Southern hospitals have lost thousands of workers, and those who remain are exhausted
NASHVILLE, Tenn. – Kipp Shipley, a nurse practitioner at Vanderbilt University Medical Center, battled the pandemic until he couldn’t do it anymore.
Shipley dressed head-to-toe in protective gear while working in the hospital’s COVID-19 intensive care unit. He treated many coronavirus patients who were too sick to be saved.
During the winter surge, he witnessed more death each day than he would normally see in a week.
Some of the sights stuck with him. Shipley watched a husband and wife – both hospitalized by COVID-19 – say goodbye for the last time. More than once, he stabilized a pregnant woman on a ventilator as she delivered a child who died in her womb.
At the end of each shift, Shipley stripped off his gear and showered at work, so he did not bring the virus home to his family. But he couldn't scrub off the horrors of the ICU. After months of stress and loss, he started to feel nothing. It was the numbness that scared him most of all.
“When I felt myself trying to shut out those emotions– no longer trying to empathize with these families – I knew I was not in a good place,” Shipley said. "I have a passion for helping people, and I wanted to keep working in health care, but I just couldn’t do it anymore."
After a year in the ICU, Shipley transferred in April to a new assignment at Vanderbilt for which he wouldn't work exclusively with coronavirus patients. Without this new job, he said, he probably would've quit one of the most prestigious hospitals in the nation.
Shipley is not alone. After 18 months of the pandemic and as the virus surges for the fourth time with frightening momentum, hospitals find themselves in a prolonged battle against a relentless enemy, fighting with tired, disheartened and depleted troops.
Many states have lost hundreds to thousands of hospital workers to burnout, early retirement and job transfers. The doctors and nurses who remain are stretched thin by long hours and climbing admissions. Many are demoralized by a stark reality: Hospitals are full because tens of millions of Americans have refused free, safe and available vaccines.
“We know how to control the virus,” said Dr. Wendy Long, who leads the Tennessee Hospital Association. “And we see folks not getting vaccinated, and those very same folks are in the hospital right now.”
In the South, dismal vaccination rates leave many communities vulnerable to the virus. In an industry where reputation is invaluable, hospital leaders who are normally tight-lipped about the struggles within their walls have begun to air their fears for all to see.
Some have resorted to begging.
Ballad Health, which owns smaller hospitals in Tennessee and Virginia, put out statements begging people to get vaccinated or at least consider wearing masks. A similar message came from leaders at 10 other Tennessee hospital systems, including Vanderbilt, which issued a public letter “to beg you" to get vaccinated. Hospital officials in Florida and Georgia have used the word, too.
“It's difficult to watch hospital administrators, when they're doing everything they can to get the communities educated … but the community just won't adhere to that advice,” said Anna Adams, a senior official with the Georgia Hospital Association. "We're still very much begging, at this point, the public to be vaccinated.”
Southern hospitals lose 6,800 employees
In Alabama, Arkansas, Georgia, Louisiana, Mississippi and Tennessee – all among the lowest vaccination rates in the nation – there are about 53,000 fewer workers in health care and social service jobs than there were before the pandemic, according to a U.S. Bureau of Labor Statistics report updated through June.
More than 6,800 of those employees were lost by hospitals specifically. Those same hospitals, facing a surge of virus patients that approaches or exceeds all prior peaks, have no choice but to do more with less.
And more with less isn’t pretty.
Doctors and nurses work longer hours but spend less time with each patient. Extra beds are squeezed into once-private hospital rooms. Elective surgeries are delayed. Patients with moderate ailments are sent home early or not admitted at all. Emergency rooms are so packed it is difficult for ambulances to unload patients and return to the streets.
In Georgia, some hospitals became so full they told ambulances to take patients in need of a hospital bed elsewhere. In Tennessee, members of the National Guard are used to free up medical professionals from desk jobs. In Louisiana, at a hospital hit especially hard by the virus, staff said they are numb to the sound of zipping up body bags.
Staff shortages are so severe in the University of Arkansas health system that they affect every patient and complicate basic tasks such as drawing blood, delivering food and cleaning rooms. Dr. Cam Patterson, the health system CEO, said he is considering moving employees from the fundraising department into clinical positions.
If trends don't reverse soon, Patterson warned, nurses who normally have three patients will be taking care of 10. Doctors who normally treat 20 patients will have 50 or 60.
"When COVID first appeared, they were rolling up their shirt sleeves and ready to go. They were in the first quarter," Patterson said. "When this third surge started here in Arkansas, they were worn down. They were in the fourth quarter. Now it feels like they're in double overtime in a game that should have already been won."
Smaller hospitals struggle to afford traveling nurses
Though burnout robbed many hospitals of medical professionals just when they are needed most, it is far from the only drain on their manpower.
Throughout the pandemic, nurses have left steady jobs at individual hospitals to work for contracting agencies as traveling nurses, moving from state to state to fill temporary openings at elevated pay. Many hospitals face the worst nursing shortage in recent memory.
At the University of Arkansas for Medical Sciences' Medical Center in Little Rock, there are about 140 empty nursing jobs.
“Every hospital in the state is competing with each other for a finite pool of talent at a time when we all need more nurses and technicians, not less," Patterson said. "And I think some people are deciding to sit on the sidelines because this is just brutal, brutal work."
As demand for medical staff increased, the price of traveling nurses skyrocketed. Some smaller hospitals, faced with outbreaks and tight budgets, simply can't pay enough to retain their nursesor hire replacements.
Lisa Smithgall, the director of nursing for Ballad Health, described a worrisome cycle: If a nurse resigns or goes on extended leave during the pandemic, a hospital in desperate need of a quick replacement will hire a traveling nurse at an outsized rate. News of that kind of pay spreads quickly, spurring more nurses to leave the hospital and be whisked away by contracting agencies, restarting the cycle again, Smithgall said.
The impact is clear. Before the pandemic, Ballad Health generally employed fewer than 70 traveling nurses across all its facilities at any given time. As of August 2020, this total had risen to about 150, Smithgall said. As of last month, it was more than 400.
“The rate we are paying today is upwards of four times for contracted labor,” Smithgall said. “But in other parts of the country, if the average nursing salary is anywhere between $30 to $40 an hour, they’re paying contact rates that are at $175 or $250."
Contributing: USA TODAY Network, The Associated Press
Follow Brett Kelman on Twitter at @brettkelman and Cassandra Stephenson at @CStephenson731.