Worn out nurses straining hospital budgets

In parts of the country where covid-19 continues to fill hospitals, the rotation of traveling nurses is helping to fully staff intensive care units. Hospitals have to pay handsomely to get this temporary assistance, and higher wages are tempting some nurses to hit the road.

Nearly two years after the start of the pandemic, there is some truth in a joke spread among disaffected ICU nurses: they are asking their hospitals for adequate compensation for the dangers they have been exposed to. And the nurses are rewarded with a pizza party instead.

Teresa Adams said this was exactly what happened at the Ohio hospital where she worked. A facility across town offered bonuses to keep nurses from leaving. But not her. They have a pizza party.

“I’ve heard a lot of noise about ‘Well, this is what you signed up for.’ No, I didn’t sign up for it, ”she said of the unprecedented stress caused by the pandemic.

Adams is an intensive care nurse who helped build and staff a covid unit at one of Ohio’s largest hospitals. She recently moved to California in search of a lucrative job as a nurse.

Traveling nurses undertake temporary assignments to hospitals or other understaffed health facilities. Contracts usually last several months and usually pay more than full-time positions.

Adams hopes to eventually return to her home hospital, although she is now annoyed by the management.

“I didn’t sign up for an institution because I had a calling,” she said. “There is a difference between knowing your calling and knowing your worth.”

Payback may be on the way as hospitals try to stabilize a worn-out workforce.

The use of traveling nurses became popular in the 1980s due to a shortage of nurses. Although they have always been paid more for their flexibility, some traveling critical care nurses can now earn up to $ 10,000 a week, which can be several times more than full-time nurses earn.

While some hospitals offer retention bonuses or increased wages for full-time employees, nurses say that doesn’t compare to the financial health of travel. Hospital managers are now trapped in a costly recruitment cycle – in particular, they are competing for the most highly trained intensive care nurses who can monitor coronavirus patients with advanced life-support devices known as ECMO (extracorporeal membrane oxygenation) machines.

“Our ECMO nurse turnover is incredible because they are the most experienced nurses. And this is what all my colleagues are faced with, ”said Jonathan Emling, Nurse and Director of the ECMO Unit at Ascension St. Thomas in Nashville.

Due to a shortage of ECMO nurses, the hospital cannot admit additional coronavirus patients who need oxygenation of blood outside their body, he said. Regular nurses no longer have the experience to start training.

“We will train these people, and in six months they will go on a journey,” said Emling. “So it’s hard to put that much training and time into them to see them leave.”

And when they leave, hospitals are often forced to fill them with travelers.

“It looks like a patch,” said Dr. Iman Abuzeid, co-founder of Incredible Health, a San Francisco-based nurse recruiting company. “We need it now, but it’s temporary.”

Incredible Health is helping to quickly place full-time nurses in some of the nation’s largest healthcare systems. The number of full-time nursing advertisements on the company’s platform has grown by 200% over the past year.

Some states employ traveling nurses to help hospitals. But for many hospitals, higher costs are draining their budgets, making it especially difficult for those that have paused planned operations – often the largest hospital revenues – to accommodate coronavirus patients.

“Every leader we interact with is under pressure to reduce the number of traveling nurses in their teams, not only in terms of costs, but also in terms of quality of care,” Abuzaid said.

It’s bad for morale too: camaraderie suffers when newbies need help finding syringes or other supplies, but they get paid two or three times as much as nurses showing them the ropes.

Some hospitals are trying to stem turnover by offering large signing bonuses to regular nurses, as well as loan forgiveness or tuition assistance for further education. Hospitals have also increased salaries for nurses as they receive certifications, especially in intensive care units.

Other medical centers are looking outside the US

Michigan-based Henry Ford’s health care system has announced plans to recruit hundreds of nurses from the Philippines. Small public hospitals are also being sought abroad. Cookeville City Regional Medical Center, located in Tennessee with a population of 35,000, is currently recruiting the first foreign nurses.

“The cost of paying a local recruiter to bring one full-time employee is more expensive than what we’re going to spend on one foreign nurse,” said Scott Leti, chief nursing officer at Cookeville Regional.

Leti hopes that overseas employees decide to stay here for more than a year or two. Even new nurses sometimes leave or burn out, he said: Cookeville hired several recent US medical graduates who quit after just a few months.

According to a poll published in September by the American Association of Intensive Care Nurses, two-thirds of ICU nurses of all ages were considering retirement due to the pandemic.

When a nurse leaves – whether in retirement, a transitional nurse, or a job in another field – the remaining nurses can become dangerously thin and care for more patients at the same time. Patients with Covid are particularly demanding, especially those using ventilators or ECMOs, who may require 24/7 individual assistance. Patients with Covid can be hospitalized for weeks or months.

“My ability to care for people has suffered. I know I missed something, otherwise I wouldn’t have missed it if I had time to do it, ”said Kevin Cho Tipton, a leading public health nurse in South Florida. “Many of us feel that our work is getting worse.”

The worry of providing poor quality care is a heavy burden on nurses. But in the end, Tipton says, patients suffer.

This story is part of a partnership that includes WPLN, NPR and KHN.

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