'Nursing abyss': Nationwide nursing shortage continues to affect local healthcare
If the invaluable nature of nursing wasn't clear before 2020, for most of us, the pandemic made the term "frontline worker" take on a whole new meaning.
Healthcare systems were forced to switch gears rather quickly to handle an unprecedented number of ill patients during the pandemic. Nurses were working extra shifts, communicating with families who were unable to visit their sick loved ones, and testing and eventually vaccinating for COVID-19. For nursing aides, phlebotomists, technical workers and most others working in hospitals, it was all-hands-on-deck.
"We came together and took on roles outside of our job description," said Kristen Plutko-Ronosky, stroke program manager at Allegheny Health Network Wexford Hospital. "We became vaccinators. We were working at COVID clinics doing nose swabs, doing testing for COVID. In addition to that, we became the lifeline between patients and families. It was a closed environment so it was up to us to update you on how your family member was doing.
"I don't think anyone was ready for the pandemic, but we got ready quickly," she said.
Nurses were the backbone of the pandemic. Healthcare heroes, grappling with the nature of an unknown, deadly virus and juggling to care for an influx of patients, all while functioning with a nationwide nursing shortage that created additional stressors to hospital systems.
"When looking and working through the nursing shortage, is it challenging? Yes. But we do it and we'll continue to do it," said Plutko-Ronosky. "Being short-staffed during all of this, we were pulled to other units, stayed over, worked extra hours. We continue to do it and we work through it."
COVID pandemic made situation worse
While the nursing shortage was made more visible over the last two years, those in the industry have been feeling the weight of dwindling staff for years.
Linda Homyk, vice president of Patient Care Services and chief nursing officer of Heritage Valley Health System, said Heritage Valley had been feeling the shortage before COVID began.
"It was starting and we anticipated this because of our aging workforce," she said. "We knew we were going to have a post-baby boomer nursing shortage."
Currently, the U.S. has the highest number of citizens over 65 than any other time in history. Approximately 1 million registered nurses are older than 50, according to a recent study, which could mean one-third of the workforce will likely reach retirement in the next 10 or 15 years.
According to the Bureau of Labor Statistics, nearly 200,000 nurse openings are projected to be available each year through 2029, and that includes retirements and those exiting the workplace.
Additionally, the general population is aging, which could mean an increased need for health services for the elderly that could continue to drive the ever-increasing need for nurses and other healthcare and hospital workers.
But studies consistently show increased burnout as a result of the pandemic, which means fewer people are pursuing nursing, and even more are leaving.
A recent survey conducted by the American Association of Critical-Care Nurses asked 6,000 acute and critical care nurses about the impact the last 18 months have had on their profession.
Of those surveyed, 92% said they believed the pandemic depleted nurses at their hospitals and 66% feel their experiences during the pandemic have caused them to consider leaving nursing.
"I've been a nurse for 41 years. To be honest, I've seen nursing shortages in my career. This is sort of a nursing abyss. I've never seen this bad of a nursing shortage in my career," said Elaine Strouss, dean of the School of Health Sciences at the Community College of Beaver County. "It's no longer a nursing shortage; it's gone way beyond that."
Many nurses who had children didn't want to work in the hospital for fear of bringing COVID home to their children. Others had to stay at home with their children when youngsters were doing virtual learning. Older nurses were cashing in their retirements early when the pandemic hit. And others left the fear entirely due to burnout or decided to opt for virtual nursing.
"So many people took retirements early, and the shortages were also related to childcare," Homyk said. "Nursing is a heavily female donated world, and some had to help their students with school. So we saw people decrease time because of that. And we also saw people just change careers, work from home opportunities. That really affected hospitals."
Nursing burnout is often linked to long hours, lack of sleep, high-stress environments, lack of support and emotional strain from patient care. Those who work in critical or end-of-life care are especially prone to burnout due to low recovery and high mortality rates of patients, the University of St. Augustine for Health Sciences found. Additionally, nurses who work in a 1:4 nurse-to-patient ratio have increased burnout, raising the risk by 23% with each additional patient.
The uncertainties of COVID exacerbated these already concerning burnout projections. But nurses pushed continued to do their jobs in spite of the stressors.
"Nurses are really resilient," Homyk said. "It takes a special person to be a nurse."
Hospitals offer incentives
Local hospital networks are creating incentives to not only hire new nurses but to retain current staff.
Allegheny Health Network recently raised its minimum base salary rate for bedside registered nurses to $30 per hour with current bedside registered nurses receiving an increase to main differentiation between experience levels.
Claire Zangerle, chief nursing executive, said in addition to fairly compensating nurses, AHN is trying to maintain the hospital culture for employees. With hundreds of agency nurses coming through the hospital, Zangerle said maintaining culture is to ensure current employees are respected and have a positive work environment.
"We have to reimagine, refocus and retain, and look at the culture of these units to make sure we are staying within what we say our culture is," Zangerle said. "We want to work on the culture and recognition of our staff."
In addition to enhancing the base rate for nurses, AHN is accelerating its merit increases, increasing its incentive payments and offering base pay increases for clinical and non-clinical roles, including a $15 minimum wage for all AHN employees.
The hospital system also offers loan or tuition forgiveness for May 2022 graduates of AHN's West Penn School of Nursing and Citizens School of Nursing in exchange for a three-year commitment to work as direct care or bedside with AHN.
A majority of students graduating from AHN's two nursing schools are interested in the loan and tuition forgiveness program, Zangerle said, and the system is expecting an 80% retention rate.
In Beaver County, Heritage Valley offers sign-on bonuses for nurses who agree to commit two years to the health system, as well as tuition reimbursement and education assistance to help students complete or go back to school.
"Once you get in the door, there are opportunities available," said Homyk, who was born and raised in Beaver County, first attended school at the Community College of Beaver County, and has been with Heritage Valley for 42 years.
She feels passionate about community healthcare and is proud to serve her neighbors.
"It's about giving back to those you live by and work with," Homyk said. "Healthcare gives everybody a good solid career, great pay, good benefits, and when you get into it there is an opportunity to grow and do more."
It starts with quality education
CCBC's approach to educating nurses begins in high school.
The community college's Health Academy allows high school juniors and seniors to begin their journey into healthcare. Students can earn up to 28 college credits to be used towards a degree at CCBC or another college institution.
"It's a whole year's worth of college they would have done and out of the way," said Carolyn Iorio, Health Academy Champion. "It provides a guided pathway into high-demand careers in the healthcare field."
Students enrolled in the Health Academy spend part of their day with CCBC taking gen-ed college courses and then the rest of their day at their high schools. The program has around 50 students.
CCBC's School of Health Sciences, where students can become nurse aides, phlebotomists, registered nurses, radiologic technologists, and more. The school partners with Heritage Valley, where students complete clinical hours. Many CCBC students also work part-time at Heritage Valley.
Once students complete their first semester of clinicals and are patient care associates, they are able to get experience at the bedside. If those same students work with Heritage Valley after graduation, their time spent working as a student will count towards their experience in the field.
"They'll have experience at the bedside and they get early exposure," Homyk said.
CCBC encourages continual education. In the healthcare industry, many hospitals, like AHN and Heritage Valley, will pay for their employees to further their education.
"They can come into the associate program as a licensed practical nurse and then become an RN, and then go on from there," Strouss said. "CCBC is not your last stop."
CCBC also has an articulation agreement with four-year universities in the region so students can take classes at CCBC and then transfer to a four-year program.
"We try to make things very accessible for students," Strouss said.
Although CCBC saw a slight decline in students interested in nursing since the pandemic — from approximately 200 to 150, Strouss said — new students continue to enroll in the college's nursing programs. And area hospitals reach out to CCBC for its graduates.
"We get calls in the fall semester, a good six months before graduation, so everyone is really interested in our students because they're good. They've proven to be good nurses," Strouss said. "Our program is rigorous because we want to put good nurses out there."
Iorio said she was especially encouraged by her high school students in the Health Academy program during the pandemic. Many health professionals feared fewer students would be interested in pursuing nursing given the nature of a volatile pandemic and the stress of the job. But Iorio said that wasn't the case at CCBC's Health Academy.
"There was always that worry with COVID that it would deter students from wanting to become nurses," she said. "I was actually surprised because my students throughout the pandemic and the past two years, they wanted to help. They still want to get into these nursing programs and different healthcare programs because they want to help."
"We are in desperate need of nurses. I think it's fantastic our teens are seeing that and wanting to help their communities," Strouss said. "Our future for healthcare is dependent on these folks."
Plutko-Ronosky said nursing is a unique and diverse industry that has a wide variety of different specializations.
"Nursing is that forever career. You can pivot; you can work different shifts. It's a profession you can do a lot in — OB, pediatrics, geriatrics. You don't just have to be a floor nurse, but you do have to get your feet wet," she said.
She believes nurses still in school would benefit from more hands-on opportunities and transparency about what the job could look like each day.
"We focus on the textbook level, but it needs to be the real-world level as well. Preparing for the real world," Plutko-Ronosky said. "You may be on one unit but be pulled to another unit. This is your job description, but you may be called outside of this. We need to tell our nurses that and better prepare them. I think it needs to start at an academic level."
Driven to serve
Growing up, Plutko-Ronosky wanted to be a veterinarian.
"I always said the animals needed me," she said.
But when her grandmother suffered a heart attack at a young age, Plutko-Ronosky spent time by her grandma's bedside at the old Aliquippa hospital, and her young mind started turning.
"I saw the difference the nurses made in her everyday life," she said. "The medical field was where I saw myself."
After graduating from Center High School, she began her path to the medical field and never looked back. Plutko-Ronosky is currently the Stroke Program Manager at Allegheny Health Network's new Wexford Hospital. She has been a nurse for 18 years, acquiring several degrees, including her master's, and certifications along the way, and has worked in stroke care for nine years.
"It is a privilege to do what you love every day," she said. "Nursing is not for the faint of heart. It has to be a career you're driven to do. Not every patient is going to remember your name, but they will remember what you did for them."
Dani Fitzgerald is the community features and health reporter with the Beaver County Times. Reach her at dfitzgerald@timesonline.com. Follow her on Twitter @dfitzgeraldb.
This article originally appeared on Beaver County Times: Nursing shortage continues to affect local healthcare
