Georgia nursing shortage at crisis levels

Combined ShapeCaption
5 facts about the U.S. nursing shortage.According to research in the American Journal of Medical Quality, a shortage of registered nurses is projected to spread between 2009 and 2030.The South and West, authors forecast, will suffer the greatest RN shortage.The shortage is due to a variety of factors, including an aging workforce. A 2013 survey found 55 percent of RNs are 50 or older.According to the American Association of Colleges of Nursing, a shortage of nursing school faculty is also restricting nursing program enrollments.And nursing school enrollment just isn't growing fast enough to meet the demand for services

Resurging COVID-19 cases, patients’ anger have weary nurses leaving the front lines

Carey Mullis believes she was put on this earth to nurse. But she’s not sure whether she can take the pandemic’s toll in her south Georgia hospital any more.

COVID-19 has turned Georgia’s chronic nursing shortage into a crisis, one whose effects may be felt for years to come. As exhausted staff bear the crushing fourth wave that is building here from the delta variant, many COVID-19 nurses with long experience are quitting, moving to calmer jobs or barely hanging on.

In a state that already had one of the nation’s lowest ratios of nurses to population, job postings for nurses jumped by double-digit percentages in each of its regions in 2020, then jumped again. As of this week, 11,000 nursing positions across the state sit vacant, according to the nursing job service Vivian. More than 1,700 of those are in intensive care units.

It’s not close to over: A recent survey by Vivian found 43% of nurses nationwide are considering leaving health care.

As cases soar, hospitals and staff once again describe treating patients in meeting rooms, hallways and any available space. Yet they are having to scale back services for lack of staff. Hospitals from Piedmont Henry County to Phoebe Putney in Albany to Augusta University Health have halted elective surgeries. Wellstar Kennestone regularly closes sections of its emergency department simply for lack of nurses, according to staff. Wellstar says it is doing what it can to manage capacity, as its emergency department, like those at every other hospital, is swamped.

When replacement nurses can be found, they’re often new graduates or temps from other states or countries like the Philippines, as desperate hospitals pay top dollar to staffing companies scouring the globe.

ExploreHow hospitals are dealing with the coronavirus pandemic

In the midst of it all, something has changed: a tired public, younger victims, shattered hopes that the pandemic was ending. The applause of spring 2020 has faded. Patients and their families can get angry, sometimes citing misinformation about the virus, or barking when asked if they’re vaccinated.

The only no- or low-cost way to stop turnover is to treat nurses with more kindness and respect, an Emory researcher said. But people’s tempers are short.

At Colquitt Regional Medical Center’s emergency room in Moultrie, it’s all very personal for Mullis. “Nursing really used to bring me a lot of joy,” she said. In the pandemic, many nurses “have developed anxiety—depression, nightmares, whatever it is. A lot of people are struggling with just the day to day of: Is this truly what they want to do anymore?

“I can’t blame the people who have left, and I can’t even say that I haven’t considered leaving many times lately,” Mullis said. “We’re giving all we have to these people, and sometimes they’re just not making it. Lately it’s been 20- and 30-year-olds, not just the elderly people...it’s just been so much, back to back to back.”

A vicious cycle

No one tracks where all the state’s nurses work. No one but the workplace can really know when a nurse stops practicing, unless she or he lets their license lapse. Nurses often renew their licenses regardless. Georgia currently has 141,000 nurses licensed, according to the state.

What experts do know is that the number of nurses in Georgia has stagnated for a decade, growing only slightly as the population surged, according to research led by Jeannie Cimiotti, an associate professor in Emory’s School of Nursing.

Even before the pandemic, those who stayed in the profession were often exhausted and felt powerless in workplaces that too often failed to help them or ignored their ideas about improving patient care, Cimiotti said. In recent decades, about one-third of nurses experienced burnout at any given time.

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Nurse Carey Mullis moves a COVID patient from the emergency room to a room on a COVID floor at Colquitt Regional Medical Center. Mullis believes she was put on this earth to nurse. She's won awards at it. But she sees her colleagues leaving, worn down by the constant deaths, and wonders if she might leave, too. (Curtis Compton / Curtis.Compton@ajc.com)

Credit: Curtis Compton / Curtis.Compton@

Nurse Carey Mullis moves a COVID patient from the emergency room to a room on a COVID floor at Colquitt Regional Medical Center. Mullis believes she was put on this earth to nurse. She's won awards at it. But she sees her colleagues leaving, worn down by the constant deaths, and wonders if she might leave, too. (Curtis Compton / Curtis.Compton@ajc.com)

Credit: Curtis Compton / Curtis.Compton@

Combined ShapeCaption
Nurse Carey Mullis moves a COVID patient from the emergency room to a room on a COVID floor at Colquitt Regional Medical Center. Mullis believes she was put on this earth to nurse. She's won awards at it. But she sees her colleagues leaving, worn down by the constant deaths, and wonders if she might leave, too. (Curtis Compton / Curtis.Compton@ajc.com)

Credit: Curtis Compton / Curtis.Compton@

Credit: Curtis Compton / Curtis.Compton@

Health care systems have balked at spending money to hire more nurses, and decades of advocating for state-mandated workload limits have failed.

Burnout poses risks to patients, she said. Nurses can experience fatigue, struggle to concentrate, and have trouble making decisions. Research shows that hospital-acquired infections and other health problems can increase.

The Georgia Center for Nursing Excellence works with state officials to identify staffing trends from what data there are. In 2020, there were 8,000 more job openings for Georgia than the year before, said the center’s CEO, Pat Horton. Before the latest wave of COVID-19, she forecasted that the state would need to replace 30% of its nursing workforce over the next five years. It may well be more now. “There’s a shortage everywhere we look,” she said.

Shortages create a vicious cycle, further exhausting the remaining nurses.

ExploreAs COVID-19 surge continues, Georgia hospitals running out of ICU beds

“They are in the battlefield for our patients right now,” said Georgia Board of Nursing President Tammy Bryant. “There’s not enough of them. They’re being burnt out. You know, we thought we had this under control as we got to fall; and now we’re back in the second upswing. So they’re tired now.”

Gov. Brian Kemp has put hundreds of millions of dollars into hiring contract staff, but Georgia is competing with other Southern states that are also deluged with COVID-19 cases. Under Georgia’s state of emergency order, the nursing board has issued temporary permits to get nurses in the field more quickly and for retired nurses to come back. Including permits solely for the purpose of administering vaccines, those total 10,766.

None of it has solved the shortage. And it’s hamstringing every health care provider, not just hospitals.

“We’re in a staffing crisis,” said Neil Pruitt, CEO of PruittHealth, one of the largest long-term care providers in the Southeast.

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Nurse Carey Mullis works with a COVID patient just after his arrival by ambulance inside an emergency room at the Colquitt Regional Medical Center. The fourth wave of COVID is causing many nurses with long experience to consider quitting and moving to calmer jobs. (Curtis Compton / Curtis.Compton@ajc.com)

Credit: Curtis Compton / Curtis.Compton@

Nurse Carey Mullis works with a COVID patient just after his arrival by ambulance inside an emergency room at the Colquitt Regional Medical Center. The fourth wave of COVID is causing many nurses with long experience to consider quitting and moving to calmer jobs. (Curtis Compton / Curtis.Compton@ajc.com)

Credit: Curtis Compton / Curtis.Compton@

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Nurse Carey Mullis works with a COVID patient just after his arrival by ambulance inside an emergency room at the Colquitt Regional Medical Center. The fourth wave of COVID is causing many nurses with long experience to consider quitting and moving to calmer jobs. (Curtis Compton / Curtis.Compton@ajc.com)

Credit: Curtis Compton / Curtis.Compton@

Credit: Curtis Compton / Curtis.Compton@

Pruitt said he had resorted to a pilot program of bringing in nurses from the Philippines, which he said costs about $40,000 per nurse just to make the hire, a significant cost.

PruittHealth has had to limit admissions at some of its nursing homes because it can’t hire enough frontline workers to adequately staff the facilities.

Nearly a dozen state contractors were already assigned to Coffee Regional Medical Center as the current surge from the delta variant hit. But on Tuesday, worsening conditions forced them to request an additional 24, said Vicki Lewis, its president and chief executive officer.

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A sign, one of many posted at Piedmont Athens Hospital, reminds visitors not to abuse the nursing staff. (Jennifer Peebles / AJC staff)

Credit: AJC

A sign, one of many posted at Piedmont Athens Hospital, reminds visitors not to abuse the nursing staff. (Jennifer Peebles / AJC staff)

Credit: AJC

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A sign, one of many posted at Piedmont Athens Hospital, reminds visitors not to abuse the nursing staff. (Jennifer Peebles / AJC staff)

Credit: AJC

Credit: AJC

The patient census has run over capacity for days on end. Some two-thirds of the patients in the 98-bed hospital tested positive for COVID-19, and nearly all of them were unvaccinated. Severe pneumonia is common among those patients, and on Tuesday evening, the Georgia State Patrol rushed borrowed ventilators to their door.

Nurses themselves may not be vaccinated, especially in rural areas. Despite strong medical research showing the vaccines are safe, some nurses, like many other Georgians, are swayed by misinformation or waiting for full FDA approval of the vaccines. But those who are vaccinated come to work knowing that if more of their neighbors had joined them, this surge would never have happened this way.

South Georgia State College and Wiregrass Georgia Technical College are training new health care workers to pitch in at Coffee Regional. Enrollment at nursing schools across the state seems to be holding steady or doing well, officials said, perhaps driven by a drive to help, or the new prominence of a solid profession.

“They are in the battlefield for our patients right now. There's not enough of them. They're being burnt out."

- Tammy Bryant, Georgia Board of Nursing President

How many of those students will graduate, especially given the complications of getting clinical experience, is an open question. In March 2020, many hospitals barred nursing students from entering their doors because they didn’t have enough masks to protect them from the virus, and their schools had trouble finding protective gear.

When nursing students returned to the field, their experiences could be harrowing. They constantly feared that they would contract the virus, said Shorter University senior Ben Prevost, 22.

“You could tell the nurses were exhausted. They were just as sad and scared as we were.” said Prevost, who is president of the Georgia Association of Nursing Students. “Every time they would walk into a COVID positive room, they would take a deep breath.”

ExploreGeorgia to boost hospital funding to fight new coronavirus surge

Yet for many, their mission drive increased. Prior to the pandemic, Prevost wanted to be a pediatric nurse. Now he wants to work in an ICU.

Tift Regional Medical Center is another Georgia hospital that has worked with local nursing schools in hopes of locking down the graduates. They accepted that they would have to provide some of the clinical training that the schools couldn’t.

In one local nursing class that started with thirty-some students, the hospital’s chief nursing officer, Tonia Garrett, said, six stayed on course for graduation.

Emotional toll

As Garrett spoke of Tift’s situation this week, the hospital had run out of beds, and two dozen patients were stuck in the ER waiting for admission. Twenty of her nurse managers and nurse educators had stepped out of offices and gone back to the front lines to fill in staffing holes. The COVID-19 patient count is near Tift’s previous peak, with no sign of slowing.

“It’s just amazing how quickly that this is escalating,” Garrett said.

She understands she can’t keep every nurse. Her fallback is to try to at least keep them working for her health system if they leave the front lines and to rotate other nurses in. Tift also encourages therapy groups for nurses to talk about what they’ve been through.

“Those nurses that were in ICU this time last year that are still there, that’s the ones that have struggled the most emotionally,” Garrett said.

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Nurse Carey Mullis, says, “I can’t blame the people who have left, and I can’t even say that I haven’t considered leaving many times lately. We’re giving all we have to these people, and sometimes they’re just not making it. Lately it’s been 20- and 30-year-olds, not just the elderly people ... it’s just been so much, back to back to back.” (Curtis Compton / Curtis.Compton@ajc.com)

Credit: Curtis Compton / Curtis.Compton@

Nurse Carey Mullis, says, “I can’t blame the people who have left, and I can’t even say that I haven’t considered leaving many times lately. We’re giving all we have to these people, and sometimes they’re just not making it. Lately it’s been 20- and 30-year-olds, not just the elderly people ... it’s just been so much, back to back to back.” (Curtis Compton / Curtis.Compton@ajc.com)

Credit: Curtis Compton / Curtis.Compton@

Combined ShapeCaption
Nurse Carey Mullis, says, “I can’t blame the people who have left, and I can’t even say that I haven’t considered leaving many times lately. We’re giving all we have to these people, and sometimes they’re just not making it. Lately it’s been 20- and 30-year-olds, not just the elderly people ... it’s just been so much, back to back to back.” (Curtis Compton / Curtis.Compton@ajc.com)

Credit: Curtis Compton / Curtis.Compton@

Credit: Curtis Compton / Curtis.Compton@

Hospitals say they put safety as paramount and staff accordingly, but critics say some of the blame for nurse attrition lies with hospitals themselves.

Gerard Brogan, a nurse and director of nursing practice at the union and professional organization National Nurses United, maintains that in recent decades, hospitals have cut registered nursing staff to boost their bottom lines. Experienced leaders and go-to experts disappeared as less expensive health care workers such as licensed practical nurses and certified nursing assistants shouldered more of the work. During short-term surges, hospitals brought in in high-priced visiting nurses.

This approach doesn’t work in a global pandemic where hospitals across the nation are scrambling for nurses.

“We’ve been railing against this for many years, knowing as the hospital industry does that there will be a pandemic,” Brogan said. “It was never a question of if, it was a question of when.”

‘Nurses coming and crying’

Joey Ellerbee, a nurse who lives in Woodstock, has been the nurse thrust into leadership as his hospital got swamped. When the pandemic had lulled, some employees were furloughed. Now that the lulls have turned back into waves, he realized many of his coworkers never returned.

“I don’t know where they’re at,” he said. “I guess they all left nursing, I don’t know. Because it’s bad everywhere across the country, and if they all went to travel (as contract nurses), then why is it still so bad all across the country?”

Ellerbee was promoted to charge nurse in Wellstar Kennestone’s emergency room. On good days, filling in to treat patients, with great teammates, there was nothing better, he said.

There hasn’t been a good day in months.

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Emergency rooms with COVID patients are marked with special droplet precautions signs inside the emergency department at Colquitt Regional Medical Center. As hospital wards overflow, the ER can become a holding zone for patients requiring a bed, even though they’re not specially designed to keep staff safe from COVID-19. (Curtis Compton / Curtis.Compton@ajc.com)

Credit: Curtis Compton / Curtis.Compton@

Emergency rooms with COVID patients are marked with special droplet precautions signs inside the emergency department at Colquitt Regional Medical Center. As hospital wards overflow, the ER can become a holding zone for patients requiring a bed, even though they’re not specially designed to keep staff safe from COVID-19. (Curtis Compton / Curtis.Compton@ajc.com)

Credit: Curtis Compton / Curtis.Compton@

Combined ShapeCaption
Emergency rooms with COVID patients are marked with special droplet precautions signs inside the emergency department at Colquitt Regional Medical Center. As hospital wards overflow, the ER can become a holding zone for patients requiring a bed, even though they’re not specially designed to keep staff safe from COVID-19. (Curtis Compton / Curtis.Compton@ajc.com)

Credit: Curtis Compton / Curtis.Compton@

Credit: Curtis Compton / Curtis.Compton@

As the hospital wards overflow, the ER becomes a holding zone for patients requiring a bed, even though they’re not specially designed to keep staff safe from COVID-19. Hospitals try to house those who test positive in special negative-pressure rooms that suck away air contaminated by virus droplets.

The stress from that is compounded at times by the change in patient attitudes.

“It’s not like the beginning, when everybody was understanding, and they saw what we’re going through and dealing with,” Ellerbee said. “Now it’s like they’re pissed off because they’re sitting here wondering why they can’t get a room.”

He recently transferred out, to the intensive care unit meant for patients who’ve been wounded, for example in crashes or violence.

Back in Moultrie, Carey Mullis’ supervisor is watching to see what she does. Mullis has been open with her boss, Toni Leigh Bullard, especially in the last two weeks, coming to her in tears.

“She’s fabulous. She really is one of our strongest nurses,” Bullard said of Mullis.

“We’ve dealt with a lot of death throughout our times, not just with COVIDit’s the defeat now that you see. You know you’ve seen nurses coming and crying, or leaving work crying. Just because they don’t feel like they can do enough. It’s devastating.

“You walk through the nurses’ station and you hear it every day,” Bullard said: “‘I’m not sure how much longer I could do this.’”

AJC Staff Writer Carrie Teegardin contributed to this article.