Rural U.S. hospitals stretched thin after nurse shortage exacerbated by the pandemic

Nursing shortages are impacting healthcare workers and hospitals across the United States. In just the past few days, nurses and other workers in Southern California and Oregon authorized a potential strike against provider Kaiser Permanente. Staffing shortages are part of those disputes. John Yang reports from South Florida on how shortages are affecting hospitals there.

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  • Judy Woodruff:

    Last night, we reported on heightened interest in careers in the medical field, including moves to train more nurses.

    Tonight, we look at how the shortage of nurses is affecting health care workers and hospitals. In just the past few days, nurses and other workers in Southern California and Oregon authorized a potential strike against Kaiser Permanente, and understaffing is part of those disputes.

    John Yang is back with a report from South Florida on how shortages are affecting hospitals there.

  • Dakota Redd, Chief Nursing Officer, Hendry Regional Medical Center:

    And then, tomorrow, we're down midshift again.

  • John Yang.:

    Every morning, chief nursing officer Dakota Redd sits at his desk and plugs holes, moving nurses around on the schedule for the next several days to meet his hospital's daily needs.

  • Dakota Redd:

    If you move Bret to — back to 11:11, at least you're covered until 11:00, and then we can try to see what we can do at 11:00 to get you some help.

  • John Yang.:

    It's a constant struggle for Redd at Hendry Regional Medical Center. The public hospital serves the largely rural agricultural population around Clewiston, Florida, a small city on the southwestern shore of Lake Okeechobee, nicknamed America's Sweetest Town for its location in the heart of Florida's sugar industry.

    The medical center is a major employer in Clewiston and, with 25 beds, the biggest hospital for more than 20 miles.

  • Dakota Redd:

    We provide primary health care for this community. And so, if we can't provide that care, that means that you may have to travel an additional 30 to 45 minutes to get that care, to seek that care, which is why it's so important that we manage better for rural hospitals, so that we don't lose that.

  • John Yang.:

    Many hospitals serving rural communities like this one were already facing a shortage of nurses before the pandemic. But the past 18 months have put this problem into sharp relief.

    Mary Mayhew is president of the Florida Hospital Association.

    Mary Mahew, President, Florida Hospital Association And, certainly, before the pandemic, we were facing a nursing work force shortage. The pandemic was like a gasoline can over the fire.

  • John Yang.:

    A recent study commissioned by the group found that, before the latest Delta surge, the state had an 11 percent vacancy rate for registered nurses, roughly the same as the national rate. It also found that a quarter of Florida's registered nurses and a third of critical care nurses left positions in the last year, citing job dissatisfaction, burnout, or other opportunities in health care.

    And it projected that, if current trends remain the same, by 2035, there would be a shortage of nearly 60,000 nurses.

  • Mary Mahew,:

    We have nurses that are retiring at younger ages. We have nurses who have left the intense 24/7 environment of the hospital for other opportunities in the community.

    And then, certainly, we have nurses that have pursued opportunities with staffing agencies around the country.

  • John Yang.:

    After his morning huddle, Dakota Redd makes his rounds, checking in on his staff to see how they're doing and what they need.

  • Dakota Redd:

    We do have a backup plan, all right?

  • Woman:

    OK.

  • Dakota Redd:

    Any questions about that?

  • John Yang.:

    The worst of the Delta spike here came over six weeks from August to September. At one point, the 10-bed emergency department had seven patients on ventilators. The day we visited was the first since July without a hospitalized COVID patient.

    But Redd says his staff is emotionally and physically drained, and with eight vacancies in the emergency department, about half what he needs, stretched very thin.

  • Dakota Redd:

    The overriding concern is always, do I — am I giving them enough tools to do their job? Am I providing them with what they need to do what we're ask — what the ask is?

  • Brittney Jonhston, Registered Nurse:

    I would describe nursing at this time almost like we're going to war.

  • John Yang.:

    For registered nurse Brittney Johnston, a Clewiston native, caring for people she grew up with is one of the joys of working here.

    But during the Delta surge, it became a source of sadness.

  • Brittney Jonhston:

    In 12 years of my nursing career, I have never — in this hospital, I have never, never, never seen seven, eight ventilators going on in my emergency department.

    This past Friday, I had a classmate of mine. I'm 37 years old. We went to kindergarten together all the way to graduation. And I — he passed away of COVID. And I was in the room. And I was working. We did a code for over two hours. And the physician just said: "Can just one person just make it? Can't just want one make it?"

  • John Yang.:

    To deal with short staffing, nurses work extra shifts, and alongside nurses hired on short-term contracts.

    Right now, these so-called travel nurses are about 40 percent of Hendry's emergency department. High demand for travel nurses during the pandemic means higher salaries than for staff nurses, sometimes leading to resentment and to bigger budget holes for hospitals.

    But it's an attractive option for staff nurses who feel underpaid, like Tamika Cade. She left Hendry's emergency department after eight years for a nearby travel nurse job.

  • Tamika Cade, Registered Nurse:

    I'm stressed. I'm burnt out. I'm tired. I'm exhausted. Well, these circumstances are going to be the same anywhere I decide to work. Why not go 55 miles up the road and do the same thing for double the pay?

  • John Yang.:

    In September, she returned to a new position in Hendry's I.T. department, working with nurses on the computer systems they use. She says she's happy to be back, but never would have returned for full-time patient care.

  • Tamika Cade:

    You know what? I needed a break from it for a while, because it took a toll on me. It took a lot out of me. And I just needed a moment, like a minute, to just do something different besides that, right, because it's a little traumatizing.

    Let me — I can't — there's no other way to put it.

  • Woman:

    How many days have you have COVID?

  • John Yang.:

    But as the Delta surge ebbs, Hendry's nurses fear the trauma of their work is only bound to intensify again.

  • Woman:

    Yes. And have you had the vaccine?

  • Woman:

    No.

  • Woman:

    No. OK.

  • John Yang.:

    Especially in an area that's less than 50 percent fully vaccinated.

  • Brittney Jonhston:

    We're just waiting for the next strand to come through and then making sure that we're prepared mentally and physically and emotionally.

  • John Yang.:

    To address the long-term shortages, Mary Mayhew of the Florida Hospital Association says changes can't wait.

  • Mary Mahew,:

    Right now, urgently, we need to make sure that our nursing programs in our community colleges and our university system are able to open the gates a little bit wider to add to the number of slots.

    We know that there is still great interest, in terms of the number of applications that our nursing schools are receiving. But we have got to expand the capacity to meet that.

  • John Yang.:

    Because, even if COVID eventually does recede, the need for qualified nurses never will.

    For the "PBS NewsHour," I'm John Yang in Clewiston, Florida.

  • Judy Woodruff:

    So concerning. Thank you, John, for that report.

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