Health care workers with the Carilion Clinic in Roanoke wear enhanced personal protective equipment inside the health system’s facilities (Photo courtesy of the Carilion Clinic).
Last week, the Virginia Nurses Association held a virtual news conference to discuss the COVID-19 pandemic. Unlike in the summer, the tone wasn’t optimistic. This time, nurses across the state had gathered to share the growing toll of providing intensive care amid worsening staffing shortages.
“Our nurses are mentally depleted, exhausted and traumatized,” said association president Linda Shepherd, adding that the impact on health care — especially when it came to staffing shortfalls — was “bleak.”
Despite ample evidence of nursing burnout, though, many of the stories about workers leaving the industry have focused on a growing number of staff vaccination mandates. Those now include a recent order from President Joe Biden, who announced vaccines would be required for all health care workers at facilities accepting Medicare or Medicaid reimbursement — the vast majority of hospitals and nursing homes.
“Nurses Are In Short Supply,” one NPR headline read. “Employers Worry Vaccine Mandate Could Make It Worse.” Other articles have focused on worst-case scenarios, including a hospital in upstate New York that had to suspend delivering babies after some nurses in the maternity unit resigned rather than get vaccinated.
But many of Virginia’s largest health systems, which implemented vaccine mandates weeks before the Biden order, say the requirements have had an at-most minimal impact on staffing levels.
At Sentara, a large hospital system based in the Hampton Roads region, just over 74 percent of its approximately 28,000 employees are fully vaccinated — including 72 percent of nurses, according to spokesperson Lauren Patton (the system’s deadline for full vaccination is Oct. 18).
So far, only 11 total staff members have resigned and cited the mandate as their reason for leaving, though Patton didn’t specify what positions those employees held. Northern Virginia’s Inova Health System, another of the state’s earliest adopters, also saw 89 total resignations across a variety of departments as a result of its vaccine requirement, said CEO Dr. J. Stephen Jones. But the vast majority of its employees have chosen to comply with the policy.
“Those 89 are 0.4 percent of our workers,” Jones said. “Which I do take personally. I take a single person leaving here personally. But what it tells you is, if the overwhelming majority chose to get vaccinated even without being mandated, they clearly want to work in a place where the people around them are vaccinated, too.”
VCU Health, one of the first hospitals in the state to implement a mandate, said 99.2 percent of its medical team is cooperating with its vaccination policy. The system isn’t tracking resignations as a result of the requirement, but only 106 employees — less than 1 percent of its 13,405-member team — aren’t currently in compliance.
For many nurses across Virginia, what they consider a disproportionate focus on vaccine resistance is concerning for two reasons. One, it ignores the majority of nurses, who are largely vaccinated and supportive of workplace mandates. According to the most recent industry survey from the American Nurses Association, 88 percent of respondents were already vaccinated or planned to get the shots, and 59 percent supported employer requirements.
“Ninety percent of our nurses are vaccinated but we’re still seeing high turnover rates,” said Melody Dickerson, chief nursing officer for the Virginia Hospital Center in Arlington, at last week’s news conference. The other concern is that focusing on hesitancy among what appears to be a minority of nurses obscures the biggest reason for current staffing shortages — an influx of unvaccinated COVID-19 patients who are creating additional work for hospital staff.
“The nurses that do leave — they’ll find another job somewhere,” Dickerson added. “But the real reason for this turnover is all the other factors we’ve been talking about today.”
It’s a problem that was brewing even before the start of the pandemic. According to Kathy Baker, the associate chief nurse and associate vice president of VCU Health, experts have been predicting a looming nursing shortage for years, driven by an aging workforce and a lack of new young professionals to take their place. That’s not due to a lack of interest, Baker said, but rather a shortage of nursing faculty to train the next generation.
“Schools of nursing can’t ramp up fast enough to accommodate all of the admissions,” she said. “If you look across Virginia, all of them have waiting lists. They turn away qualified applicants every year.” And the start of the pandemic corresponded with the period when many experts predicted a lack of nurses would begin to reverberate across the health care industry.
But COVID-19 massively sped up the process, according to Baker. After more than a year and a half of intense and emotionally distressing work — especially for nurses caring directly for COVID-19 patients — burnout has prompted some to leave the industry. It didn’t help that the latest surge came after vaccines were widely available, leading to wide frustration with patients who ended up in the hospital after refusing to take them.
“Nurses feel disrespected by communities who initially hailed them as heroes but now refuse to follow simple steps that would ease their burden,” Shepherd said. But new opportunities might be an even bigger factor for the churn. Baker said some workers have left frontline care to pursue advanced nursing degrees or even unrelated higher education (she knows of two nurses who took advantage of VCU’s education benefits to pursue non-nursing master’s degrees).
The rise of contract nursing has also become a major challenge for the industry. As COVID-19 hotspots continue to emerge across the country, companies are aggressively recruiting nurses to hard-hit areas for much higher wages than they’d ordinarily make. Jones estimated Inova spent between $13 and $14 million on contract workers last winter when Northern Virginia was going through a COVID-19 surge. And with so many young nurses choosing to take those jobs, there are concerns that hospitals might run out of money to keep paying temporary workers and offer competitive wages to full-time staff — especially if cases continue to climb through the fall and winter.
“The hospitals that have been hit the hardest, they’ve really used up a lot of their bonuses,” Baker said. “Compensation is at its highest level in the travel nurse industry. And the concern is, with this disruption in the industry, is it really best serving the patients given the dollars it’s taking? It’s eroding the ability of the hospitals to retain their workforce.”
But an even deeper issue at this point in the pandemic is the sheer number of patients. Hospitals across Virginia have been pleading with people to get vaccinated amid a rush of severe coronavirus infections, combined with emergency room volume that’s exceeding pre-COVID levels. Jones said increased demand is the major reason why Inova is currently experiencing staffing constraints.
“We’ve actually done a good job of having what would ordinarily be adequate nursing staff,” he said. “The challenge is that volumes are much higher than what we’d normally be taking care of.” Other providers, including pediatricians, are seeing the same surge in patients, leaving ample openings without enough nurses to fill them.
That spike in demand is a main reason why some hospitals have been reluctant to implement their own vaccine mandates. Even the worst walk-offs tend to represent a small fraction of staff, including 700 unvaccinated employees at Yale New Haven who are currently at risk of being fired, according to Becker’s Hospital Review. While the number seems high, it represents less than three percent of the system’s roughly 30,000 employees.
But even small losses can make a big difference for overburdened health systems (the hospital in New York that paused maternity services, for example, only lost about six nurses). And some rural hospitals fear losing an even greater number of staff. At Ballad Health in Southwest Virginia, the total employee vaccination rate is only around 64 percent. CEO Alan Levine has estimated a mandate could lead 900 nurses to quit.
“We really cannot afford to lose any nurses because of the high number of COVID patient’s we’re caring for,” chief operating officer Eric Deaton added in an interview last week. “We don’t want to be a reason why anybody leaves their job.”
Still, not requiring vaccinations can also be a liability for health systems. On Wednesday, 387 Ballad staff members were out due to COVID-19 symptoms or positive test results. And given the relatively low number of resignations at health systems that have implemented the mandates, many are skeptical they’ll prove a driving force in staffing shortfalls.
Dr. Michael Martin, president of the Virginia chapter of the American Academy of Pediatrics, said he hasn’t seen a single employee quit since his Northern Virginia practice introduced its own vaccination requirement.
“I’ve done work on vaccine hesitancy,” he said “And if staff like their jobs, are happy at their jobs, they generally will very quickly agree.
“There’s very rarely a true religious, passionate, philosophical opposition,” Martin added. “It’s usually vague feelings that are promoting them not to do it. And so when you change the formula — like they’re actually going to lose something they perceive is important — that shifts the equation for them.”
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