Respiratory therapist and registered nurse cover a body of a Covid-19 patient with a sheet at a hospital in California in December, 2021. (AP Photo/Jae C. Hong, File)

Rural hospitals, already struggling with financial strains due to Covid-19, face an even more significant threat, experts said – the workforce shortage.

Hospitals say they are short on workers in all areas of the healthcare system, not just the clinical ones. According to the American Hospital Association (AHA), about 20% of all hospitals across the country expect worker shortages to reach dire levels.

“It (the pandemic) has really stressed the workforce in ways that we’re not going to recover from for decades,” said Julia Harris, a senior policy analyst with the Bipartisan Policy Center. According to Haris, 2021 saw the biggest drop in the number of nurses in the workforce in history. Over 100,000 nurses disappeared from the hospitals’ nursing supply, putting a lot of pressure on smaller facilities to hire nurses.

“But then, the smaller rural hospitals really can’t compete dollar for dollar with other centers and so workforce is their number one expense,” she said. “When we’re talking about competition to keep the people needed to run a hospital, it’s very scary to think about what they’re going to do when the federal funds dry up.”

The pandemic hasn’t stopped causing workforce issues, said Dr. James Hoekstra, president of High Point Medical Center during a webinar hosted by the North Carolina Healthcare Association.

“The stresses that were put on the healthcare systems, especially the rural hospitals, during the pandemic are actually continuing,” Hoekstra said during the webinar. “We have lost a lot of providers to retirement. We’ve lost a lot of providers to going to different areas of the country to travel and earn more money. We’ve lost a lot of providers and staff to burnout and what we’ve been left with is a situation where we’ve had to hire a lot of what we call travelers or contract labor.”

That leaves the hospital with higher costs.

During the pandemic, thanks to federal Covid funding, rural hospitals were able to pay top dollar for travel nurses, sometimes paying as much as $200 per hour. Those salaries were subsidized with federal Covid relief funds. Now, all hospitals pay between $7,400 and $1,400 per week, according to Vivian Healthcare, a healthcare labor placement company. And with Covid funding drying up, hospitals are responsible for all of those fees. 

Whitfield Regional Hospital in Demopolis, Alabama, lists a travel nurse opening on Vivian for just under $1,700 a week – which includes a more than $900 a week salary, plus a nearly $700 a week tax-free stipend for a 13-week assignment. The hospital currently has 20 openings for full-time nurses. 

According to a Vivian spokesperson, staff nurses traditionally make far less than travel nurses. Currently, the national average for a staff nurse is about $37 an hour, while travel nurses make on average $3,600 a week, the spokesman said in an interview.  

“Rural hospitals pay more generally, especially factoring in cost of living (e.g. Houston average weekly is $2,761. Lubbock, TX is $2,831). During the pandemic, wages have shown the strongest correlation to Covid case counts rather than geography,” the spokesman said.

At Northeastern Vermont Regional Hospital in St. Johnsbury, Vermont, nurse positions start around $30 an hour, CEO Shawn Tester told Kaiser Health News. At the height of the pandemic, the hospital paid staffing agencies around $175 per hour. Now that fee is down to over $100 an hour, he said, but the hospital is working to negotiate that rate down further.

According to the U.S. Bureau of Labor Statistics, U.S. health care organizations will need to fill nearly 200,000 nursing positions every year from now until 2030. Some studies even project that the country will face a shortage of more than 29,000 nurse practitioners by 2025.

Vivian’s research into nursing shows the outlook for clinical staffing doesn’t look good. Nearly 65% of the 3,000 nurses they surveyed said they were looking to transition out of the profession in the next 5 years. Almost half (44%) said they felt like their unit is short-staffed “all the time.”

National organizations hope Congress will step in to do something about it. 

In a letter to U.S. Representatives Rosa DeLauro (D-Connecticut) and Tom Cole (R-Oklahoma), chair and ranking member of the House Subcommittee on Labor, Health and Human Services, Education and Related Agencies, the AHA said that 781 hospitals across the country, or 18.9%, said they would face critical staffing shortages.

“While the nation may be rounding the corner in the battle against Covid-19, the health care workforce continues to contend with many immediate challenges related to the pandemic, as well as a health care landscape that has been deeply altered,” the AHA wrote. 

The AHA is asking Congress for $1.51 billion to fund healthcare workforce development programs for the 2023 fiscal year’s budget, including $374 million for rural health programs. The request represents an increase of $43 million over levels approved in 2022.

“Rural health programs… are vital to ensuring that needed services remain available in America’s rural communities,” the AHA said. “We also urge Congress to support funding to establish a Rural Emergency Hospital Technical Assistance Program, to support rural hospitals who are making the transition to maintain critical services for their communities.”

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