We thank readers for sharing comments about our pre-Thanksgiving missive about jobs and nurses (https://www.cumber.com/market-commentary/jobs-data-nurses).
Here’s a partial list of replies.
John wrote,
David, I was surprised that you did not touch on the Traveling Nurse phenomenon, which exacerbated the shortage and compensation-related issues.
Would be interesting to see a similar discussion on the Doctor Shortage and how it’s even more pressure on the need for advanced nursing positions….
Fred wrote,
David.
I know highly paid emergency room physicians that are on the verge of giving up their high salaries and many former nurses who underscore the emergency situation created by combining low wages with anti-vaxxers and gov officials who profess lack leadership skill and become sycophants for loonies who somehow consider it a "constitutional right" to endanger others by refusing to abide sound public health practices. If we look at where employees are lacking, the correlation of "contact with loonies" and labor shortage is unmistakable….
Jack wrote:
I had surgery at major hospital in Atlanta in early October and ended up spending a week plus in hospital post-surgery. Got a real eye-opening education into nursing shortage, which I am not sure is as bad as numbers look. The problem is that during early covid the hospitals started hiring temps. Well, the majority of my nurses were temps. Some were temps who simply went from one Atlanta hospital to another. The pay differential between temps and full time can and usually is substantial to enormous. Many, if not most, of these temps are young. They are using nursing temp jobs as way to see the country and save a lot of money. They are often paired singles, work long hours, maybe 10 four days, and do nothing but sleep during that period. Then they spend the other three days touring the area. They may be in one hospital for as little as four weeks to a couple of months, not usually more. Clear friction with full-time nurses because of pay differential. Number of full-time told me that they were thinking about going temp. Would stay in Atlanta area and just hop between hospitals for couple months at a time each. The hospitals, out of necessity, have created a mess. Except for the benefits, why work full time when you can earn 2x the pay or more working temp? And most of these temps come through a screening agency which provides health insurance, etc.
As you well know and have written, we do have a big demographic problem. And we do not have enough nurses overall, or the temps would not be able to command a 2–3x pay differential.
With one exception, I was generally pleased with quality of care of temps. I felt I had continuity because I might have same temp for 3–4 days. They are apparently all experienced when they come. But not necessarily devoted to nursing as career. It is all about making as much money as possible in short period of time, seeing the country, and then maybe moving on to another career, at least in the case of some. They frankly could not keep up temp pace for a long time. Work, eat, sleep, work….
It a new dynamic. As I tell my daughter, as well as nieces and nephews, go forth and multiply, but they are not doing it at a fast-enough rate. Immigration is one clearly answer, but I am afraid the good old US under Trump and/or Fox doesn’t look quite as appealing as it once did to those abroad with skills. Only to the unskilled, who of course are lined up at the Southern border!
David B, a retired oncologist, writes:
The thing that’s so galling about the nursing statistics you quote is that it didn’t have to be such a dire situation. When those who oppose vaccination invoke their freedom to do so, they completely miss (or ignore) their responsibility for spreading virus to their neighbor or putting healthcare workers at risk when they crash into the hospital looking to be saved. How many times do we have to see nurses sobbing from sheer exhaustion/frustration before the message hits home?
I am truly frightened about what’s facing our children and grandchildren.
Frank wrote:
My own experience suggests the problem goes back a long way prior to Covid.
When I started clinical care, nursing programs and their directors were revered, and I learned how to care for patients with the help of some excellent nurses.
Towards the end of my career, the advent of EMR records and the requirements imposed on nursing to key entry data often strained the system towards a break point. Nurses would be in front of computer screens for half their shift and often stay overtime, without pay, to enter all the required data.
Added to the push to extend coverage ratios … floor nurses would often have eight patients compared to decades ago ratios of 5:1 … each patient with the associated data entry requirements.
The signing bonus and shift differential situation has existed for a while, in both ER and Obstetrics and ICU RNs as well as CRNAs (Nurse Anesthetists) in my field. As managers, we viewed those dynamics to be a symptom of a poor work environment or a poor benefit package. Maintaining a healthy environment and a benefit package that respected the employee eliminated the “jumping ship” patterns for salary & bonuses that you’re describing.
The bottom line is that it’s a tough job and getting tougher; and way too much emphasis is directed towards the money centres of hospitals like operating rooms and elective surgeries; and the average nurse in other areas, where basic care is provided, has been burdened for decades.
Again, thanks to all who responded, adding their thoughts and insights to the conversation. In closing, we’d like to suggest Ed Yong’s long-form exploration of this issue for The Atlantic, “Why Health-care Workers Are Quitting in Droves,” https://www.theatlantic.com/health/archive/2021/11/the-mass-exodus-of-americas-health-care-workers/620713/.
Ed Yong won a Pulitzer for his coverage of the pandemic in 2020.
David R. Kotok
Chairman of the Board &Chief Investment Officer
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