Kansas nurses cope with ‘moral distress’ as COVID creates hospital staffing shortages
Last month, a nurse at Newman Regional Hospital in Emporia posted this message to the hospital’s Facebook page:
“It’s come to a point where you not only pray for your family member to not get COVID, but you pray that they don’t have any other illness or medical emergency either because there’s not enough space or staff for them to receive adequate medical care,” said Julie Glass.
“We were lucky enough during all our other surges to have hospitals that could take our intubated patients. Not anymore.”
Like hospitals across Kansas, Newman Regional is short on nurses. The result is a sense of despair among some of those on the job, who are often taking on extra shifts or may be left with more patients than they can — or should — handle.
Low staffing has led to struggles with capacity, as hospitals are not able to take on as many patients.
As the COVID-19 delta variant advances through the state, it is filling hospitals with patients that require extra attention, while forcing staff to look further and further away for facilities with the space and personnel to take transfers.
According to the Kansas Hospital Association (KHA) 13 of Kansas’ 125 hospitals statewide are anticipating “critical” staffing shortages within the next week.
Even before the pandemic, nurses were in short supply, with turnover usually higher than 10% and vacancies around 5%.
But in 2020, hospitals have seen staff burn out, retire or leave for higher paying jobs.
Turnover among Kansas RN’s more than doubled from 7% in 2019 to 16% in 2020. At the end of the year, hospitals reported that 9% of RN positions were vacant.
Data from 2021 was not immediately available. But facing a nationwide nurse shortage, hospital administrators say they are seeking out short term contractors and asking already exhausted staff to take on extra shifts.
On Wednesday, Missouri Gov. Mike Parson announced the state would spend $15 million to bring contract medical personnel to the state.
Cindy Samuelson, a spokeswoman for KHA, said staffing has been the number one complaint among hospitals for weeks.
“It continues to be really stressful and challenging for the people that are left to care for patients,” she said.
Moral Distress
Heather Crawford, a nurse at Menorah Medical Center in Overland Park, said the ongoing shortages are continuing to push nurses out of the profession.
COVID-19 requires more intensive nursing care, so more nurses are needed to attend the patients. They are being asked to do work outside their specialty, she said, and patient loads are increasing.
Most painful, Crawford said, is having to prioritize patients with the greatest needs while making others wait. The result is “moral distress” for nurses as they are caught between what they know is right and what the immediate situation requires.
“What we’re taught to do is to advocate for our patients and that means having empathy for the people in the hospital,” Crawford said. “Nobody wants to leave their grandmother sitting for 30 minutes waiting to go to the bathroom. Nobody wants their uncle to fall trying to get themselves to the bathroom because their call light has been going off and their nurse just can’t be in multiple places at once.
“It’s not that we don’t care, we have to prioritize and we are stretched so thin all the time that it puts you in a very stressful situation, a very distressing situation.”
The distress extends to small hospitals across the state.
In Emporia, Renee Pankaskie at Newman Regional Hospital said every nurse on staff has been picking up at least 12 extra hours each week. Some have taken more.
“We’re all very tired and struggling but we also have a really amazing team and we’re like family,” Pankaskie said. “We just have to show up every day because we have to and part of the power of being a nurse is we’re able to just push through and lean on each other a lot.”
But Julia Pyle, the Chief Operating Officer at the hospital, said she’s seen the fatigue weigh on the staff.
“Just the stress and guilt that goes along with knowing you’re at home when maybe your comrades are working short, I think nurses across the nation deal with that anyway and then you add the stress of a pandemic,” Pyle said. “That just wears on people’s resilience, or ability to be resilient.”
Newman Regional normally has open nursing positions. But it’s current vacancy rate of about around 10%-15% is about 7% higher than normal, Pyle said. She works to balance paying for contract workers with asking existing staff to take on extra hours.
In Medicine Lodge, CEO Ashley Taylor, said 6 nurses, about a third of their staff, have left in the past year. Many who were close to retirement left early because of the pandemic.
The staff that remains, she said, has become less willing to pick up extra shifts then they were last year.
“The fear and the anxiety that they had from a year ago, they were just starting to shake,” Taylor said. “(With the delta surge) It’s like they’ve all got PTSD again.”
For the first time in 15 years, Taylor said, the hospital had to seek temporary help from a contracting agency. She’s currently working to hire 7 to 8 new nurses and a doctor.
The staffing problems, she said, won’t leave with the pandemic even though it’s made them worse.
“They’re tired. And it’s so hard to bounce back from the mental and physical exhaustion and get your head back in the game. They’re just tired if you don’t have to do it, why would you?” Taylor said.
“If I were just coming into healthcare at this point I would probably run the opposite direction, too.”
Finding staffed beds
Fewer nurses also forces hospitals to send patients farther and farther away.
“When (large hospitals) they say they’re full that may not actually mean that every bed is taken it may mean that they cannot accept any more because they can’t staff it,” said Gary Morsch, founder of Docs Who Care - a non-profit that helps staff rural hospitals.
“Then what happens is the smaller hospitals...they are having increasing trouble transferring patients.”
On August 4, the Kansas Hospital Association reported 39% of staffed hospital beds were available statewide, and 22% of ICU beds were available. The capacity struggles were spread across the state with the lowest capacities in the Kansas City area, Northeast Kansas, and South Central Kansas.
Samuleson, with the hospital association, said she’s been told some hospitals have sent patients as far as Texas, Arkansas and Ohio.
Courtney Schmelzle, the Community Outreach Coordinator at the Nemaha Valley Community Hospital in Seneca, said it has fairly been lucky in its ability to transfer patients to Topeka Hospitals.
But in one situation when they were unable to get patients placed in Topeka, it took 14 calls before they found a hospital taking patients.
The need is driven by COVID patients as well as higher than normal volume of hospital admissions for this time of year as patients who delayed medical care need treatment, administrators said.
Medicine Lodge Hospital has sent patients to hospitals in Denver because closer facilities are full, Taylor said.
“Our hospital’s full. We send one home, by the afternoon that bed’s back up,” Taylor said.
“When our backs are against a wall and we’re calling our resources and they don’t have room themselves what do you do?”
Because every hospital is experiencing the same problems, Panaskie, the Emporia nurse, said Newman has taken transfer patients from other hospitals for the first time. Additionally, they’ve had to keep patients they would normally transfer away for better care or send them several hours away.
Those patients, she said, require the staff to learn on the job despite knowing they may be better served with specialized care at another hospital.
“We’ve had to stretch as an ICU staff learning more critical things than we have before and growing our own experience to better care for these patients that we normally wouldn’t keep as long,” Panaskie said.
“We are tired but that doesn’t mean that we’re done fighting. We want people to seek care if they need care. We don’t want people to be scared to go to the doctor.”
This story was originally published August 12, 2021 at 10:22 AM.
