nurse shortage

In this May 8, 2020 file photo, registered nurses Beth Andrews, top, and Erin Beauchemin work with a patient in the COVID-19 Intensive Care Unit at Harborview Medical Center in Seattle.

JOHNSON CITY — Hoping to fill 350 permanent nursing positions, Ballad Health has brought in more than 300 contract employees to help supplement its nursing staff during the novel coronavirus (COVID-19) outbreak, which continues to put a strain on the system’s resources.

“We’re searching for more because we need more right now,” Lisa Smithgall, the chief nursing officer at Ballad Health, said Thursday about the demand for nurses, pointing to the recent increase in COVID-19 hospitalizations.

On Thursday, Ballad Health reported having 224 coronavirus patients at its facilities, a record number for the health system, which increased again on Friday to 233.

Recently, the pandemic has put into sharp relief a problem that has persisted in the United States and across the globe even before COVID-19: a shortage of nurses.

“It’s just a challenging, vicious circle that’s been going on for quite some time,” said Melinda Collins, associate dean of the Milligan University School of Sciences and Allied Health. “The shortage of nurses locally is not new, but when we’re stressed with ... higher need and things, that just comes to the forefront even more.”

Local leaders say multiple factors have caused a national scarcity in nursing staff: The workforce composed significantly of Baby Boomers is aging, and not enough new nurses are stepping in to replace those who leave. Some schools also haven’t been able to accept as many students because of a lack of faculty, who are also approaching retirement age or can find more lucrative jobs elsewhere.

According to the American Association of Colleges of Nursing, schools turned away more than 80,000 qualified applicants in 2019 because of shortages in faculty, clinical sites and classroom space.

Additionally, burnout pushes some nurses to leave the profession, and a more diverse assortment of specialized positions, such as at insurance companies and surgical centers, means fewer nurses are opting to work in the more intense environment of a hospital, which tend to be open 24/7 and care for sicker patients.

“Nurses sometimes choose the path of least resistance, and something that works better with work-life balance,” Smithgall said. “But we certainly need those dedicated nursing providers to work in a hospital because we need people to be cared for.”

Smithgall said that Ballad Health, being outside a major metropolitan area, tends to pull many students from local programs, including East Tennessee State University and Milligan University.

She said ETSU has the largest nursing program in the state and graduates hundreds of students a year, attracting enrollees from all over Tennessee. She estimated that 40% of those graduates tend to live here, go to school here and stay here.

Even though many people are educated in the region, Collins said, those students don’t always settle down in Northeast Tennessee.

Wendy Nehring, the dean of the ETSU College of Nursing, said there are many graduates of the program who want to go to more populous areas like Nashville, Chattanooga, Knoxville, or Asheville, but the majority do remain in the region.

Nehring said the ETSU has worked closely with Ballad Health and the local VA medical center to ensure a steady supply of nursing staff. Four years ago, the university developed an accelerated bachelor’s program that works with Holston Valley Medical Center, which Nehring said has resulted in 30% to 40% of those classes staying at Ballad hospitals.

Since 2009, Nehring said the number of students seeking a bachelor of science in nursing at ETSU has increased from 650 to about 1,000. She estimates there are another 300 students in the graduate program.

At Milligan, Collins estimated that between 75% and 90% of students who graduate from the institution’s nursing program tend to stay in the region. Graduating classes typically contain about 20 to 30 students, and Collins said the program probably has room for another 20 to 30 enrollees.

According to the U.S. Bureau of Labor Statistics, employment of registered nurses is projected to increase by 7% between 2019 and 2029, which is faster than average compared to other occupations.

Collins said she believes there can never be enough nurses, noting that boosting the ratio of nursing staff to patients tends to improve health outcomes.

“All those quality things that we want to do take more nurses,” she said.