TALLAHASSEE, Fla. - Hospital administrators on Monday gave House committees a glimpse into the challenges facing health care professionals, describing efforts to re-imagine how care is delivered amid a nursing shortage and sizable financial hit from the COVID-19 pandemic.
At the forefront of the concerns is a shortage of nurses, which the executives told lawmakers has created an emergency for hospital administrators.
Neil Finkler, chief clinical officer of AdventHealth Orlando, told the House Health & Human Services Committee that staffing nurses was a challenge before the pandemic. But COVID-19 has ramped up the urgency to address the shortage, Finkler said.
"A lot of nurses either left nursing altogether. They left the bedside, or they went to become traveling nurses because they were getting upwards of $10,000 a week to go travel and become a nurse in (COVID-19) hot spots around the country," Finkler said.
Finkler said that 79 percent of AdventHealth’s nursing-job postings currently are being filled with nursing-agency staff.
In an effort to mitigate the problem, AdventHealth implemented strategies known as "stretch nursing," in which nurses take on additional patients and increase the patient-to-nurse ratio, and "team nursing," which involves a more collaborative approach.
"This is really one of the great existential threats to our ability to continue to deliver healthcare. This is not sustainable. It limits consistency. It limits our mentoring capability. It limits team building, and it limits a lot of the things that we have done to improve the quality of care that we provide," he said.
The challenge of losing nursing staff who leave to pursue traveling nurse posts elsewhere is one that needs to be addressed, said John Couris, president and CEO of Tampa General Hospital.
"When those nurses leave to travel --- and I do not begrudge them for that, they have student loans to pay off, they have bills to take care of, and they look at this for an opportunity to take care of bills and student loans --- when they travel, it puts a tremendous amount of pressure on our ability to care for people," Couris told the House Pandemics & Public Emergencies Committee. "In my opinion, that needs to stop. We need some help. It needs to be regulated in a state of emergency."
Couris said that hospitals are being forced to adapt because COVID-19 is not expected to go away any time soon.
"Our approach and strategy has been focused on, not this notion and idea of a new normal. It’s how do you co-exist with COVID-19? COVID-19 is endemic. It will be with us very much like the flu is with us," Couris said.
Tom VanOsdol, president and CEO of Ascension Florida, which includes hospitals in Pensacola and Jacksonville, painted a grim picture of the harsh realities nurses and other medical and administrative staff are facing amid the pandemic. According to state health officials, 51,240 Floridians have died of COVID-19 since the onset of the pandemic last year.
"Our caregivers are exhausted. They’re fatigued physically, mentally, emotionally and spiritually," VanOsdol told the House Pandemics & Public Emergencies Committee Monday afternoon.
Staffing challenges extend beyond nursing, VanOsdol said. He recounted having to step into other roles along with other hospital executives in an effort to keep operations running smoothly.
"When we were critically short-staffed in housekeeping, due to difficulty hiring workers and furloughs due to community COVID exposure, I was one of eight members of our executive team who donned scrubs and filled in, stripping beds, cleaning rooms, taking out linens and trash, cleaning bathrooms, whatever needed to be done," VanOsdol said.
Critical staff shortages are compounded by a financial squeeze being put on hospitals, caused in part by the suspension of elective surgeries, the executives said.
Ascension Florida lost more than $50 million in net operating income over the last 18 months, even after receiving federal coronavirus pandemic aid, VanOsdol said.
VanOsdol also told lawmakers that hiring traveling nurses to come to Florida from other states has become problematic, because of a "laborious" licensure application process.
Rep. Tracie Davis, a Jacksonville Democrat who serves on the House Health & Human Services Committee, asked the administrators what lawmakers can do to help with the various obstacles hospitals face.
"I would say that collaboration between policymakers and health care professionals is really crucial with regards to our ability to make sure that we have an adequate workforce moving forward. We need more students. We need more professors. We need more seats," Finkler answered.
Finkler also said that much of nurses’ time has become focused on paperwork, which puts them in front of a computer instead of at patients’ bedsides.
"The sad reality today is that 40 percent of a nurse’s time is spent documenting," he said. "I would ask us collectively to start looking at things like, what do nurses have to document?"
Ascension Florida is one of the hospital systems that has moved to require COVID-19 vaccinations for employees. Rep. Dana Trabulsy, R-Fort Pierce, asked VanOsdol how the requirement, which will go into effect in November for Ascension staff, might affect the hospital system’s current nurse shortage, suggesting that some nurses may quit because of the requirement.
"With your mandate on Nov. 12, are you prepared with a shortage of nursing staff, for a 40 percent turnover rate that day?" Trabulsy asked.
"We are going to do everything possible to mitigate against that, to answer questions, provide support, debunk myths, provide the facts and data and the science and encourage folks to make the decision to get vaccinated," VanOsdol said.
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