Pa. is one of the largest producers of nurses. Why are so many hospitals understaffed?

Staffing shortages can be seen affecting nearly every field of work, and hospitals have been affected by chronic understaffing for years.

Pennsylvania currently stands as one of the largest producers of nurses per year, according to Wayne Reich, CEO of the Pennsylvania State Nurses Association.

Behind Florida and California, the number of registered nurses in the state totaled 190,470.

And despite the large number of nursing graduates entering the workforce, just as many are leaving the field. “Nurses coming out of school are working for a couple months, and they’re finding out that it’s not really what they signed up for – and they’re leaving," Reich said.

According to Reich, hospitals are seeing a shortage of nurses that want to work at the bedside, face-to-face alongside patients.

Reich said the conditions at the bedside right now are such that nurses do not want to be there.

On some occasions, fresh graduates will choose to go back to school and become advanced practitioners, others leave the profession altogether, which Reich believes is troublesome.

In California, in an attempt to expand access to more affordable Bachelor of Science in nursing programs and fill critical nursing shortages in the state, a proposed bill could allow several community colleges with existing two-year nursing programs to offer a four-year nursing program.

According to The Hospital and Healthsystem Association of Pennsylvania, hospitals are working hard to recruit, retain and develop caregivers through increased pay, flexible schedules and tuition assistance programs.

Despite this, hospitals statewide still face average vacancy rates of “14% for nurses and even greater challenges in rural communities.”

Pennsylvania is projected to have a shortfall of more than 20,000 nurses by 2026 – the worst nationally.

'Healthcare professionals are being asked to do more and more'

Dr. Emmanuel B. John has worked across the country, including in California, the Midwest, Virginia and currently serves as Dean of the York College Nursing program. John believes the nursing shortage is caused by a variety of factors, and many nurses do return back to school after serving a year or two in the field.

York College has established partnerships with local hospitals and healthcare facilities, providing students a valuable opportunity to gain experience throughout their education.

Collaborations with WellSpan Health and UPMC enable students to work in real-life healthcare settings, helping them graduate as well-rounded nurses.

"We have programs in abundance, but it still regardless of having the best nursing programs − there is still a shortage." John said, adding, "a handful of students come back immediately for their master's degree, or to become nurse practitioners."

Although both registered nurses and nurse practitioners focus on patient care and observation, NPs are permitted to prescribe treatments, order tests and diagnose patients — duties normally performed by physicians — whereas RNs are not and often work under a physician who determines patient care, diagnoses and follow-up.

York College encourages registered nurses to have two to three years of experience before they come back, so they can develop more experience working with patients. "There are other institutions that only require one year of experience."

One thing John believes stems from burnout is pressure from the high expectations from the hospitals.

"There is pressure on the hospital (healthcare) system, there is pressure on reimbursement rates for hospital services, and because of this, healthcare professionals are being asked to do more and more."

John said healthcare professionals providing care and services for patients and their families are also human beings, which is often overlooked. "We all have our physical limitations."

Poor working conditions

A new study from the University of Pennsylvania School of Nursing’s Center for Health Outcomes and Policy Research showed that, aside from retirements, poor working conditions is the leading reason nurses leave healthcare employment.

According to the study, across a variety of healthcare settings including hospitals, long-term care facilities and ambulatory care, planned retirement was the most cited reason nurses are leaving healthcare employment, followed by poor work-life balance and insufficient staffing, which ultimately lead to burnout.

“Nurses are not principally leaving for personal reasons, like going back to school or because they lack resilience,” said senior author Karen Lasater. “They are working in chronically poorly staffed conditions which is an ongoing problem that predates the pandemic.”

Some hospitals seeing mass layoffs

Pittsburgh-based healthcare Giant UPMC announced in April of this year its plan to cut more than 1,000 jobs, many of them nonclinical, within its hospitals.

A spokesperson for UPMC said this round of layoffs did not affect bedside nurses and that demand for an increase in staffing “are made based on the needs of the community.”

Currently operating more than 40 hospitals and 800 doctors’ offices and outpatient centers across Pennsylvania and around the world, UPMC said the company reduced staff through “non-clinical administrative workforce," offering affected employees enhanced severance pay and benefits coverage, to ensure its facilities continue to thrive.

In York County, UPMC hospitals have received feedback online within the last few months for complaints including increasingly long wait times, and a lack of attention and communication from nurses.

In a statement made in April by Paul Wood, UPMC Vice President and Chief Communications Officer, the realignment would not “alter UPMC’s investments in our communities, facilities, commitment to clinical care and research, strategic growth, or to offering those throughout our workforce industry-leading benefits.”