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How did we get here? Inside Maryland’s dire nursing shortage

Nurses at work at the Anne Arundel Medical Center in Annapolis. While nursing shortages have long been an issue for American hospitals, many in health care consider the current nursing shortage to be among the most severe that they’ve ever seen. (Submitted Photo)

$30,000 retention bonuses. Daily emails from competitors, offering you as much as four times your current salary. Workers being asked to graduate early or work in a different state than the one in which they’re licensed, all to fill high-demand openings.

No, this isn’t Wall Street. It’s the cutthroat world of nursing.

Maryland and the nation are experiencing a massive nursing shortage, exacerbated by the ongoing effects of the COVID-19 pandemic, causing hospitals and the state to take extreme measures to retain and recruit nurses.

But while nursing shortages have long been an issue for American hospitals, many in health care consider the current nursing shortage to be among the most severe that they’ve ever seen.

“I’ve been in health care leadership since 2000 and been through a lot of cyclic shortages in my career, and I think this one is going to challenge the industry more than any other previous nursing shortage we’ve had,” said Leslie Simmons, chief operating officer and executive vice president for LifeBridge Health.

The question is, why? Though the nation is currently experiencing a surge in COVID-19 cases (though, in Maryland, case numbers seem to be on the decline once again), there have been other points in the pandemic that seemed like they would have been harder on hospitals, such as early in 2020, before doctors fully understood how to treat COVID-19, and last winter, as cases, deaths and hospitalizations all soared to their all-time peaks.

So, why has the current phase of the pandemic been, arguably, one of the worst in terms of hospital staffing?

There’s no single, concrete answer. For many nurses, the stressors of the pandemic, from emotional burnout to unsustainable hours, are finally coming to a head after 20 months; for others, tempting offers from travel nursing agencies or even work in other industries are drawing them away from staff nursing positions.

But regardless of the causes of the shortage, one thing is clear: Hospitals are struggling to find solutions.

 ‘Doing the work of at least a half of another person’

Burnout, or the experience of being fatigued due to intensive working conditions, is nothing new for nurses. But during the pandemic, that fatigue has only gotten worse as nurses and other front-line staffers have been forced to work increased hours, put their lives on the line to care for sick patients, at times without adequate personal protective equipment, and witness a significant number of patients pass away from COVID-19.

That stress has led to an increased number of nurses leaving the profession altogether.

“Their resilience has been sorely tested, and unfortunately, some have chosen to step away,” said Bob Atlas, president and CEO of the Maryland Hospital Association.

It’s a vicious cycle; the more nurses leave, the more pressure is placed upon those who stay in their jobs. One intensive care unit nurse, who asked to remain anonymous to protect her job, said there are around three patients per nurse in the ICU, whereas the ratio is supposed to be two to one.

‘We’re recruiting international nurses. I’m working with four agencies right now to try to bring them in, but so is every other health system,’ says LifeBridge Executive Vice President Leslie Simmon. ‘So, we’re all sort of competing for those same resources.’ (Submitted Photo)

“(We) are doing the work of at least a half of another person,” said the nurse, who works in a Prince George’s County hospital.

This has been further exacerbated in the current stage of the pandemic; not only are COVID-19 cases high, but patients are catching up on health services they delayed throughout the first year of the pandemic, leading to an increased demand for care, Atlas noted.

Additionally, during previous phases of the pandemic, different parts of the nation were experiencing different levels of transmission, allowing nurses to work where they were most needed. However, throughout the fall, as case counts grew nationwide due to the emergence of the highly transmissible delta variant of the virus, the talent pool was spread extremely thin.

For nurses who were already considering retirement or a change in careers, this increased pressure has pushed them to make those jumps earlier than they otherwise may have. Other nurses are trying to ease their stress levels by decreasing the number of days they work, perhaps switching from working three 12-hour shifts per week to only one.

Factors motivating the overall exodus from the workforce — especially by women, who make up the majority of nurses — are also contributing to the nursing shortage. Women who are unable to find affordable child care, for instance, are quitting in order to stay home with their children.

And although the number is small, there are nurses leaving their jobs due to being unwilling to receive the COVID-19 vaccine and who do not qualify for a medical or religious exemption. Health care workers in Maryland are required to be vaccinated.

The team at LifeBridge is trying to work with around 400 employees, half of whom are clinical staff, who still will not either get the vaccine or submit to regular testing, Simmons said in an interview earlier this month. Those who don’t comply will be terminated.

“We are praying that we can continue to work with those people and change their minds,” she said. “We don’t want to lose a single one.”

 ‘Too good’ to pass up 

Other nurses aren’t leaving health care altogether, but they may be leaving their staff nursing jobs for higher-paying careers with travel nursing agencies. These agencies previously attracted nurses who were interested in seeing different cities across the country, according to Diana Wylie, vice president of business development for Chesapeake Medical Staffing, an agency with an office in Timonium.

‘We cannot keep burdening the health care industry with rates as high as they are now,’ she says Diana Wylie, vice president of business development for Chesapeake Medical Staffing. ‘At some point, as an industry, we have to come together and say, “what is a reasonable wage?’” (Submitted Photo)

But now, with nurses in such high demand amid the pandemic, the salaries for travel nurses have skyrocketed, with some even offering three or four times what staff nurses at hospitals make; a registered nurse working for an agency can make up to $150 an hour, Wylie said. This immense surge in rates is now the main factor influencing nurses to become travel nurses.

“The financial benefits of traveling right now are almost too good for most nurses to pass up,” she said.

It’s been a challenge for hospitals; many are seeing their nurses leave their jobs to work for agencies, only to have to shell out large sums to contract travel nurses to fill their positions.

According to Simmons, agencies are doing everything they can to recruit nurses, including some that are willing to match the $30,000 retention bonuses that LifeBridge hospitals offered nurses that agreed to stay with the health system for three years. The ICU nurse also noted that she and her fellow staff nurses are constantly inundated with emails from travel nursing agencies offering incentives for them to sign on.

“’If I can make three times as much money as I’m making right now doing the same thing, why wouldn’t I?’ I think that’s the thought process of many nurses,” said the nurse, who is a staff nurse herself.

Wylie said that Chesapeake Medical Staffing is not trying to “price-gouge” hospitals; after all, hospitals are their clients, contracting out the nurses that agencies recruit, vet and hire. She attributed the salary increases to supply and demand, also noting that, now that nurses have seen the prices some agencies are able to offer, many have decided they are unwilling to settle for less.

Still, she said, it’s undeniable that the current situation is unsustainable over the long term.

“We cannot keep burdening the health care industry with rates as high as they are now,” she said. “At some point, as an industry, we have to come together and say, ‘what is a reasonable wage?’”

Competing for the same resources 

In Maryland, the state government has made moves to address the nursing shortage; since early in the pandemic, nursing students at some institutions have been able to “exit early” to join the workforce a few weeks before they otherwise would have.

Hospitals and state officials have been working together – with some success — to try to ease the nursing shortage, says Sherry Perkins, president of Anne Arundel Medical Center. (Submitted Photo)

Gov. Larry Hogan recently announced that nursing students would have more flexibility to work in hospitals as those institutions see fit. Additionally, for the duration of the COVID-19 public health emergency, RNs and licensed practical nurses who hold a current active license in any other state or jurisdiction are allowed to work in Maryland.

These solutions have been helpful, according to hospital and health care leaders in the state.

“(These measures) are great examples of the Maryland Hospital Association, of our state administrative leaders working together to remove obstacles,” said Sherry Perkins, president of Anne Arundel Medical Center.

At the same time, Simmons noted, all the hospitals in the state are now competing to draw from the same pool of LPNs, nursing students, and out-of-state and international nurses as one another.

“That funnel is not as big as it needs to be,” she said. “We’re recruiting international nurses. I’m working with four agencies right now to try to bring them in, but so is every other health system. So, we’re all sort of competing for those same resources.”

Hospitals have made internal efforts to recruit and retain nurses; Luminis Health, the parent company of AAMC, recently unveiled a significant number of new salary and benefit offerings for all employees, including nurses and other high-demand clinical positions. At LifeBridge, bonuses of up to $30,000 are being offered to nurses who agreed to stay for three years.

Simmons said these bonuses, along with other benefits, worked initially to improve the hospital system’s turnaround numbers, but the impact lessened when the offers from travel nursing agencies became too tempting. Perkins, meanwhile, reported that AAMC is currently able to hire nurses at a higher rate than they are leaving.

Ongoing factors that were contributing to nursing shortages in the state prior to the pandemic, such as the fact that the nursing workforce is aging and there aren’t enough nursing educators to train the next generation of nurses, will also need to be addressed in order to improve the situation.

“This is an ongoing problem that we thought would have stopped by now and it hasn’t,” said the ICU nurse. “It’s going to take very creative problem solving to fix this crisis because it’s affecting nurses, it’s affecting patients, it’s affecting community members.”