Record COVID cases are transforming a long-standing problem in Arkansas — the state’s nursing shortage — into a crisis.
“I’ve been a nurse a long time,” said Trenda Ray, chief nursing officer at the University of Arkansas for Medical Sciences in Little Rock. “This is something I’ve never seen in my career with nursing.”
“Unfortunately, it’s a perfect storm,” said Dr. Cam Patterson, UAMS chancellor. “You cannot cover adequately for that number of people not available at the bedside.”
The health system recently put out the call for UAMS workers in nonclinical areas “to pitch in and do what they can,” he said. “People are transporting patients and answering call lights.”
The current spike in omicron cases has far surpassed the two previous pandemic surges, last winter’s and last summer’s. That’s because omicron, while apparently a milder variant of the coronavirus, is much more infectious. Nurses and other health care workers are calling in sick or are isolating themselves to avoid infecting others.
On Tuesday, 627 UAMS employees were off work because of the virus, with 371 of those health care workers. UAMS has about 11,000 employees.
On Wednesday at Baptist Health, which has 11 hospitals in Arkansas, 323 of the system’s 11,000 employees were out for reasons related to COVID-19. But that was an improvement over earlier in the week, said Cathy Dickinson, chief human resources officer.
“Omicron has definitely impacted our ability to staff,” she said in an email. “Earlier this week we were down 584 employees of our approximately 11,000 due to reasons related COVID-19. On any given day, 23 percent of the employees who are out are bedside nurses.”
Hospitals around Arkansas are suffering from the pandemic-exacerbated staffing shortages.
“Prior to this month, the largest number of staff we have had out in a single month was in August 2021,” said Meredith Green, senior vice president and chief nursing officer for Washington Regional Medical System, based in Fayetteville. “In the first two weeks of January, we already had more than double the number of team members out as we did throughout the entire month of August.”
“The challenge with the current surge is that not only do we have a large number of staff who are out, but we are also seeing increased demand for care in all areas of the system, including our hospital units, emergency department, outpatient clinics and especially at our COVID-19 testing location,” Green said. “This surge in demand for outpatient care is not something we have seen at this level with previous surges.”
On Tuesday, St. Bernards Healthcare, based in Jonesboro, was operating without about 6% of its staff of about 4,100, said Mitchell Nail, media relations manager for St. Bernards.
The coronavirus-related vacancies are “across the board,” Nail said. “It impacts everybody down to billing, your technicians, your environmental services, your nutritional services, as well as your doctors and nurses.”
Mandates Play Little Role
Vaccine mandates appear to have little bearing on the staffing shortages in Arkansas.
State law prohibits UAMS, a state agency, from imposing a requirement.
St. Bernards requires all staff, not just clinicians, to be fully vaccinated, Nail said. With a deadline of Nov. 1, only 43 people refused vaccination, and they were terminated, he said.
Dickinson said Baptist was reviewing federal mandates “to determine what might apply to Baptist Health and its employees. Once we understand the nature and scope of these mandates, we will be providing further updates with our staff.” Currently, 75% of Baptist Health employees are fully vaccinated, she said.
Washington Regional implemented a COVID-19 vaccination requirement for all staff in 2021. “Fewer than 5% of our workforce applied for an accommodation based on a medical disability or sincerely held religious belief with the vast majority (over 90%) being approved,” said Natalie Hardin, director of marketing and public relations for the health system. When Washington Regional’s policy became effective, fewer than 1% of its workforce resigned because of it, she said.
Years in the Making
The shortage is nationwide and is compounded by several factors, some of them years in the making.
First, is the aging out of the workforce of the baby boomer generation.
Second, with an aging U.S. population comes an increased demand for health care workers.
Finally, there is the nearly two-year-old pandemic itself, the stresses of which caused many health care workers to leave the profession. Morning Consult, a polling and data research company, reported in October that 18% of health care workers have quit their jobs during the COVID-19 pandemic, while another 12% have been laid off. The workers surveyed cited the pandemic, insufficient pay or opportunities and burnout.
At the same time as the health emergency increased demand for nurses, some left positions at hospitals to become travel nurses, where they could earn significantly higher pay, or left to take advantage of big sign-on bonuses at other facilities.
The problem is so acute that in September the American Nurses Association called on the U.S. Department of Health & Human Services to declare the nursing shortage a national crisis.
Hospitals in Arkansas are employing a number of strategies to cope with the shortage. Staff at UAMS, Ray said, are engaging in “lots of teamwork. We know we have a lot of staff who are working extra. They’re working overtime.”
Sign-on and retention bonuses are one tool, as is incentive pay. Last summer, UAMS paid a retention bonus to nurses who met certain criteria for in-patient areas, Ray said. More than 400 nurses signed up, she said. For acute-care nurses who had worked at UAMS for at least three years, that bonus totaled $10,000.
Baptist Health provided incentive pay and temporarily increased base pay during last summer’s surge, Dickinson said.
St. Bernards also has offered sign-on bonuses. “It’s a combination of what can you do to attract new talent and what can you do to keep the talent that you already have,” Nail said.
“We’re doing everything that we can to entice people to stay and to encourage people to join our team,” Patterson, of UAMS, said.
Another strategy has been the hiring of short-term travel or contract nurses, who earn considerably more money than their counterparts. The median pay for registered nurses in the United States in 2020 was $75,330 per year, according to the U.S. Bureau of Labor Statistics. But the average travel nurse can average more than $3,000 per week.
An analysis by the Arkansas Democrat-Gazette in September found that spending on travel nurses by UAMS — which, unlike other hospitals, is subject to the state’s Freedom of Information Act — had risen from $806,132 in fiscal 2019 to more than $5.7 million in fiscal 2021.
As of last week, UAMS was employing 128 travel nurses.
“Obviously, we’re in the market for traveling nurses,” Patterson said. “We don’t like to be, but it’s a necessity. And unfortunately, we’re all competing with each other.”
Baptist Health’s Dickinson said, “Extra pay to become a travel nurse and facilities offering huge sign-on bonuses makes consistent staffing very difficult to maintain.”
The omicron-compounded staffing challenges have not yet affected scheduled procedures at most hospitals, although UAMS is “deferring procedures that can be safely deferred right now,” Patterson said.
Nail said St. Bernards had not had to pause elective procedures since 2020. “We’re doing everything in our power to keep it from getting to that,” he said, “because at some point an elective procedure no longer becomes elective.”
Several hospital officials interviewed are hopeful the next few weeks will bring an easing in COVID cases, pointing to trends seen in New York City. And Arkansans can help by getting vaccinated, wearing masks and social distancing, they said.
But in the meantime, staffing at hospitals in Arkansas remains all hands on deck. Said Ray, of UAMS: “We have a great team and they pull together and they’re here to take care of their patients. But it is definitely a challenging time.”