Hospitals Are Paying Billions To Recruit Nurses In The Face Of Looming Shortage

By 2024, there will be more than one million job openings for registered nurses.
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MORGANTOWN, West Virginia (Reuters) - A shortage of nurses at U.S. hospitals hit West Virginia’s Charleston Area Medical Center at the worst possible time.

The non-profit healthcare system is one of the state’s largest employers and sits in the heart of economically depressed coal country. It faces a $40 million deficit this year as it struggles with fewer privately insured patients, cuts in government reimbursement and higher labor costs to attract a shrinking pool of nurses.

To keep its operations intact, Charleston Medical is spending this year $12 million on visiting or “travel” nurses, twice as much as three years ago. It had no need for travel nurses a decade ago.

“I’ve been a nurse 40 years, and the shortage is the worst I’ve ever seen it,” said Ron Moore, who retired in October from his position as vice president and chief nursing officer for the center. Charleston Area Medical’s incentives include tuition reimbursement for nursing students who commit to work at the hospital for two years.

“It’s better to pay a traveler than to shut a bed,” he said.

Hospitals nationwide face tough choices when it comes to filling nursing jobs. They are paying billions of dollars collectively to recruit and retain nurses rather than risk patient safety or closing down departments, according to Reuters interviews with more than 20 hospitals, including some of the largest U.S. chains.

In addition to higher salaries, retention and signing bonuses, they now offer perks such as student loan repayment, free housing and career mentoring, and rely more on foreign or temporary nurses to fill the gaps.

The cost nationwide for travel nurses alone nearly doubled over three years to $4.8 billion in 2017, according to Staffing Industry Analysts, a global advisor on workforce issues.

The burden falls disproportionately on hospitals serving rural communities, many of them already straining under heavy debt like the Charleston Area Medical Center.

These hospitals must offer more money and benefits to compete with facilities in larger metropolitan areas, many of them linked to well-funded universities, interviews with hospital officials and health experts show.

Along West Virginia’s border with Pennsylvania, university-affiliated J.W. Ruby Memorial Hospital in Morgantown is spending $10.4 million in 2017 compared with $3.6 million a year earlier to hire and retain nurses.

But these costs are part of the facility’s expansion this year, including adding more than 100 beds as it grows programs and takes over healthcare services from smaller rural providers that have scaled back or closed.

J.W. Ruby, the flagship hospital for WVU Medicine, offers higher pay for certain shifts, tuition reimbursement, $10,000 signing bonuses and free housing for staff who live at least 60 miles away.

Next year, the hospital is considering paying college tuition for the family members of long-time nurses to keep them in West Virginia.

“We’ll do whatever we need to do,” said Doug Mitchell, vice president and chief nursing officer of WVU Medicine-WVU Hospitals. 

Not like other shortages

Nursing shortages have occurred in the past, but the current crisis is far worse. The Bureau of Labor Statistics estimates there will be more than a million registered nurse openings by 2024, twice the rate seen in previous shortages.

A major driver is the aging of the baby boomer generation, with a greater number of patients seeking care, including many more complex cases, and a new wave of retirements among trained nurses.

Industry experts, from hospital associations to Wall Street analysts, say the crisis is harder to address than in the past. A faculty shortage and too few nursing school slots has contributed to the problem.

Hospitals seek to meet a goal calling for 80 percent of nursing staff to have a four-year degree by 2020, up from 50 percent in 2010. They also face more competition with clinics and insurance companies that may offer more flexible hours.

Healthcare experts warn that the shortfall presents risks to patients and providers. Research published in August in the International Journal of Nursing Studies found that having inadequate numbers of registered nurses on staff made it more likely that a patient would die after common surgeries.

UAB Hospital in Birmingham, Alabama, has invested millions to attract nurses, but still has 300 jobs to fill. At times, nursing vacancy rates in some of its departments has hit 20 percent or higher.

“We’ve rarely canceled a surgery or closed a bed because of lack of staffing,” said Terri Poe, chief of nursing at the hospital, the state’s largest, which serves many low income and uninsured residents.

Last year, the medical center covered nearly $200 million in unreimbursed medical costs for patients. It spent $4.5 million for visiting nurses during fiscal 2016, including $3 million for post-surgery services, compared with $858,000 in 2012.

Healthcare labor costs typically account for at least half of a facility’s expenses. They jumped by 7.6 percent nationally last year, after climbing at a rate closer to 5 percent annually in recent years, said Beth Wexler, vice president non-profit healthcare at Moody’s. The spending has proven a boon for medical staffing companies like AMN Healthcare and Aya Healthcare.

Missouri’s nursing shortage reached a record high in 2017, with almost 16 percent - or 5,700 - of positions vacant, up from 8 percent last year. Thirty-four percent of Missouri registered nurses are 55 or older.

“Our biggest challenge is getting the pipeline of experienced nurses,” said Peter Callan, director of talent acquisition and development at the University of Missouri Health Care in Columbia, which is expanding. “There are fewer and fewer as people retire.”

Last year, the academic medical center hired talent scouts to identify candidates, Callan said. It spends $750,000 a year on extras to attract and keep nurses, including annual $2,000 bonuses to registered nurses who remain in hard-to-fill units and up to five years of student loan repayment assistance. It offers employee referral bonuses and a chance to win a trip to Hawaii.

Smaller hospitals find it much harder to compete in this climate. More than 40 percent of rural hospitals had negative operating margins in 2015, according to The Chartis Center for Rural Health.

In rural Missouri, 25-bed Ste. Genevieve County Memorial Hospital had to offer signing bonuses, tuition reimbursement and pay differentials when staffing is “critically low” in units such as obstetrics.

They haven’t closed beds, but have hired less experienced nurses, raised salaries and turned away at least one patient who would have been in its long term care program.

“We’ve had to try whatever it takes to get nurses here,” said Rita Brumfield, head of nursing at the hospital. “It’s a struggle every day to get qualified staff.”

To see the entire graphic on the U.S. nursing shortage, click http://tmsnrt.rs/2xQ9Y0K

 

 

(Editing by Michele Gershberg and Edward Tobin)

Before You Go

Birth Photos That Celebrate Labor and Delivery Nurses
(01 of22)
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"As a doula and birth photographer I always want the best care for my clients. Nurses can play a huge role in a women's birthing experience. Sarah Deitrich, an R.N. at Sutter Maternity & Surgery Center in Santa Cruz Ca, goes above and beyond with every patient she cares for her. Her kindness and expertise is like no other in her field. I know when my birthing mamas are in her care they will feel loved, supported, and respected. It is always a privilege when I get to work alongside her." (credit:Paige Driscoll/Santa Cruz Birth Photography & Doula Services)
(02 of22)
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"And she turned around presenting the most beautiful creature they had ever laid eyes on!" (credit:Elliana Gilbert)
(03 of22)
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"Student midwife Kathy labored for over twenty hours, and L&D nurse Jen stayed by her side for hours. During the course of labor, they chatted and found out they were actually neighbors and are now great friends. What a wonderful way to start to a friendship!" (credit:Colette Hoekstra/Coco Photography)
(04 of22)
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"Mom was having a difficult time effectively pushing. The midwife and L&D nurse decided that the towel pull technique would be the best thing to try. This nurse was amazing! She not only stabilized the mom's foot, she also pulled with the incredible strength, helping her successfully deliver her nine pound, five ounce son." (credit:Erin Monroe)
(05 of22)
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"This was actually the nurse's step grandson. Her husband passed away a couple of years prior to the birth, so it was very emotional." (credit:Laureen Carruthers Photography)
(06 of22)
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"This amazing mama welcomed two sweet boys. Each with a their own nurse." (credit:Kourtnie Elizabeth Photography)
(07 of22)
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"This image shows a nurse comforting a mother after the sudden loss of her baby. It’s a sad story but sheds light on a very caring nurse, who is shown here gifting this mom with a silver heart charm (in her hand)." (credit:Leilani Rogers)
(08 of22)
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"This mama had a great birth team. Here, the nurse is attaching a mobile fetal monitor so the mama could move around. She welcomed her second baby boy to the world shortly after this photo was taken." (credit:TC Birth Photographer)
(09 of22)
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"This tiny baby was born via C-section at 25 weeks, and cared for diligently by her amazing team of nurses. You can tell they love their job!" (credit:Capturing Joy Birth Services)
(10 of22)
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"Mom had been in prodromal labor for two days, but this nurse managed to reassure her that everything was fine. She had such a loving way to talk and add a bit of humor to her presence. And she she spoke, mom started to cry healing cathartic tears." (credit:Diana Hinek)
(11 of22)
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"The midwife in the image was so calm and centered on KS at all times. She calmed her when it was all getting too much and bought her back to a calm and focused state." (credit:Natasha Gilmartin)
(12 of22)
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"Knowing that their baby would be born very sick, this family's nurse stayed with them and supported them through the entire labor and delivery. She rejoiced with them as their baby was born and cried with them as he passed. This family will never forget her kindness and support on their hardest day." (credit:Lane B Photography)
(13 of22)
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"The support they shared for the infants, parents and doctors was invaluable." (credit:Kourtnie Elizabeth Photography)
(14 of22)
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"Walking the L&D ward accompanied by a loving, emphatic and supportive nurse." (credit:Diana Hinek)
(15 of22)
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"This mom had not one but two amazing nurses who stood by her at every step, making sure she could be as comfortable as possible despite her long labor." (credit:Diana Hinek)
(16 of22)
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"For a labor and delivery nurse, the extraordinary miracle of birth can become ordinary. Even after a decade supporting babies, Sarah still radiates joy as she stands next to a miracle being born." (credit:Hello World Birth Photography)
(17 of22)
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"As the laboring mother struggled to figure out the most effective way to push, this nurse decided to get creative and grab a bed sheet. She made a knot at one end then held the other and told the mother to just pull like a game tug of war. She cared for both parents throughout the labor and delivery and celebrated with them as they welcomed their first son into the world." (credit:Lane B Photography)
(18 of22)
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"After a C-section, this nurse helped this stunned dad understand that it was time for him to take the scissors and cut the cord." (credit:Lore Photography)
(19 of22)
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"Nurse Katrina was amazing! Mama had a little girl who was sunny side up. Nurse Katrina was there for all 4 HOURS of pushing to make sure that both mom and baby were ok." (credit:Junebug Photography Studio)
(20 of22)
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"Danielle is a longtime L&D nurse and a personal friend of Heather, the mama in this image. Danielle ended up not being on shift for the births of Heather's first two children.The two were thrilled when Heather's third labor and Danielle's scheduled shift aligned for Cohen's birth and Danielle was able to support and care for her friend through her all-natural labor and delivery." (credit:Sarah Lewis Photography)
(21 of22)
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"Tristan (RN) introduces Keilan to his mother Danielle for the first time in the ICU, almost 48 hours after his birth via crash C-section. Danielle narrowly survived HELLP syndrome, which caused her liver to rupture in early labor. This image was taken just after she first regained consciousness after the C-section and surgery to repair her liver and was able to meet her baby (and learn it was a boy). There was not a dry eye on that entire floor." (credit:Sarah Lewis Photography)
(22 of22)
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"This nurse made an effort to be in the room with this mama as much as she needed but still giving her the freedom she wanted, even though there were about 6 other mamas giving birth that day! She was always so sweet every time she came in, and let mama labor the way she wanted to!" (credit:Junebug Photography Studio)

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