While COVID-19 played a role in shortages, the problems began well before the pandemic.
Sublette County Rural Health Care District Director of Nursing Vicky Marshall has been a nurse for nearly 24 years, but lately she’s found herself daydreaming of becoming a waitress or bartender.
“I’m tired, which makes it hard to come to work, and it makes it hard to take care of patients,” she said. The ongoing fatigue makes a career shift more tempting, she said.
A sparsely populated county that rambles over nearly 5,000 square miles, Sublette does not have a hospital. Instead, the medical clinic in Pinedale runs an emergency room mainly designed to stabilize and transfer patients to the nearest hospital, roughly 70 miles away in Jackson. Marshall is so exhausted because she’s been running a 24/7 emergency room with just four nurses, she said.
In normal times, she managed seven full-time registered nurses and an additional on-call nurse. But it’s been about five months since that was the case.
“And you know, we’re not the only ones. Star Valley’s got shortages. Jackson has shortages. Evanston has shortages. Everybody has shortages of nurses,” she said.
The problem isn’t just in Wyoming — in the United States employment in the health care industry was down by 450,000 between February 2020 and Dec. 3, 2021, according to the Bureau of Labor Statistics.
While providers say staffing has long been an issue for the state, the persistence of the COVID-19 pandemic is turning that simmering problem into a full blown crisis. From nurses to licensed clinical social workers, health care providers are worn thin and seeking opportunities where pay is better.
When asked about which Wyoming hospitals are suffering particularly acute staffing shortages, Josh Hannes, vice president of the Wyoming Hospital Association said singling out just one is impossible.
“You could call any hospital in the state,” he said.
A long-standing problem
In 2017 the Wyoming Department of Workforce Services published a report examining health care staffing in the state and predicted that a nurse shortage would hit within a decade. And it’s not just about nurses — it’s workers across the health care spectrum, from the people who provide daily care for those with developmental disabilities to clinical social workers.
“The needs here are immense,” said Heath Steel, president of the Wyoming Association of Mental Health and Substance Abuse Centers and EVP of operations for Volunteers of America Northern Rockies. “We have a hard time recruiting and bringing back young professionals into this field.” That’s a problem that existed long before the pandemic, he said.
Steel pointed to a lack of investment in education as one key problem. Most of the positions his organization is hiring for require a master’s degree, he said. The broader challenge of retaining younger workers in Wyoming plagues his field as well, according to Steel.
Toni Decklever, a registered nurse and member of the Wyoming Nurses Association, said that while there’s been some interest in expanding the nursing school programs already offered in the state, the wages offered in academia are substantially lower than for those practicing in the field. That makes it difficult to recruit additional faculty that would enable nursing programs to expand.
“I have never ever seen things like this. We have members right now that are up to 40% vacant,” said Jeff Gardner, executive director of Wyoming Community Service Providers (an organization that supports centers that serve people with intellectual and developmental disabilities). Gardner has worked in his field for 32 years and there’s always been an issue with staffing, he said, but the pandemic greatly exacerbated the problem.
Those perpetual staffing vacancies are mostly caused by the low wages offered, he said. The community service providers are primarily reimbursed through Medicaid, which sets the rates. “We have to work within those rates,” Gardner said.
Low pay and burnout
“It’s a very difficult job that doesn’t pay very well,” Gardner said of the typical work in his field. “If you’re having to support someone physically, it can be emotionally exhausting.” In one case, a member of his association reported losing someone who had been employed for 20 years to a job at a fast-food franchise that paid more.
Marshall in Sublette County lost two registered nurses to traveling nurse positions — in which she says they can make roughly six times as much money — and a third to a hospital position where pay is also better. She’s since struggled to find nurses to replace them.
Lori Hart, executive director of the Wyoming State Board of Nursing, laughed when she said her office has been getting at least one phone call or email every day from a nurse who wants to open an aesthetics practice, where pay is often better and the work is less stressful.
“You’d think we were the most Botoxed state from the number of phone calls and emails that we get on the subject,” Hart joked. (While data on the most Botoxed state in the union is elusive, Groupon released a list of the most Botoxed cities based on the number of deals the company sold. None were based in Wyoming).
The seemingly non-stop flow of COVID-19 patients has left health care providers burned out, industry representatives say.
“If [COVID patients] go to the ICU, and especially if they’re on a ventilator, their length of stay just dramatically increases, and their chance of mortality greatly increases too, unfortunately. And it’s just hard to watch,” Tim Thornell, CEO of the Cheyenne Regional Health System, said.
“We’re just tired,” Decklever said. “There’s no breaks.”
And each time someone resigns, that puts a greater strain on those remaining, who must deal with a greater number of patients with fewer people to take care of them. Many nurses are working mandatory overtime because there’s simply not enough staff, according to Decklever. They cannot take vacation time, she said. Even lunch breaks are difficult to squeeze in.
Marshall is worried she may lose yet another nurse due to the immense pressure on their four-person team. “I had one come to me today and say, ‘I don’t know how much longer I can do this’. Well, if I lose another one it decimates my nursing staff, and we can’t do it,” she said.
What that means for patients
While other places of business can reduce hours or cut back on the number of days that they’re open, health care providers can’t scale back as easily — although in Wyoming, they are having to in some ways.
In Sublette County, the shortage means that nurses often have to go from working a full shift in the clinic to working in the ER, Marshall said.
“You work all day with the COVID people and then you’re here all night,” she said. “It’s exhausting and dangerous because when you’re tired your brain isn’t always functioning at top capacity.”
Patients have expressed frustration, she said, because when they call the Pinedale or Big Piney/Marbleton clinics to refill a prescription they no longer receive a quick return call. When they were fully staffed, “we had the time to take care of their needs that same day. But now we just don’t have the staff for that. But we still try. We still try.”
Meanwhile, at CRMC, staff are being forced to postpone elective surgeries, according to Thornell.
The need for substance abuse disorder services has also increased, Steel of Volunteer of America Northern Rockies said. The greater need for services in conjunction with continued staffing issues means that they’re running long waiting lists. Wait time for high-intensity treatment, for example, is around 45 days.
An end to the crisis is nowhere in sight. Most of the solutions health providers recommend — from finding ways to increase enrollment in nursing programs to reforming Medicaid so that they can pay workers more, would take years to implement.
In the meantime, people like Marshall are trying to brace themselves for a potential holiday surge in COVID patients.
“Hoping it’s not going to spike,” she said. “But I’m not holding my breath.”