recruitment and retention
In an effort to overcome the nursing shortage, Rempher said ARMC has focused strategies in two areas: recruitment and retention.
"We recognize that reward and recognition are very important for retention and for recruitment actually," Rempher said.
"We have different ways that we reward our staff through greeting cards and through (a program) called Cheers ... where you can send heartfelt messages to your coworkers (and) leaders can attach monetary value to that," he added. "There is a way for people to be recognized for going above and beyond and that's something we do quite regularly."
Weeks said Blakey Hall has also offered monetary rewards to staff through bonus programs throughout the pandemic.
In terms of recruitment, Rempher said the hospital completes routine assessments of the compensation offered to staff to make sure the facility is on par with the local market.
"We stay consistent with that (and) we're usually in the top tier as it relates to hourly rates," he said.
Similarly, Weeks said the assisted living facility has raised pay rates for some of the hardest-to-fill positions like medication administrators. The facility also did an across-the-board pay raise about a year and a half ago.
"We're hoping that'll draw some more people in," he said. "It's discouraging though because I've heard facilities that are paying people ... a rate that's not going to be attainable to keep for a long term and they still can't keep people coming to work."
Sign on bonuses have also been used at the hospital to boost recruitment efforts, according to Rempher.
"We also offer not only sign on bonuses for nurses, but we also offer referral bonuses for our own nurses," Rempher added.
Those sign on bonuses, Rempher said, are a direct result of the nursing shortage.
"When competition for talent intensified, that was something that (started)," he said. "I've been a nurse for 30 years (and) there have been sign on bonuses for 30 years so its just part and parcel of the process."
Dougherty said the compensation and benefits offered to him at ARMC have never made him want to look elsewhere for employment as he feels they are on par with other healthcare facilities in the area.
"The nursing shortage is something that gets talked about every few years. It was true before I was a nurse and may be true for a while after," Dougherty said. "I just hope if anyone is thinking about nursing ... they could be inspired to just join. I think it is just an amazing and worthwhile profession."
Elizabeth Pattman is the trending topics reporter for the Times-News in Burlington, covering business, COVID-19 and all things trending. Contact Elizabeth (she/her) at epattman@gannett.com. I'm also available on social media @EPattmanTN on Twitter or @burlingtontimesnews on Instagram.
