COVID accentuated the pre-existing condition of staff shortages. In coastal Delaware, other factors heighten the need for a remedy.
By Pam George
Photograph by Neil Parry
From the May 2022 issue
Julie Short didn’t dither over career choices after high school. Like her grandmother, she attended Beebe Healthcare’s nursing school, now the Margaret H. Rollins School of Nursing. “I joke with my manager and say, ‘You know, I drank the Kool-Aid in the womb because I have grown up at Beebe,’” says the fifth-generation nurse, whose mother has worked at Beebe for more than 40 years.
“I have a loyalty to Beebe,” says Short, a rapid response and “code blue” nurse. (A code blue is called when a patient experiences unexpected cardiac or respiratory arrest that requires resuscitation.)
"I don’t want to leave because I know it so well,” she adds. But, although nursing is in her DNA, she is disheartened to see her profession under so much duress. “They’re just leaving,” Short says of burned-out fellow staffers. “People I’ve seen there for years are just like, ‘No, I’m done. I’m out.’”
Some became traveling nurses, who take high-paying temporary positions, usually in other states. Others have left the profession entirely, either as a career change or retirement.
Drops like these don’t happen overnight, and there’s no easy fix. But coastal health systems are working hard to retain staff and recruit new employees.
A long time coming
While some blame COVID for the exodus, staff shortages in the health care industry are nothing new. Nursing has experienced a deficit for some time, and age is a factor. Consider that 55 percent of registered nurses are 50 and older, and more than 1 million registered nurses will likely retire in 10 to 15 years, according to the American Association of the Colleges of Nursing. “Nurses are getting older, and the work continues to get harder,” notes Rick Schaffner, executive vice president and COO of Beebe Healthcare and himself a nurse.
By 2025, the nursing shortfall will be “more than twice as large as any nurse shortage experienced since the introduction of Medicare and Medicaid in the mid-1960s,” according to a team of Vanderbilt University researchers.
There is also a pressing need for physicians. According to data published in June 2021 by the Association of American Medical Colleges, the United States could see an estimated shortage of between 37,800 and 124,000 physicians by 2034.
In Sussex County, the shortages are exacerbated by a soaring population as the emergence of new communities outpaces growth of the county’s health systems. Compounding the demand: Many newcomers are seniors, who have a higher risk of developing one or more chronic conditions.
To meet the demand for services, new facilities are opening or under construction. Beebe Healthcare, for instance, opened its South Coastal Health Campus near Millville, which has a freestanding emergency department and a second cancer center location. Beebe’s Specialty Surgical Hospital is scheduled to open in May on a health campus near Midway. And Bayhealth continues to add to its Sussex campus in Milford, home of the Dover-based health system’s new hospital.
But sparkling new buildings won’t benefit the community if there are not enough people to run them, and recruitment to the resort area has never been easy. Like it or not, Sussex County is still rural and, historically, young medical school grads gravitate toward urban hotspots with teaching hospitals and higher paychecks.
These budding caregivers also have substantial student debt. And as anyone who’s tried to buy a house here knows, prices are soaring. Combine all the above, and you can see why area health care recruiters have long faced difficulties.
Then along came the pandemic.
Overwhelmed and overworked
In 2020, when Delaware went into quarantine, photographer Neil Parry noted that he could stay home, but his nursing friends could not. “It got my attention,” he says.
Parry embarked on a photo series of first responders in uniform standing outside their homes. “We could shut everything down and sit in our living rooms,” he says. “They had no choice but to go to work every day, deal with patients and come home to families, not knowing at that time how dangerous that might be.”
He photographed Short, who stands with Parker Shandrowsky, a Sussex County paramedic. The blue sky is reflected in the glistening canal behind them, and a gentle breeze lifts an American flag. Like many of Parry’s subjects, Short is smiling. But several wear somber expressions, as if they know that the pandemic will soon change their lives.
Indeed, two years later, some nurses have called it quits, and more are likely to follow suit. In November 2021, 32 percent of registered nurses surveyed in the United States said they might leave their current direct-patient-care role — an increase of 10 percentage points in under 10 months, according to McKinsey & Company, a management consulting firm.
“It’s burnout,” says Jennifer Spinelli, director of talent acquisition for TidalHealth, formed by the merger of Peninsula Regional Health System and Nanticoke Memorial Hospital. “The acuity level of patients is very demanding.”
Where are these caregivers going? Some leave the industry altogether. Or, like Beebe’s Schaffner, they enter management. “A lot of nurses are no longer working at the bedside,” he notes. The manager who initially hired Short became a traveling nurse. “I never thought she would leave,” Short says.
But it’s hard to resist the pay: Traveling nurses generally make more money than full-time staffers, and agencies are actively recruiting them. “There is hiring pressure from nursing agencies,” agrees Matthew Morris, vice president of patient care services and chief nursing officer for Atlantic General Hospital and Health System.
More than a few leave health care for new careers. Regardless of the reason, without a wealth of candidates to replace them, the remaining caregivers have a higher patient load. “The stress of staffing shortages has stretched us further than we could have imagined,” says Lydia Cole, who posed for Parry’s project. Since then, the ICU nurse left Sussex County to work in a Wilmington-area hospital.
What’s more, patients are becoming, well, impatient. “The stress or burnout is not only [because of] the COVID surges and the pandemic’s emotional toll; it is also compounded by the level of workplace hostility and violence from patients,” Morris says. (Of the nearly 21,000 workers in private industry who reported some form of on-the-job violence in 2019, 70 percent were in health care and social assistance positions, according to the Bureau of Labor Statistics. Those numbers have steadily climbed to the point that in January, a national accreditation agency mandated that hospitals have workplace violence programs and reporting systems in place to keep the agency’s highest standard of approval.)
Confronting burnout
There is not a “one-size-fits-all solution” to the shortage, says Kim Blanch, community services manager at Beebe. She is also the lead on Beebe’s Trauma-Informed Committee, which helps others interact with people who have or may have experienced trauma. And not all trauma is physical: Coping with scared, sick COVID patients and their families creates emotional trauma.
The upshot is that Beebe’s behavioral health team regularly makes rounds on hospital floors to counsel patients and staff, says Shawna Mayles, nurse manager of the team and of Beebe’s addiction services. Stressed caregivers can also retreat to “safe spaces” with massage chairs and calming essential oils. If caregivers can’t find the time for such a respite, counselors walk them to a private area. “Once they can voice their feelings and have a minute to calm down, they’re OK,” Mayles says.
The committee she and Blanch serve on pulled together a list of resources for staff. For instance, some local therapists have offered pro bono services. “We are really looking at ‘How do we create sustainable and long-term support because, again, well-being is so important,’” says Rita Williams, manager of oncology psycho-social services at Beebe Healthcare and a committee member. “As caregivers, it’s really important that we are taking care of ourselves so we can take care of patients.”
Beebe recently instituted “code lavender” for caregivers who hit their emotional limit while working. “They notify a nurse supervisor and say, ‘I’m having an event.’ They don’t need to say what it is,” explains Mayles. “The supervisor can send someone to respond.” Bayhealth has a similar program.
Beebe also has a health coach to lead mental and physical health programs. Similarly, TidalHealth’s employee wellness committee has a program called RISE (resilience in stressful events).
At TidalHealth’s Nanticoke hospital, the Sunshine Cart, laden with snacks and coffee, makes the rounds. “It brightens the day when people see it,” says Spinelli. Hospitals are offering other perks too, including donations from the community such as gift cards or yoga classes.
DoorDash certificates and the like are welcomed by employees working overtime, especially if they have kids or spouses at home, says Shana Ross, vice president of human resources for Bayhealth. In addition, she and her team have talked with a firm about helping workers file their taxes — “anything we can do to help alleviate the stress and burden on the staff,” she says.
But for some caregivers, peer support is the best stressbuster. “We nurses understand the challenges we have all gone through within the past two years,” says Cole, the former Sussex nurse now working upstate. “So, I’ve found that reaching out to fellow nurse friends to vent about a difficult day — or just to check in — helps the most.”
Retention and recruitment
Complimentary food and tax help are all well and good, but for many workers, the best recognition has a dollar sign attached to it. “Hospitals should be investing in their permanent staff — the nurses who have dedicated years to these institutions,” Cole says. “These investments would include increasing pay to what hospitals pay their travel staff.” She also recommends bonuses and retention incentive programs.
Bayhealth, for one, has instituted retention bonuses and tuition-reimbursement programs. Morris says that Atlantic General has been flexible with compensation, scheduling, benefits, and other financial rewards. Beebe has created a competitive salary structure and offers health care, vision and additional benefits, Schaffner notes. And TidalHealth has scholarship opportunities, loan repayment programs, and living stipends for existing staff and incoming staff who choose to work on Delmarva.
Since doctors tend to practice where they do their residencies, Bayhealth, TidalHealth and Beebe are all rolling out physician residencies in family and internal medicine. (TidalHealth’s internal medicine residency will be headquartered in Salisbury, but there will be rounds in the system’s Sussex County locations.)
However, health systems also need seasoned specialists, and Beebe is actively recruiting well-known physicians. One recent addition is Dr. Diana Dickson-Witmer, a specialist in breast cancer surgery and oncology.
As for nursing, Beebe benefits from the Rollins diploma program at the hospital’s Lewes campus. TidalHealth has strengthened its relationships with Delaware Technical Community College and Delaware State University. “We are opening our doors to the students to do their clinical in our facilities,” Spinelli says. “We want to show them why they should come work here.”
What’s more, TidalHealth isn’t waiting for students to reach college to make connections: Representatives are attending fifth-grade career fairs. “We are trying to get in front of these students to tell them about health care, so they know what is out there,” Spinelli explains.
But thanks to COVID, it’s not an easy sell. “I think people are afraid to be in health care,” says Bayhealth’s Ross. “They don’t understand all we do to protect our staff, the patients and the community.”
In the meantime
It will take years for young students to graduate from nursing and med schools or gain a diploma in an allied health field. So, how are hospitals coping with current crisis? “You won’t find many health systems across the country that aren’t using contract labor,” Schaffner says. But there are only so many traveling caregivers, he adds. “It’s not an unlimited resource.”
And in the resort area, housing temporary workers can be an issue. This is true even as far as Dover, Ross says. (Schaffner notes that some seasoned traveling nurses have their own RV homes.)
Another complication: While these caregivers provide much-needed hands, they don’t fully understand the health system’s culture and values, Morris notes. “We spend a great deal of effort in selection and training of any temporary staff to ensure they will provide the top-notch care we expect from all our associates.”
Bayhealth, meanwhile, does its best to convert the itinerant nurses into full-time employees. “We are doing everything in our power to recruit, train and attract more folks to the area to understand what the state has to offer,” Ross says.
During COVID surges, hospitals cope by using telehealth visits and halting elective services to reassign staff as needed. And even when cases are down, technology continues to play a prominent role. For instance, Atlantic General is expanding telehealth services and remote patient monitoring.
Meanwhile, patients need to give their caregivers the same compassion they expect to receive. “We are doing the best we can with who — and what — we have,” Beebe rapid-response nurse Short says.
Ross agrees. “We’re doing our best to provide world-class health care not only to our patients but to the community in general.”