Nursing leaders in Oregon and nationwide continue to sound the alarm about high worker burnout rates, staffing shortages in hospitals and other health care settings, and the country’s failure to train a new generation of nurses.
The Oregon Nurses Association and the American Federation of Teachers — to which the Oregon union belongs — have issued new reports saying nurses are quitting the industry because profit-focused hospital systems and other facilities are failing to hire enough staff. That leaves remaining nurses exposed to workplace violence as well as exhaustingly long shifts and excessive patient volumes, according to the unions.
Plus, educational institutions are failing to produce enough new registered nurses, the reports said. College nurse training programs typically don’t offer attractive wages to nurse instructors, so class capacities are limited, according to recent studies and news reports.
Experts have long predicted health care workforce shortages in the United States, although they differ on the causes. They stress that the shortage isn’t only of registered nurses. There’s also a looming nationwide lack of doctors and physician assistants as well as lower-level — and lower-paid — workers such as nurses aides and medical assistants.
In the union reports, nursing leaders said hospitals should hire more staff and take other steps to make nursing a more attractive line of work, such as backing away from mandatory 12-hour shifts.
But some hospital leaders have said the lack of qualified candidates makes it hard to hire more staff. Plus, many hospitals in Oregon and nationwide have reported operating losses in recent months because rising wage and benefit costs have outstripped revenues. In particular, hospitals have sapped their budgets by spending heavily on hiring temporary contract labor, including nurses and others, at high pay rates, to handle the workload during the COVID-19 pandemic.
“Understaffing is the core problem, which leads to other horrible conditions like crushing workloads, mandatory overtime, extended shifts lasting 12 to 16 hours, constant fatigue, worker injuries and skyrocketing rates of violence against healthcare workers,” said the American Federation of Teachers president, Randi Weingarten, in a statement.
The Oregon Association of Hospitals and Health Systems issued a brief statement in response to the reports:
“Oregon’s hospitals have been saying for over two years that the system is in distress, and a big reason is the nationwide staffing shortage. Patient safety is always our top priority, and as a short-term solution (hospitals) have used contract labor to fill staffing gaps. In the long term, we need common sense solutions to rebuild our nursing workforce.”
Some observers say a fundamental driver is the aging health care workforce. Doctors, physician assistants and nurses are retiring in waves.
Plus, many agree that the stress of providing care during the COVID-19 pandemic has accelerated that trend, souring workers on the health care business.
But the union studies found the situation is complex. “National demographic data show the industry is seeing an exodus of nurses under the age of 44 from the profession,” the American Federal of Teachers said in a news release. That’s “a significant reversal of the trend, between 2016 and 2022, or nurses under the age of 44 making up a greater share of the RN workforce.”
The pandemic has left the nursing workforce mentally worn out, the union’s report said: “61% of nurses believe that COVID-19 stresses have had a negative impact on their mental health and 30% report they received or believed they needed mental health services due to the pandemic. Nearly 50% said the pandemic had negatively impacted their physical health, as well as their relationships with family members (42%) and co-workers (41%).”
Oregon Nursing Staff Plans Faulted
The Oregon Nurses Association, meanwhile, criticized hospitals for failing to live up to their state-mandated nurse staffing plans, and faulted the Oregon Health Authority for failing to enforce those plans.
Under state law, all hospitals are supposed to have nurse staffing committees, composed of management and nurses. These panels develop and approve nurse staffing plans that set out staffing levels to be maintained in various hospital departments.
But the Oregon Health Authority, in reviewing scores of hospitals, has found that many hospital nurse staffing plans don’t meet state standards, and that hospitals don’t comply with their own staffing plans. Plus a great majority of hospitals seek — and obtain — health authority permission to fall short of their plans.
In its annual report this year on nurse staffing plan compliance, the agency said that it had granted 16 of Oregon’s 18 largest hospitals waivers from their nurse staffing plans, along with 17 of Oregon’s 22 medium-sized hospitals, and 14 of the state’s 25 smallest.
Health authority reports indicate the agency is wrestling with how to get hospitals to comply with the nurse staffing plan requirements. The agency is evaluating whether it should levy financial penalties against non-compliant hospitals.
“Oregon’s current law is not working in large part because OHA fails to enforce the law. Specifically, 85% of nurses report that their unit is not being staffed according to Oregon law, and 84% of nurses believe that OHA has been ineffective in enforcing Oregon law,” the Oregon Nurses Association report said.
The nurses association said a survey of its nurses found half are caring for “too many patients” on most of their shifts. The lack of staffing means delays in responding to patient call lights, administering medication, and providing hygiene and nutrition, the report said. Almost all nurses surveyed reported missing legally mandated meal and rest breaks at times, and nearly half said they miss meal and rest breaks most of their shifts, according to the association
The health authority defended its handling of the nurse staffing plan program.
“OHA is committed to enforcing the nurse staffing law in all Oregon hospitals,” said spokesperson Jonathan Modie. Hospitals that fail to meet their plan must “write a plan of correction (POC) that explains, for each deficiency, how the hospital will return to compliance with the requirement and maintain compliance in each hospital unit,” he noted. The agency is working on developing a process for levying financial penalties against non-compliant hospitals, he said.
Meanwhile, experts nationwide struggle with how to fix the health care worker shortage.
The Center For American Progress, a liberal-leaning nonprofit research group, contends the nursing profession has been plagued by worker shortages for many decades.
“The nursing shortage cannot be solved unless higher education institutions train more nurses,” according to the organization’s recent report.
A key reason colleges and universities aren’t able to produce enough nurses is because they lack nurse instructors. And that’s because those schools don’t pay the instructors enough, the report said.
“In 2021, nurse practitioners and nurse midwives — who have at least a master’s degree — made a median annual wage of approximately $113,000 and $121,000, respectively, whereas the median wage for a college nursing instructor with equivalent credentials was about $77,000,” according to the report.
The federal government needs to give nursing schools more money so they can hire and keep nursing instructors as well as improve their facilities, according to the report.
You can reach Christian Wihtol at [email protected].