Solutions for Nevada’s long-standing nursing shortage prove elusive

Before applying for nursing school in August 2021, Miranda Sanders says she and her colleagues saw how nurses were called to the front lines during the pandemic, and how the pandemic affected working conditions. But that didn’t turn her away from the career path.

“It made me want to do it even more,” Sanders says. “With the shortage, there’s just such a great need in our society. And it’s very fulfilling to be able to fill that need.”

Now in her second semester of nursing school at UNLV, Sanders started as a paid nurse apprentice at Sunrise Hospital on March 25. The position isn’t required for her degree, but she says other nurses recommended it.

Sanders will be one of 18 nurse apprentices enrolled at UNLV, all of whom are gaining paid experience at local hospitals and healthcare facilities while working towards their associate’s or bachelor’s degrees. In January, Gov. Steve Sisolak said the state health department and board of nursing have called on eligible nursing students to “strongly consider” becoming a nurse apprentice to help with the “constant challenge” of staffing hospitals across the state.

At press time, COVID-19 hospitalizations across the state continued “to decline to the lowest levels Nevada has experienced since March 2020,” and are not negative impacting hospital capabilities, according to the Nevada Hospital Association. With a seven-day rolling average down to 123 new daily cases, the association recently reported less-serious “warning” levels for staffing in hospitals across the state—one notch down from the “crisis” levels that have persisted in previous months.

After surpassing more than 10,000 COVID-19 deaths in Nevada, staffing issues continue to be a concern for officials, facilities and workers.

Shortages of nurses are “not new,” according to Dr. Carrie Hintz, an associate professor of nursing at UNR. “Nevada has quarreled with nursing. Up here in the north, there are five schools that feed into Northern Nevada hospitals, and we still have a shortage,” she says, adding that the issue has gained more attention recently because of a “historic” increase in well-paid travel nurse opportunities.

Originally from Elko, Hintz spent most of her 15-year nursing career in rural parts of Nevada. She says those areas are getting hit “particularly hard,” because they have less resources.

According to a recent report, six of Nevada’s 13 rural hospitals (46%) are at risk of closing, with two at “immediate risk.” The report, from the national policy group Center for Healthcare Quality and Payment Reform, also finds that quality, more than a quarter of rural hospitals are at risk of closing due to financial difficulties—both pre-existing and those aggravated or brought on by the pandemic.

“If you look from a global context and across the country, hospitals are decommissioning beds, closing down lines of service. So, we’re going to see more [of that],” Hintz says, adding that many facilities decommissioned beds during the pandemic to adjust for staff shortages.

Hospitals have taken different approaches to dealing with financial issues throughout the pandemic. For example, during the summer of 2020, Clark County officials approved a plan to cut $14 million in costs for the publicly funded University Medical Center (UMC) by implementing a hiring freeze and offering early retirement.

One nurse, who asked that her name before being disclosed, says she remembers about 10 nurses or ancillary workers taking the offer and leaving her department at UMC second and third surges of COVID. “It was a great idea, but unfortunately not at the right time,” she said, adding that the hospital eventually had to hire travel nurses and implement mandatory overtime.

Without disclosing the number of employees who took advantage of the program, UMC spokesman Scott Kerbs claims that the voluntary separation program from two years ago is “not relevant” to current staffing levels at the hospital. Since the hospital announced in early March that it was re-implementing the policy, more nurses have signed up for voluntary shifts. Currently, fewer than 20% of the hospital’s nursing units require mandatory overtime, Kerbs says.

He adds that the hospital contracts with a “large number” of travel nurses, and hopes to call off mandatory overtime shifts “whenever possible, depending on patient volumes.”

Since January, UMC has brought on 41 nurses and expects to continue hiring in the coming months. Since 2019, the total number of bedside nurses at the hospital has increased by 119, Kerbs says. “In support of our commitment to patient safety, UMC maintains the best nurse-to-patient ratio in the state,” he adds.

As she considers future employers, Sanders says, she has concerns about understaffing causing unsafe work environments. She says nurses can’t be as effective making serious decisions when they have too many patients. “It just motivates me to make sure I’m working at hospitals that do have safe ratios,” Sanders says, adding that facilities without good nurse-to-patient ratios will likely face greater shortages.

On the other hand, Hintz says, fixing ratios won’t fully address factors contributing to the quality nursing shortage. “It’s not just about the number of nurses in a particular area. It’s about turnover and retention,” she says, adding that ancillary staff, training, work environment and other factors—which vary by region and facility—need to be considered when making policies that aim to address the shortage across healthcare facilities.

“They have to allocate that money from somewhere,” Hintz says. “When California put ratios in, they got rid of a lot of ancillary staff. And sometimes, you don’t need another nurse. You need a tech or CNA [Certified Nursing Assistant] that can walk your patient to the bathroom, take their vitals. With ratios, it only takes one bad patient to [ruin your night.] And there’s no flexibility for the number of patients [they’re handling.]”

Sanders says she’s eager to gain additional experience in a hospital as she works towards her degree and certification, and students like her can help take some tasks off workers’ plates. “If they’re facing a shortage right now, then that is a possible solution to help them, just to decrease the workloads of nurses by allow nurse [apprentices] to do the everyday basic things that just take up their time,” Sanders says.

But getting qualified students and nurses into facilities won’t be enough to address staffing issues that have been mounting for decades, Hintz says. After members of Congress asked the White House COVID-19 Task Force to investigate travel nurse agencies for “price gouging,” the American Nurses Association released a statement in February calling attention to “chronic causes of cyclical nursing shortages that have occurred over the past 50 years.”

“More needs to be done to effectively investigate and mitigate the root causes of nursing shortages,” the association stated. “Changes must be made in providing better work environments, appropriate compensation and benefits, and making patient safety a top priority to attract and retain nurses today and in the future.”

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