Jul. 5—First of two stories.
Long before COVID-19 arrived in Alaska, the state was in the midst of a nurse shortage. Now, health care industry professionals say the pandemic drew attention to the problem — and, in some cases, may have even made it worse.
"There's a lot of burnout, a lot of stress," said Jared Kosin, president of the Alaska State Hospital and Nursing Home Association.
Many Alaska nurses who were older and more susceptible to severe illness from COVID-19 opted to retire early. Others left the profession altogether.
Kosin and others also described how Alaska's health care workforce has long relied on transient employees from the Lower 48.
During the pandemic, they said, some out-of-state nurses left in pursuit of higher pay or to assist in places with greater need while many who didn't have close ties to Alaska returned home to be closer to family and loved ones.
Some of the nurses who stayed in the profession described the current climate as a kind of crossroads.
"Now that we're hopefully at the back end of the pandemic, we're starting to come down from that adrenaline of the last year, year and a half," said Carrie Doyle, a registered nurse and currently a director at Providence Alaska Medical Center.
"Now that the nurses have time, they really are now starting to contemplate, 'Where am I at my career? Am I where I want to be?' " she said.
A booming market
One measure of the present shortage is how many nursing jobs are available statewide.
A quick job search for nursing jobs at Providence will likely turn up over 100 openings, said Florian Borowski, the hospital's chief human resources officer.
"There's lots of opportunities for people with the registered nurse certificate," he said. That was true before the pandemic, and it's especially true now as the demand for nurses to fill those jobs increases, he said.
At the Alaska Native Medical Center, Dr. Robert Onders, the hospital's administrator, said while demand for nurses has remained relatively consistent during the pandemic, he's recently seen a hospital-wide shift in where the jobs openings are — and which types of jobs remain unfilled.
More job vacancies appear to be opening up particularly for entry-level hospital positions, which has caused starting salaries for those jobs to increase, he said.
"We're feeling that strain: CNAs, CMAs, lab techs, respiratory techs, surgical techs, pharmacy techs — those are all positions that are key on that health care team-based care," he said.
"It's challenging right now because there's lots of opportunities across multiple industries that need people to fill those positions," he said.
A long-standing problem
Alaska health experts say the potential for a worsening nurse shortage both in the state and nationwide has been a top concern for years.
In 2017, a wide-scale study conducted by the federal Health Resources and Services Administration found that there would likely be a significant nursing deficit by 2030 throughout the nation — and especially in Alaska, said Marianne Murray, a director of nursing at Alaska Pacific University in Anchorage.
A root of the problem was that most nurses surveyed belonged to a larger, baby boomer generation that was about five to 10 years away from retirement, the study said. An Alaska-specific piece of the puzzle had to do with the state's geography and schooling options, Murray said.
It's more difficult to travel to and from Alaska than other states, plus Alaska doesn't have as many schools of nursing as other states, according to Murray. "That makes the replenishment of those last positions more difficult," she said.
Alaska has also long been a temporary home for a large number of traveling nurses who come up to the state for short-term postings, she added.
"It's kind of like this constant kind of hamster wheel of trying to fill the hole," Murray said.
Pandemic adds stressors
During the pandemic, the pay and the demand for traveling nurses also increased nationwide as COVID-19 surged. At various points in the pandemic, that demand drew travel nurses away from the state to places with higher case counts and deaths, or more competitive pay, said Donna Phillips, the Labor Program Chair with the Alaska Nurses Association, and a nurse at Providence.
"There's a lot of competition for travel nurses," she said during a recent interview. "The money started flowing for these travel nurses because people were desperate."
The pandemic also drew attention to existing staffing shortages.
"I think even before COVID-19, the health care workforce was an issue and a priority, I think across the state," Onders said. "COVID has made that underlying challenge a little bit worse," he said.
During the pandemic, a constant focus on the number of available hospital beds was a reminder that it was never just about the physical beds, Kosin added: The top concern was staffing. The number of staffed beds was the true measure of hospital capacity, he said.
For nurses, the high-risk, high-stress months of the pandemic also took a toll. Workers had to make choices related to their personal risk factors, Onders said.
"When COVID patients were at a high volume in the hospitals, some people chose to potentially modify or step out of the health care workforce," he said.
Nationally, "we did lose a number of health care workers to COVID that they passed away after they contracted it at work," Phillips added. "People got nervous about that."
She's part of the nurses union at Providence that she says now has about 70 fewer bedside nurses than it did before the pandemic.
"I don't know how many of those people were full time," she said. "But it's still a pretty significant number of people that we don't have working in the hospital any longer."
By June, with about half of eligible Alaskans vaccinated and COVID-19 generally on the decline statewide, many nurses are finally able to catch their breath — and many see this as an opportunity for reflection on their priorities and the kinds of work environments they want.
For Phillips, that looks like advocating for better working conditions and lower patient-to-nurse ratios. She and her colleagues are currently in negotiations with Providence to try to have fewer patients per nurse and enough nurses to watch patients during meals and rest breaks, she said. Phillips has been a nurse in Alaska for over 20 years, and she said the long days and hours can take their toll.
Doyle, one of the Providence nurse managers, said she sees her leadership role as helping nurses "reconnect with why they got into nursing in the first place."
She said she hopes that more Alaskans, post-pandemic, will continue to recognize how meaningful and important nurses' work is.
During the pandemic, "everybody saw how nurses contributed to the health of the society," she said.
Murray, the director of APU's nursing program, said she'd recently read a study showing that applications for nursing schools "skyrocketed" nationally during the pandemic. She's hopeful that renewed interest in the field can begin to help solve Alaska's shortage.
"I think what happened is that people saw that nurses made a huge difference," she said. "I mean, they were at the bedside, they were your frontline workers — fearless and always there. So I think that people recognized that this is a excellent profession."