J.W. Cowan began his career 40 years ago trying to recruit nurses to what he now calls “forgotten man’s territory” in rural Alabama.
“A good rural nurse, I don’t know of anything that’s any tougher than that,” he said. “They persevere. They put the community, they put the hospital first, and my hat just goes out to them.”
Today, he is still trying to recruit nurses to Choctaw County near Mississippi, except he’s doing it in a pandemic. And the job has only gotten tougher and nurses are more in demand across the country, making it even harder to staff rural hospitals.
Cowan is an administrator at Choctaw General Hospital. His staff are working back-to-back, 12-hour shifts during the pandemic. One nurse worked a 96-hour week, and it’s not unusual for nurses to work seven days in a row to keep the hospital staffed.
Like at Choctaw General, hospitals across Alabama are reporting a shortage of nurses. Cases of COVID-19 are spiking ahead of a holiday season that experts fear could increase the rate of spread.
COVID-19 is time consuming for staff because patients require extensive care. Yet an increasing number of staff are out sick because they were infected by or exposed to COVID-19, said Alabama Hospital Association President Don Williamson.
He said many Alabama hospitals were already short-staffed before the pandemic.
“Right now, we are in a very worrying position, and I think an increasingly unstable position relative to COVID,” said Williamson, adding that the state’s 7-day average for hospitalizations has nearly doubled in the last five weeks.
Choctaw Hospital in Butler is short five nurses and a lab person, said Cowan. Several of the hospital’s nurses are at home with COVID-19. Two may never return because their illness was so severe. Yet it’s not easy to bring in reinforcements.
Williamson says he’s spent hours this week on the phone with hospitals who face staffing shortages to treat the influx of COVID patients. Some, like University of Alabama at Birmingham, are not facing an immediate staffing shortage.
“(Most nurses) want the glamor and lights of Birmingham, Mobile and Tuscaloosa. They don’t want to come to Butler, Alabama,” said Cowan.
Hospitals in larger urban areas have a shot at competing for traveling nurses in a nationwide bidding war that has driven up nursing salaries during the pandemic surge, sometimes drawing nurses in-state away from smaller, rural hospitals to higher paying gigs in cities.
“It certainly has been a challenge to recruit nurses because the market has been very competitive and a lot of that is due to COVID,” said Andy North, spokesman for DCH Hospital in Tuscaloosa.
Baptist Health hospitals, with locations in Montgomery and Prattville, have had success attracting and retaining some travel nurses by promoting their supportive workplace culture, said spokesperson Kadie Agnew.
“Sometimes you have to be creative,” she said. “Some (nurses) have decided to stay long-term because they’ve enjoyed it here and become really a part of the Baptist family.”
Right now, the hospital is finding it challenging to staff travel nurses, as many have done so well this year, they are taking the holidays off, said Agnew.
In north Alabama, where hospitals are seeing some of the state’s biggest rise in COVID-19 cases this month, Huntsville Hospital reports it does not face a staffing shortage. Nearby in Athens there is a somewhat different story.
At the Athens-Limestone hospital, a 71-bed acute facility that serves the county just west of Huntsville, there is a relative lull in COVID-19 from earlier this month when 22 COVID patients were hospitalized.
Traci Collins, interim president and chief nursing officer, says tests this week show cases are steeply on the rise again. She says staffing shortages and having staff out sick with COVID-19 represents a double whammy.
And then there’s what she calls “COVID fatigue” for healthcare workers.
“People are just really, really tired. Its physically, emotionally deteriorating,” she said of the disease’s unpredictable course and the demands of wearing full PPE and of administering a barrage of medicines and supplemental oxygen to patients.
“I think it’s been very hard on our staff to see these patients come in in a bad state, get better and decline.”
Hospitals will do what’s needed to take care of COVID-19 patients, said Williamson. That may mean redirecting staff from other parts of the hospital to the COVID-19 ward.
He said hospitals are in conversation about if and when to once again pause elective procedures, requiring some patients to put off treatments addressing chronic, painful health problems.
For the state’s hospitals already facing financial challenges, repeating such a move represents a big financial loss. The first six weeks of the state-mandated moratorium on elective procedures this spring cost Alabama hospitals $739 million, according to Williamson.
However the rising demands of COVID-19 are addressed, he said, it is inevitable that cases will continue to rise this winter, surpassing the surge in the spring.
“I think it’s almost a foregone conclusion that we’re going to exceed our previous worst case scenario, and we’re going to find ourselves dealing, frankly, with a fairly stressed healthcare system.”