Working conditions, understaffing is driving nurses to quit

Even before the COVID-19 pandemic, Oregon and the U.S. were facing a significant shortage of nurses. But with the additional stress of the pandemic, more nurses are burning out and leaving the profession altogether. We hear from Jodi Barschow, RN and president of the Oregon Federation of Nurses and Health Professionals, and Lisa Powell, vice president and chief human resources officer at Providence St. Joseph Health.

This transcript was created by a computer and edited by a volunteer.

Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. We start today with the nursing shortage. There were not enough nurses for Oregon’s- or for the country’s- aging populations even before Covid-19. But with the additional stress of the pandemic, more nurses are burning out and leaving the profession altogether. We’re going to get two perspectives on this right now. In a few minutes we’ll hear from a hospital administrator. But we start with Jodi Barschow, a Registered Nurse and the President of the Oregon Federation of Nurses and Health Professionals. Jodi Barschow, welcome to Think Out Loud.

Jodi Barschow: Thank you, Dave. This is Jodi Barschow. I’ve been a Registered Nurse for 25 years, and thank you for having me here today.

Miller: Thanks for joining us. Can you give us a sense for the scale of the problem right now?

Barschow: With the shortages, you know, if you back up a little bit, it was as mentioned, there was a shortage of staffing issues prior to the pandemic that has only exacerbated, due to the lean staffing models and issues there. In general, the shortage of nurses in the profession is nationwide. You hear it and see it in the news. There are bidding wars happening right now, trying to get nurses and working in all departments, not just critical care areas, but medical, surgical and psychiatric and other areas, as well.

Miller: Who has been most likely to leave hospitals in the last year?

Barschow: It’s been a variety, I would say, the highest level of people wanting to consider leaving the hospitals and the profession altogether are folks that had worked in high security areas as mentioned, such as the Emergency Departments, critical care areas, medical surgical, where there’s just simply not enough staff to handle the volume and acuity of patients that are coming in.

Miller: Are these also the nurses who have the most experience?

Barschow: They tend to be, because the nurses that have a lot of experience also wanted, and continue to want to have a voice in how things are happening on the front line. What I continue to hear is an erosion of an escalating staffing concerns where highly skilled, expert nurses are put into situations where they are concerned for the ability to provide the best care, and to keep communities healthy and the ability to handle the patient volume and acuity that’s coming in through the hospital systems.

Miller: You were working as a nurse at Kaiser, Sunnyside before you started this term as President of The Oregon Federation of Nurses and Health Professionals. What did you experience in the first few months of the pandemic?

Barschow: Well, in the early stages of the pandemic, there were a lot of unknowns, uncertainties. There was this escalating concern, of course, in this global pandemic, that was evolving and escalating and people had to figure out, in the moment. They were looking for the employer, emergency preparedness, protocols, guidelines. They were looking to our regulatory bodies- the CDC, and OSHA and others for measures and protecting the workers and families, to exposure and trying to figure out how patients were going to access care back then, we didn’t have vaccines. So people were really concerned about the working conditions, spreading the virus. As I mentioned, emergency preparedness and planning, there were PPE shortages, equipment shortages. We had to do a lot of redesign of where people were working, nurses had to be redeployed to areas that they hadn’t normally had to work in. So we all had to really quickly pivot in a time of uncertainty. And as mentioned, it was a highly stressful environment, not only for just all of these process issues that we had to sort out, but also concern for peoples’ families and communities concerned for their health and safety.

Miller: That was a different era of world history, even though it’s only a year and a bit ago. What do you see as the biggest stressors right now for nurses that are making them leave in large numbers?

Barschow: A lot of it has to do with what’s been mentioned, or you might be hearing already. A lot of stress, exhaustion, burnout. People are just done. They want to leave the profession altogether. They want to be able to work safely in an environment, have the staffing that they need to safely care for patients and keep communities healthy. So it’s up to hospitals to provide these things. It’s their responsibility to resource so that we can do our jobs and provide the best patient care. So when people are coming to work in situations that are short staffed and you don’t really know what’s coming in through the door. High volume of patients, high acuity, vulnerable populations that haven’t sought care maybe throughout the whole year or more due to the pandemic, medically fragile patients, social determinant needs, psychiatric needs. All of that, combined with the shortages and staffing and not just nursing, but all of the health care professionals and the ancillary staff around that really need to support the patients to keep them healthy.

Miller: How much has the increase in gun violence in the Portland area affected the work you’re talking about?

Barschow: I think in general, from what I’m hearing, and what we’re hearing is that people are concerned for safety overall. As mentioned, this was a very stressful, trying year. Even prior to that, there’s a lot of things happening in the world that I think caused great stress. So people are concerned about their own physical safety, as mentioned. Whether it’s gun violence or any sort of violence or any kind of situation happening like that, you had to be prepared. Knowing anything can walk through the door, like for example, the Emergency Room, you have to be able to be prepared, have the adequate staffing so that if situations do escalate, that you have the staff around there to support, for example, like security and other health professionals. What we’re seeing is people are for example, nurses in the Emergency Room are seeing ratios far more than double sometimes of what the community standard is. So when you have highly acute medical and social and psychiatric needs, and all of your patients are that high acuity it’s also untenable. Unless you have the support that you need, those ancillary staff as well, there’s fear, because you don’t know if you’re missing something or you don’t have oversight over something that you should.

Miller: How much of what you’re talking about overall can be solved by hospitals adding more early career nurses to their ranks? That’s something that I think we’ll hear about in our next conversation. But something that hospitals in Oregon and around the country are working hard to do right now to hire more nurses out of nursing school.

Barschow: I have always been a big proponent of student nursing and a preceptor myself in bringing in new nurses. However, that said, you have to retain the highly expert and proficient nurses and skilled nurses to be able to train others and experiential learning is essential to be able to care for patients and keep communities safely cared for. A lot of the times student nursing, while they just have come out of the program, you get this wide array in overview of multiple different areas and then once you get to a specific area that you would want to work in, you still need quite extensive on-boarding and training for that first six months really close training and mentoring but for the first year and beyond, you’re building your skills and knowledge. And so if we’re not retaining highly skilled experienced nurses or for example, nurses leave or retire that are highly skilled and experienced, then you don’t have that time to transfer that knowledge to someone else. That’s a really big factor in the concern. You have to have a skill mix of both.

Miller: We’ve been hearing for years, if young people are looking for a career where you can get a good paying job and always be in demand, then you should consider nursing. Just briefly, would you recommend that young people right now consider and go into nursing?

Barschow: Absolutely. You know, nursing is my passion, of course. A lot of people get into this profession because they want to care for others and I think that it’s essential to onboard and grow and have nurses joining the community. We also hear things like we’re having shortages of having doctoral or educational prepared programs and systems to support nurses coming on board. I think it’s important to be able to fund and staff those programs as well, because, we’ll always need an influx of new nurses and I think part of that is what I mentioned already, having the preceptor and on-boarding and staffing is crucial, because what we don’t want to see happen is you onboard all of these new nurses and they are then placed in these situations that they’re unprepared for. They haven’t had those experiences. So, again, I would be a proponent bringing in new nurses and graduate nurses. However, that said, there needs to be that skill mix in order for them to be supported and want to stay in the profession, because oftentimes what happens then is they get placed in these situations and it’s not really what they signed up for, so to speak, and then they just leave and they leave the profession altogether and that only exacerbates the concern.

Miller: Jodi Barschow, thanks very much for starting us off today.

Barschow: You’re welcome. Thanks for having me here.

Miller: Jodi Barschow is a Registered Nurse with over 25 years experience, President of the Oregon Federation of Nurses and Health Professionals. If you’re just tuning in, we’re talking right now about the nursing shortage in Oregon. I’m joined now by Lisa Powell. She is a Vice President and Chief Human Resources Officer at Providence Saint Joseph Health, Oregon. Lisa Powell, welcome to Think Out Loud.

Lisa Powell: Thanks so much for having me.

Miller: I’m curious what stood out to you most in what you just heard from Jodi Barschow?

Powell: She talked a lot about new nurses entering the profession and that is our future, and the need to invest in those folks. We are doing that quite a bit at Providence in Oregon. For example, we just hired well over 130 new nurses that will be starting in August, we have to make sure that we do support them, make sure they have a great experience and they are supported in their training, that is paramount. And so we’re putting a big focus on that, to make sure that we have the workforce for the future.

Miller: Where do you most see the impact of the nursing shortage right now?

Powell: I would say very much what the previous guest said, in the Emergency Room, in our specialty areas, Emergency, ICU, medical, surgical, in our surgical areas, in some cases. It’s really the experienced nurses where we see a deficit. Portland is blessed in that we have a lot of nursing schools that bring us new graduates. But getting the experienced nurses, which we also need to have a healthy balance of new graduates and experienced nurses, is a challenge.

Miller: One thing our Producer heard as she was working on the segment is that even if you look at this from a ruthlessly financial standpoint, setting aside as, you never would, but setting aside, say even patient safety, that it’s better for a hospital’s bottom line to keep the experienced nurses that they already have than to spend a lot of money recruiting new nurses who can’t, initially at least, replace the people they have lost. Do you agree with that kind of financial accounting?

Powell: I don’t know that I agree with that. It’s always important for us to retain the staff that we recruit, both the new people that we recruit as well as the experienced ones. And so we do a lot to recruit and retain in terms of offering benefits, having good relationships with our Managers. Taking care of caregivers is really my job as the Chief HR Officer and so I’m always looking at ways that we can do that better.

Miller: Has attrition gotten worse at Providence Saint Joseph over the last year and a half?

Powell: Yes. It has, just as it has in many of the hospitals, you know, pre-Covid we had about an 8% vacancy. Now we have about a 12% average vacancy in terms of jobs unfilled, and our attrition has gone up about three points, about from 15 to 18% a year.

Miller: So what are you doing now to try to reverse that, to retain especially the more experienced nurses and other health care professionals?

Powell: We’re trying to make sure we’re addressing the burnout by providing lots of support in that area, making sure we’re listening to our staff, making sure that we have the right balance of staff to care for our patients, really having that back and forth to make sure we’re providing that support they need. We’re also in some cases making sure our wages are competitive, our benefits are competitive. Just taking steps to make sure we’re the best place to work and that people want to work here.

Miller: Do you have a new approach? Are you thinking differently about how to retain the new nurses so that they don’t eventually face the same burnout as the nurses that they’re replacing?

Powell: We have what’s called Providence Academy and it’s a special program that we’ve created for our new nurses called Residency, and they’re hired in a group and there’s essentially a whole training program that they go through and a check-in process. So we found that to be very effective and the feedback we get is that it is supportive, and people have a really good experience with it and the turnover rate is much, much lower. So that’s what we’ve done in terms of our new nursing staff

Miller: Overall, Do you see that the burnout and the turnover rate that you’re facing right now as a true continuation, holdover of the pandemic, something that ideally will lessen in the coming years, or is this something that’s more embedded now in our health care system?

Powell: I think the pandemic was an accelerant. But we’ve been predicting this for years. And so we’re here now, where we have a whole group of folks that are at retirement age, that’s our experienced nurses and their aging out and wanting to retire. We have the folks that the previous caller talked about that really have decided that nursing isn’t for them and want to try something different. But overall the statistics show us that there’s more demand for nurses into the future, and that demand is growing and that the supply is not there. So we do have a deficit.

Miller: Lisa Powell, thanks very much for joining us.

Powell: You’re welcome. Thank you for having me.

Miller: Lisa Powell is Vice President and Chief Human Resources Officer at Providence St. Joseph Health, Oregon.

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