The coronavirus pandemic has created a shortage of nurses. : The Indicator from Planet Money Early in the pandemic, there were national shortages of protective equipment and hospital supplies. Now, there's a shortage of nurses.
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The Economics of America's Nurse Shortage

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The Economics of America's Nurse Shortage

The Economics of America's Nurse Shortage

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UNIDENTIFIED PERSON, BYLINE: NPR.

(SOUNDBITE OF DROP ELECTRIC SONG, "WAKING UP TO THE FIRE")

STACEY VANEK SMITH, HOST:

Adam Johnston is an emergency room nurse.

You just got off an overnight shift.

ADAM JOHNSTON: (Laughter) Yeah.

VANEK SMITH: Adam has been doing the job for seven years. He works in Fargo, N.D.

And what are North Dakotans like?

JOHNSTON: We have a lot of, I think, stoic, rural population. We talk a lot. You know, like, if their presenting complaint is, my wife made me come in to the ER, there's probably something really wrong with them.

(LAUGHTER)

JOHNSTON: Like, they're probably actually pretty sick.

VANEK SMITH: Of course, Adam's job changed totally nine months ago. The hospital got ready for a huge surge of COVID cases, and Adam was put in charge of the inpatient COVID unit. He says they saw some cases and some very sick people, but they never saw the huge surge they had prepared for. But, he says, starting in the fall, they started to see more cases and more cases and more cases.

JOHNSTON: We're seeing patient volumes that are just beyond anything that we've ever seen before.

VANEK SMITH: North Dakota has seen COVID cases spike in the last couple of months. One in 10 residents of the state has gotten sick, and North Dakota has the highest COVID mortality rate in the country. Adam says the hospitals are overrun.

JOHNSTON: Facilities are adding hallway beds to their ER to be able to see more patients.

VANEK SMITH: Like, there are patients out in the hallways...

JOHNSTON: Yeah.

VANEK SMITH: ...In bed - like, in beds.

JOHNSTON: Yeah.

VANEK SMITH: And what is the staffing situation now?

JOHNSTON: It's getting rough.

VANEK SMITH: It's getting rough.

All across the country, hospitals are reporting staffing shortages. There just aren't enough nurses to meet demand right now.

This is THE INDICATOR FROM PLANET MONEY. I'm Stacey Vanek Smith. Today on the show - the nursing shortage. All over the country, hospitals are desperate for health care workers, and there just aren't enough to go around. And now some states, like North Dakota, are resorting to drastic measures.

(SOUNDBITE OF MUSIC)

VANEK SMITH: In the early days of the COVID pandemic, hospitals were scrambling for equipment - masks, gowns, ventilators, things like that. Now the problem is people. J.B. Silvers is a professor of health care finance at Case Western Reserve University.

JB SILVERS: Now we've got PPE. Now staff is the constraint. So I think going forward, that's going to be the big issue across the country. And you cannot - you can't manufacture more nurses. It just doesn't work that way.

VANEK SMITH: J.B. has spoken with nurses all over the country. And he says, simply put, they are exhausted - months of double shifts, PPE protocols, changing information, patients dying and the constant fear of infection. He says it is taking a huge toll.

SILVERS: You see people leaving.

VANEK SMITH: People are quitting. They're just quitting.

SILVERS: They're just quitting. They're saying, that's it.

VANEK SMITH: I mean, how big of a problem is this?

SILVERS: I think it's huge. I think it's really big.

VANEK SMITH: J.B. says as the supply of nurses is shrinking, demand for nurses is skyrocketing. So-called traveling nurses are typically the reserve supply for disasters. They go wherever they're needed. But right now they are needed everywhere. And hospitals, senior centers and nursing homes across the country are madly competing for nurses. There are reports of hospitals offering $6,000 a week to lure them in. J.B. says that is creating a crisis situation, especially for hospitals in rural communities and low-income areas. They don't necessarily have the money to bring in reserves or to even keep the nurses they have. At the same time, they're seeing a flood of very sick patients. States like Mississippi, Colorado and Missouri are desperate. In fact, the hospital staffing situation in North Dakota got so bad that the governor, Doug Burgum, announced the state would be taking a pretty drastic measure.

(SOUNDBITE OF ARCHIVED RECORDING)

DOUG BURGUM: So today we took a step to help address the staffing issue with an amended state health officer order that now is going to allow asymptomatic COVID-positive health care workers to work in COVID units of licensed health care facilities.

VANEK SMITH: In other words, nurses and doctors who test positive for COVID but aren't showing symptoms are being asked to keep working. Adam Johnston, the emergency room nurse in Fargo, says he could not believe it when he heard this.

JOHNSTON: It feels like nurses are being sacrificed.

VANEK SMITH: What was especially troubling to Adam and his colleagues was that North Dakota hadn't taken many other measures to contain the COVID-19 outbreak. There was no mask mandate, no ban on indoor dining or large gatherings.

JOHNSTON: We said, well, where are the prevention measures? It felt like this concept of thank you, heroes, was tossed by the wayside. We - you know, through the first several months, we saw lots of signs - you know, thank you, health care heroes - and people on the news and in public. And there was a great, strong outpouring of support.

VANEK SMITH: Oh, yeah.

JOHNSTON: And then I saw, oh, so this is how we're going to combat COVID. We're going to put our nurses at risk. You know, now where is the recognition for being a hero in that?

VANEK SMITH: Adam says this has made things even harder at work. It feels like there's no place to relax because even the staff break room is potentially full of very sick people. You cannot let your guard down at all. Adam heads North Dakota's Emergency Nurses Association, and he and other health care workers spoke out after the governor's announcement. And the governor has since issued a statewide mask mandate and has limited gatherings and indoor dining. Adam says he truly appreciates that. Still, he says, these days, his job is just really hard.

So what are your days at work like now?

JOHNSTON: It's exhausting. You know, I'm an ER nurse. I like results. I like to see patients get sutures and go home. I like to see us, you know, do CPR and revive people. I'm very results-oriented. And to go to work every day and just say, you know, well, who's going to die today, is not what I signed up for.

VANEK SMITH: And, Adam says, the risk of physical and psychological burnout is always looming. He says he used to be able to leave his job at work. Whatever happened during a shift, he could always leave it at the door. It was key to avoiding burnout as a nurse. Now, Adam says, he just can't. There are all of these moments that haunt him. He says he keeps thinking about this one COVID patient who was getting sicker and sicker, and Adam knew he was dying, so he called the man's emergency contact so he could at least have a FaceTime moment with a family member or a friend before he passed.

JOHNSTON: There was a phone number there listed for a friend. And so I called that friend and said, you know, hey, do you have contact info for his family? And he says, there is nobody. It's just me. I live next door, and I go over there now and then and check in on him. And so that, for me, was just sort of the epitome of seeing somebody that just died alone from this...

VANEK SMITH: Yeah.

JOHNSTON: ...And just, like, very alone, like, no FaceTiming, none of that. It just sort of put into perspective how really, truly painful it is to witness that happen.

VANEK SMITH: Yeah.

JOHNSTON: Yeah, so that's one patient that I can't forget. I think about him a lot.

(SOUNDBITE OF MUSIC)

VANEK SMITH: This episode of THE INDICATOR was produced by Jamila Huxtable, fact-checked by Sean Saldana. THE INDICATOR is edited by Paddy Hirsch and is a production of NPR.

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