Nurses often juggle a lot of duties at once. So when Donna Corey had to manage the care of a patient one day last week, she didn’t hesitate, even though it’s a job she wouldn’t normally do as a nursing supervisor.
Over the last two years, Corey has had to take on more responsibility, more often. Her colleagues at Riverwood Healthcare Center in Aitkin are doing the same, as they manage pandemic-related labor shortages.
It's the work on top of the work that’s been hard, Corey said. Every shift is a sprint to fill in for missing workers and to care for a crush of ill patients.
“It has been stressful. And as we have nurses out sick, and [with]more community-based needs, those [responsibilities] increase,” she said.
Signs of that extra work are everywhere at Riverwood — like the pager Corey carries with her.
She and her team spent a recent shift trying to transfer a patient who needed a higher level of care to a larger hospital. It’s become a time-consuming and routine part of her daily work as COVID-19 patients stretch capacity at large hospitals that typically accept patients Riverwood is not equipped to care for.
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"I know that [my coworkers] probably called 10 different places last night, and weren't able to transfer [the patient] and now we're starting over today,” she said. "That's a lot of the day on the phone, calling somebody and that takes a whole person to do."
On the tail end of yet another COVID surge, Riverwood serves as a microcosm for the labor shortages hospitals everywhere are juggling — one built upon a health care system that didn’t staff beyond its immediate needs to begin with.
By one national estimate, nearly 1 in 5 health care workers have left the field since the start of the pandemic.
The exodus is fueled by burnout stemming from the pandemic: extra hours to fill in for colleagues; the relentless stream of COVID-19 patients, many of whom have chosen to forgo a vaccine; having to keep patients who need speedy transfers stable for extended periods of time when hospitals are completely full.
Meanwhile, some employees have left permanent jobs for lucrative traveling positions, and their colleagues are left behind to pick up that slack, too.
For rural hospitals, like Riverwood, it’s put into sharp focus struggles to attract new employees prior to the pandemic due to geography, said Mark Holmes, director of the Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill.
“Imagine hiring, say, a respiratory therapist. This would almost certainly mean recruiting from elsewhere, which probably means moving to the town. That’s harder than in an urban area where there are likely [people] more with that training,” he said.
Nowhere to transfer severely ill patients
In every department of Riverwood, a 25-bed critical access hospital, staff said they’ve had to do more with less during the pandemic.
In the hospital’s lab, manager Jake DeZeeuw has two open positions and is down by one employee.
“But when we talk about how we only have eight or nine bodies, one is a pretty good percentage of it,” he said. So his team is “all doing a little bit more with different shifts than what they used to work before.”
DeZeeuw even jumps in when needed.
In the emergency room, chief medical officer Dr. David Taylor said his added stress came from treating patients who need higher levels of care, a byproduct of larger hospitals being clogged with COVID-19 patients and understaffed as well.
“This fall, we had my worst day,” he said, referring to a situation when he and his team managed five patients who all needed to be admitted or transferred immediately.
But there was nowhere for them to go, he said.
During the fall hospital crunch, Taylor said his skills were stretched as he kept patients stable.
“There is a difference between inpatient care and acute care emergency room management,” he said. “And there's a lot of overlap, but I haven't done [inpatient care] since I was just out of residency.”
$10,000 signing bonuses
Meanwhile, Riverwood has lost employees. In 2021, staff turnover was 15 percent — a high watermark for the organization.
People left for a host of reasons, said human resources chief Lee Reichenbach.
"Early retirements, that was a big one,” he said. “Some [left] to take other jobs. In this current landscape, you can walk across the street and get another job at another place just because everybody has needs."
Prior to the pandemic, Reichenbach said it was already tough to find new employees because in small, aging communities like his, there aren't many younger people looking for work.
But now, with 22 jobs open at Riverwood, it's become even more challenging. To attract workers in a highly competitive environment, Reichenbach's team has started using sophisticated online tools to lure even passive job seekers.
And they're offering signing bonuses of up to $10,000 for some positions.
Filling open jobs is critical to the hospital's mission — because during the pandemic, demand for their services has actually grown, said chief financial officer Casey Johnson. The growth is fueled by COVID-19 but also by the volume of aging patients Riverwood serves.
"If you start to lose people, because of this demand, and you start getting an exodus there, you can't take care of people in your community,” he said. “That's what we're trying to avoid."
A turnstile of temporary workers
What Riverwood is experiencing mirrors trends playing out around the country and it has had far-reaching implications for hospital finances.
Complicating matters is the unprecedented shift of hospital staff from salaried positions to traveling positions — highly lucrative, short-term positions that draw scarce medical staff away from their local communities.
It's a challenging dilemma because when people leave hospitals for traveling jobs, those vacancies may be backfilled, sometimes with more traveling providers, said Erik Swanson, senior vice president of data and analytics for Kaufman Hall.
"And then the hospitals, in order to take care of their patients, were required to actually hire those resources,” he said. “That has placed tremendous strain on a number of organizations and rural hospitals alike."
Riverwood lost five staff members to traveling jobs last year, and in early February, had 12 traveling providers on the payroll to help backfill shortages. Normally, the hospital might have one traveling worker at a time.
A contract worker might have been paid 25 percent more just a year or two ago, said Johnson. Now Riverwood typically pays 50 to 100 percent more.
“The situation of travel nurses may be a ‘win’ for nurses who have been underpaid for a long time,” said Emily McCartha, a researcher with the Sheps Center at the University of North Carolina at Chapel Hill. But because traveling nurses tend to make more money than permanent staff, “if they're working on a team with nurses making less but conceivably knowing more at least about the employment setting, [it] can cause tension.”
A ‘gold rush’
That’s been the case at Riverwood.
Contract workers have been essential in giving Riverwood's overworked staff a break, said interim chief executive officer Cindi Baker. But the turnstile of temporary workers has also strained employee morale.
"They know that that traveler is making more money than they are and they feel like they're probably doing a superior job because they know the way here,” she said. “There's a gap there."
In the emergency room, nurse manager Drew Van Santen said the cycle of losing staff to travel positions only to hire more represents an “absolute gold rush."
"People are making ridiculous sums of money to do the same work that they were doing at their primary location,” he said. “I'm happy for you on one side. But at the same time, what other areas are suffering as a result of your departure?"
For the Riverwood staffers who have stayed through the pandemic, the departure of colleagues and the additional work stemming from COVID has been the most stressful part of the job.
A hopeful sign
Back on the hospital floor, nurse Donna Corey finally got some good news around lunch time: A larger hospital sent a helicopter for the patient she had been trying to transfer.
She said it was a relatively quick turnaround time given the long waits patients have faced this winter — and a sign that maybe, the latest wave of COVID is starting to ebb.
“We're always optimistic, but then it seems like the ripple comes back,” she said. “So hopefully, hopefully it is.”