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 The non-profit healthcare system is one of the state's largest
employers and sits in the heart of economically depressed coal
country. It faces a $40 million deficit this year as it struggles
with fewer privately insured patients, cuts in government
reimbursement and higher labor costs to attract a shrinking pool of
nurses.
To keep its operations intact, Charleston Medical is spending this
year $12 million on visiting or "travel" nurses, twice as much as
three years ago. It had no need for travel nurses a decade ago.
"I've been a nurse 40 years, and the shortage is the worst I've ever
seen it," said Ron Moore, who retired in October from his position
as vice president and chief nursing officer for the center.
Charleston Area Medical's incentives include tuition reimbursement
for nursing students who commit to work at the hospital for two
years.
"It's better to pay a traveler than to shut a bed," he said.
Hospitals nationwide face tough choices when it comes to filling
nursing jobs. They are paying billions of dollars collectively to
recruit and retain nurses rather than risk patient safety or closing
down departments, according to Reuters interviews with more than 20
hospitals, including some of the largest U.S. chains.
In addition to higher salaries, retention and signing bonuses, they
now offer perks such as student loan repayment, free housing and
career mentoring, and rely more on foreign or temporary nurses to
fill the gaps.
The cost nationwide for travel nurses alone nearly doubled over
three years to $4.8 billion in 2017, according to Staffing Industry
Analysts, a global advisor on workforce issues.
The burden falls disproportionately on hospitals serving rural
communities, many of them already straining under heavy debt like
the Charleston Area Medical Center.
These hospitals must offer more money and benefits to compete with
facilities in larger metropolitan areas, many of them linked to
well-funded universities, interviews with hospital officials and
health experts show.
Along West Virginia's border with Pennsylvania,
university-affiliated J.W. Ruby Memorial Hospital in Morgantown is
spending $10.4 million in 2017 compared with $3.6 million a year
earlier to hire and retain nurses.
But these costs are part of the facility's expansion this year,
including adding more than 100 beds as it grows programs and takes
over healthcare services from smaller rural providers that have
scaled back or closed.
J.W. Ruby, the flagship hospital for WVU Medicine, offers higher pay
for certain shifts, tuition reimbursement, $10,000 signing bonuses
and free housing for staff who live at least 60 miles away.
Next year, the hospital is considering paying college tuition for
the family members of long-time nurses to keep them in West
Virginia.
"We'll do whatever we need to do," said Doug Mitchell, vice
president and chief nursing officer of WVU Medicine-WVU Hospitals.
NOT LIKE OTHER SHORTAGES
Nursing shortages have occurred in the past, but the current crisis
is far worse. The Bureau of Labor Statistics estimates there will be
more than a million registered nurse openings by 2024, twice the
rate seen in previous shortages.
A major driver is the aging of the baby boomer generation, with a
greater number of patients seeking care, including many more complex
cases, and a new wave of retirements among trained nurses.
Industry experts, from hospital associations to Wall Street
analysts, say the crisis is harder to address than in the past. A
faculty shortage and too few nursing school slots has contributed to
the problem.
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Hospitals seek to meet a goal calling for 80 percent of nursing
staff to have a four-year degree by 2020, up from 50 percent in
2010. They also face more competition with clinics and insurance
companies that may offer more flexible hours.
Healthcare experts warn that the shortfall presents risks to
patients and providers. Research published in August in the
International Journal of Nursing Studies found that having
inadequate numbers of registered nurses on staff made it more likely
that a patient would die after common surgeries.
UAB Hospital in Birmingham, Alabama, has invested millions to
attract nurses, but still has 300 jobs to fill. At times, nursing
vacancy rates in some of its departments has hit 20 percent or
higher.
"We've rarely canceled a surgery or closed a bed because of lack of
staffing," said Terri Poe, chief of nursing at the hospital, the
state's largest, which serves many low income and uninsured
residents.
Last year, the medical center covered nearly $200 million in
unreimbursed medical costs for patients. It spent $4.5 million for
visiting nurses during fiscal 2016, including $3 million for
post-surgery services, compared with $858,000 in 2012.
Healthcare labor costs typically account for at least half of a
facility's expenses. They jumped by 7.6 percent nationally last
year, after climbing at a rate closer to 5 percent annually in
recent years, said Beth Wexler, vice president non-profit healthcare
at Moody's. The spending has proven a boon for medical staffing
companies like AMN Healthcare and Aya Healthcare.
Missouri's nursing shortage reached a record high in 2017, with
almost 16 percent - or 5,700 - of positions vacant, up from 8
percent last year. Thirty-four percent of Missouri registered nurses
are 55 or older.
"Our biggest challenge is getting the pipeline of experienced
nurses," said Peter Callan, director of talent acquisition and
development at the University of Missouri Health Care in Columbia,
which is expanding. "There are fewer and fewer as people retire."
Last year, the academic medical center hired talent scouts to
identify candidates, Callan said. It spends $750,000 a year on
extras to attract and keep nurses, including annual $2,000 bonuses
to registered nurses who remain in hard-to-fill units and up to five
years of student loan repayment assistance. It offers employee
referral bonuses and a chance to win a trip to Hawaii.
Smaller hospitals find it much harder to compete in this climate.
More than 40 percent of rural hospitals had negative operating
margins in 2015, according to The Chartis Center for Rural Health.
In rural Missouri, 25-bed Ste. Genevieve County Memorial Hospital
had to offer signing bonuses, tuition reimbursement and pay
differentials when staffing is "critically low" in units such as
obstetrics.
They haven't closed beds, but have hired less experienced nurses,
raised salaries and turned away at least one patient who would have
been in its long term care program.
"We've had to try whatever it takes to get nurses here," said Rita
Brumfield, head of nursing at the hospital. "It's a struggle every
day to get qualified staff."
To see the entire graphic on the U.S. nursing shortage, click
http://tmsnrt.rs/2xQ9Y0K
(Editing by Michele Gershberg and Edward Tobin)
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