State nursing shortage likely caused by low pay

Jan. 26—On Tuesday, as Beckley ARH Hospital hosted the first day of a two-day event to recruit nurses to fill vacancies, the National Guard went into 14 hospitals across the state with 10 reporting to the Beckley hospital.

Charleston Area Medical Center, Greenbrier Valley Medical Center and Princeton Community Hospital in Mercer County are also among the two dozen hospitals in the state that asked the West Virginia National Guard for staffing help during a recent spike of Covid-19 cases.

More than 300 National Guard members have been trained to provide assistance to the state's understaffed hospitals, which Gov. Jim Justice has said are overwhelmed.

Pay, in part, is creating staff vacancies. And the surge of Covid-19 cases this winter is necessitating staffing assistance from the Guard.

A survey from the West Virginia Center for Nursing found that nurses are leaving the state because of how much they are paid.

And last week, West Virginia Hospital Association CEO Jim Kaufman told the West Virginia Legislature Joint Commission on Health that the average hourly rate of pay in the state for a nurse who lives in the state is $30 an hour, compared to the national average of $36, The Herald-Dispatch reported.

State hospitals are paying travel nurses who are recruited from other countries and states $124 to $180 an hour to work alongside West Virginia nurses in state health care facilities.

Beckley ARH Community Chief Nursing Officer Angela Rivera reported Tuesday that rules requiring nurses to be vaccinated against Covid are not a factor in the staff shortage there.

"The simple answer is 'no,'" Rivera said. "Our health care providers have done what is necessary to care for our patients."

Kaufman reported the state has about 6,600 licensed hospital beds, but as of May 2020, only 5,200 were staffed, The Herald-Dispatch reported.

Kaufman said the numbers show the state lost 500 staffed beds from May 2020 to December 2020. He attributed it to health care workers leaving the state, retiring or being out with illness. He said about 40 percent of the state's nurses are 50 or older.

Beckley ARH Community CEO Jill Berry Bowen reported earlier this month that hiring and retention of staff is a priority.

She said that Beckley ARH is seeking local nurses who are invested in the community and that the non-profit hospital is working on a plan for retaining more local health care workers. Like most hospitals in the U.S., Beckley ARH relies on traveling nurses to fill the staffing void.

Bowen agreed with Rivera's assessment that Beckley ARH health care workers are not refusing to work due to vaccine requirements.

"Staff have been all in, and we are grateful," she said. "Only when Covid has affected their families have they had to step away.

"Otherwise, they are doing all things necessary to help take care of our patients."

Jeri Knowlton, ARH communication director, said Tuesday that Beckley ARH had a daily positive test rate on Tuesday of 25.42 percent, with a cumulative positive rate of 7.76 percent. The hospital was providing care for 34 Covid patients, with six Intensive Care Unit (ICU) patients where five were ventilated.

Five patients were a level below ICU in the progressive care unit (PCU), and the remaining 23 were on a general medical floor.

Knowlton said 22 of the patients were unvaccinated.

The New York Times reported that wealthier nations, including the United States, are aggressively recruiting nurses from developing countries in an effort to replenish the work force, which the Covid-19 pandemic has depleted.

The result is an upended migration pattern and questions about the ethics of wealthier nations recruiting skilled health care workers from countries which already have weak health care systems.

About 1,000 nurses are arriving in the United States each month from African nations, the Philippines and the Caribbean, Sinead Carbery, president of O'Grady Peyton International, an international recruiting firm, told the Times. While the United States has long drawn nurses from abroad, Carbery reported to NYT that recruitment to American health care facilities is the highest she's seen in three decades.

She estimated that about 10,000 foreign nurses have job offers in the U.S. They are waiting on American embassies around the globe to set appointments for their required visas.

The nursing shortage in the U.S. is nothing new. In 2019, The American Association of Colleges and of Nursing (AACN) projected that the U.S. was set to see a shortage of Registered Nurses (RNs), which would intensify as baby boomers aged.

Compounding the problem, AACN reported, was that nursing schools around the country were struggling to enroll students at a capacity to meet the rising demand for care.

The American Journal of Medical Quality published in the May/June 2018 issue the report "United States Registered Nurse Workforce Report Card and Shortage Forecast: A Revisit." The publication predicted a shortage of registered nurses around the country between 2016 and 2030, but the publication gave West Virginia, which was listed as a southern state, a grade of B in 2015 for nursing ratio. The same study predicted a grade of C+ in 2030.

Despite the grade of B for the state in 2015, southern counties in West Virginia were already facing a severe nursing shortage then. Rocco Massey, former community CEO of Beckley ARH, reported in September 2014 that while some states had a surplus of nurses, southern West Virginia hospitals did not have enough.

Massey attributed part of the problem to the closure in 2013 of Mountain State University in Beckley, a private college with a nursing program. Both Beckley ARH and RGH were already recruiting traveling nurses in 2014 in an effort to fill the nursing shortage. Massey reported that the agency which supplied the traveling nurses was recruiting from other countries.

Courtney White, marketing coordinator for Raleigh General Hospital in Beckley, said that RGH had "adequate capacity" on Monday but that staffing was short.

"Staffing continues to challenge our hospital and other health care systems nationwide," White noted.

Until Tuesday, the vaccine was required under a rule issued by the Occupational Safety and Health Administration (OSHA) on Nov. 5. OSHA required companies with 100 or more employees to require vaccinations for employees or to wear face coverings and a weekly test.

OSHA formally withdrew the mandate on Tuesday, following a U.S. Supreme Court decision on Jan. 13 which stated that challengers to the rule were likely to prevail.

"Under the former proposed guidelines, our state — and, therefore, our facility — fell under the Occupational Safety and Health Administration (OSHA) Covid-19 vaccination rule," said White. "Raleigh General Hospital takes seriously our responsibility to fulfill all of our regulatory and compliance obligations.

"Receiving the Covid-19 vaccine or submitting an appropriate exemption is a condition of employment for our team members.

"We can confirm we have experienced staffing shortages related to the Covid-19 pandemic," White continued. "Raleigh General maintains confidentiality on all matters concerning our employees, but we can assure you that we continue to follow all of the appropriate CDC protocols for the safety of our staff and patients."

White said that RGH is working to "attract, develop and retain high-performing talent at our hospitals."

She said RGH has seen an increase in the number of emergency room visits, including Covid-related visits. She reported that each patient who enters the ER is given a medical screening and is triaged based on the person's medical emergency status, in accordance with the Emergency Medical Treatment and Labor Act (EMTALA).

White said fewer than 40 Covid patients were hospitalized at RGH Monday.

"Even in the midst of this public health emergency, we strongly urge our community not to delay essential and emergency care," she added. "You may experience longer wait times, but you will be seen.

"If your condition is less severe and not life-threatening, please consider seeking care and treatment at an urgent care clinic or your primary care provider's office so our staff can focus on the most critical needs."

The ARH Recruitment Team will be at Beckley ARH on Wednesday from 10 a.m. to 6 p.m. for the Nursing Career Fair. Some candidates may receive same-day job offers, according to the Beckley ARH Facebook page.