Even for an audience well-acquainted with Oregon’s health care workforce shortage, some of the numbers discussed at the Oct. 25 Oregon State of Reform Health Policy Conference were bracing and provocative.
For instance, a staggering 30-40% of new nurses are leaving the industry after their first year, said Troy Larkin, executive director of the Providence Nursing Institute.
“You cannot pipeline your way out of that,” he said. “We have got to address retention.”
Larkin joined other experts and officials in two panels at the conference that were devoted to Oregon’s health care workforce issues, providing an overview of challenges and opportunities. The event was held at the Hilton Hotel in downtown Portland.
“Like most states, Oregon is facing a significant challenge when it comes to growing and supporting its health care workforce,” said Jennifer Purcell, director of the Future Ready Oregon program at the state Higher Education Coordinating Commission.
The solution is unclear, however. Purcell oversees implementation of the workforce training and education spending package that was recently passed by the Oregon Legislature in Senate Bill 1545.
The bill established grant programs through the Higher Education Coordinating Commission to provide funding for workforce development. Purcell said the funding will increase access to training in technology, health care and manufacturing, as well as to workforce development services and benefits.
The $200 million Future Ready package is focused on developing an equitable workforce system, Purcell said. “We've set Oregon on a path towards equitable prosperity as we continue to recover from a convergence of unprecedented challenges and opportunities, including a global pandemic, and economic crisis and a call for equity and racial justice,” she said.
Paul Gorman, the assistant dean of rural medical education at Oregon Health & Science University’s Department of Medicine, joined Larkin and Purcell on the first morning panel, which was focused on new workforce initiatives. He and Larkin are working on health care labor shortages in the education system.
Through programs designed to reach out to indigenous and rural residents, Gorman said OHSU wants to expand the health care workforce with a more diverse medical staff. Gorman works with programs such as WY’east, which provides tuition-free medical education to indigenous students, and COMPADRE, which has 30 graduate medical education programs in Oregon and California for underserved communities.
Expanding who gets accepted to medical programs and who has access to them is vital given the lack of diversity in Oregon, Gorman said. Only 14% of nurses in Oregon are men — and compared to other states, “that’s high,” he said.
Only 3.9% of nurses are Hispanic, despite 14% of Oregon’s population being Hispanic.
Adding to the challenge of training new health care staff, medical schools and nursing schools across Oregon have reported a decrease in instructors. That reflects the workload and the pay, he said. “We don’t have enough faculty,” he said.
Larkin said employment needs to be more flexibly structured in order to expand the workforce.
He suggested expanded virtual nursing for nurses who no longer want to or can’t work typical 12-hour in-person shifts. In addition, Larkin is working with high schools to promote health care career paths.
The Shortage Problem Is A Burnout Problem
In the second workforce panel, addressing retention, new state Rep. Travis Nelson, appointed in February to fill the seat vacated when Tina Kotek resigned to run for governor, said he is working to address the shortage of workers.
Nelson — a nurse and an official with the Oregon Nurses Association — said he hopes new policies will do that.
“We are not going to grow our way out of our health care worker shortages,” he said. “I think we've got to find a way to get nurses and health care workers who've left during the pandemic, because we know there are thousands of health care workers in Oregon who've left during the pandemic. We've got to find a way to get them back in the workforce. And we've got to figure out ways to retain the health care workers who are on the verge of leaving.”
Nelson said employers need to stop making workers feel “like factory workers.” To achieve this, he said Oregon needs better wellness plans within hospitals and other health care centers.
Other retention strategies he suggested include onsite childcare, student loan repayment, elder care, retention bonuses, hazard pay, flexible scheduling, and better pay and benefits.
Nelson said he has conversations with nurses considering quitting the industry, and the vast majority reflect overall understaffing or lack of appreciation by management.
While the staffing in the industry is often called a shortage, Matt Calzia of the Oregon Nurses Association said the issue is more about retention.
“Do we have a shortage or do we have a turnover problem? And what we have is a really big turnover problem,” said Calzia, who serves as the union’s director of nursing practice and professional development.
To combat turnover, Calzia suggests placing more value on the interests and specialization of staff, nurses in particular.
“We need to make sure that we're building structures that allow staff to practice at the top of their scope, whether that's a (radiation) tech or a nurse, and they're not having to fill in places where they weren't educated,” he explained.
Calzia has seen an increase in health care systems requiring nurses and other staff to fill in roles, such as weapons searches on patients, that typically wouldn’t be in their job descriptions.
“Nowhere in our education did we learn how to screen people for weapons. But because you're there, you're in that environment, you're going to do it, and it's not appropriate. That is not in our scope,” Calzia said.
The strain placed on health care workers is symptomatic of another issue, Nelson added.
“The reasons why hospitals are struggling right now is, by and large, because of labor costs,” Nelson said. “Labor costs are outrageous because in part so many folks have left the workforce.” That's forced hospials to hire very costly temporary contract labor.
By focusing on retention, Nelson believes labor costs will decrease and hospitals will be more equipped to support staff and focus on patient care.
In addition to solving faculty shortages, health care organizations are working to expand what the health care workforce looks like.
Emily Henke, executive director of the Oregon Public Health Institute, recommended employers become more flexible with their requirements and how they design their interview processes. She gave examples from the experience of her organization, which had 600 employees during the height of the pandemic.
“The majority of our staff doesn’t have a four year degree, (and) a lot of folks who don’t have a high school diploma,” she said. The work ranged from virus contact tracing to scheduling vaccination appointments.
For its contract with Washington County, Oregon Public Health Institute was required to hire 30% bilingual staff — but to reflect the populations most likely to be hardest hit by COVID it hired 90% bilingual staff, the majority of whom were people of color.
“We really analyzed the jobs that we were hiring for and made sure that our systems or job descriptions actually reflected the work that we needed done and tried to remove as much gatekeeping as possible from our job descriptions,” Henke said.
Laure McKeane, chair of the Oregon Health Authority’s Health Care Workforce Committee, said the retention problem in health care is spilling over, creating staff shortages issues at nursing and medical schools in Oregon.
“You can make $30,000 more going to work at the hospital than you can teaching, so why would somebody do that?” said McKeane, who works as oral health services director at Allcare Health.
Medical school is competitive; that’s not new, but McKeane said the competitive acceptance rates are in part due to a lack of faculty to teach applicants.
McKeane said solutions to Oregon’s workforce problems need to be creative and go beyond the provider incentives that have been a mainstay of some workplace retention efforts.
“We need to think outside the box,” McKeane said.
Clarification: An earlier version of this article included an inaccurate percentage of bilingual staff hired by Oregon Public Health Institute. The article reflects clarification provided by the institute.
Aurora Biggers can be reached on Twitter at @aurorabiggers.
