Central Florida health systems are rethinking nursing in the face of shortages – Orlando Sentinel

Natalie M. Powell, a Miramar Licensed Resident Nurse, quit her job eight months ago to join a healthcare staffing agency and has never looked back.

For years she worked in rehabilitation and group homes in the 60-hour week. As her peers burned out during the pandemic, went to recruitment agencies, or quit the job altogether, she has tried to fill the gap by working more than 80 hours a week. She considered giving up the job altogether.

“[You’re] stressed. Tired all the time, no matter how much sleep you would get, especially since you’re putting in all those hours,” she said. “It’s all about the patient. It’s no longer about your family or your children – you care about other people who are in need. … It gets arrogant.”

Now she travels across South and Central Florida filling temporary positions at health care facilities that nurses from StaffHealth.com, her agency, are requesting. She makes $6 more an hour, gets paid the same day she works, and makes her own schedule. She often chooses to be with her children during the weekdays and work on the weekends, she said.

It is estimated that one in five healthcare workers has quit their job during the pandemic, according to data intelligence firm Morning Consult. The Florida Hospital Association in October 2021, using pre-pandemic data, projected a shortage of 59,100 nurses in Florida by 2035. That number could be even larger now.

Healthcare facilities across the Orlando area are testing new methods and technologies to fill the gaps.

AdventHealth has 266 nursing positions throughout Central Florida, including part-time and traveling nursing positions, according to its website. Orlando Health has over 600 open positions for nurses in the Orlando area, according to its website. HCA Florida Healthcare has a smaller footprint in the area and has 27 open positions, its website showed.

The Florida Hospital Association’s October analysis pointed to nursing education as a key area that needs improvement: Many of Florida’s top nursing schools are turning away qualified applicants because they have insufficient places, a problem attributed to scarce nursing faculties and lack of funds is extension.

HCA Florida Healthcare, AdventHealth Central Florida, and Orlando Health offer tuition reimbursement, signing bonuses, and career opportunities to attract nurses from the limited graduate pool. The hospital systems have expanded partnerships with nursing schools and added more clinical sites.

However, adding new nurses is only part of the solution, said Teri Moore, Orlando Health’s chief intensive care unit nurse operations manager Dr. P. Phillips Hospital in Southwest Orange County.

“We have new nurses coming in and we’re hiring like crazy,” Moore said. “But these nurses don’t have the necessary experience because a lot of that experience has retired, gone or burned out. So experience is definitely something we are focusing on and trying to find ways to really keep experienced nurses at the bedside.”

Matthew Mawby, the co-founder of StaffHealth.com, said his business tripled during the pandemic. StaffHealth.com surveyed about 300 of its nurses and asked why they switched to an agency: 82% pointed to low pay and 84% said their job responsibilities had increased, Mawby said.

Marissa Lee, vice president of the National Nurses United Union and registered nurse at HCA Florida Osceola Hospital, acknowledges that hospitals are to blame for their nursing staff shortages.

Citing federal data from 2017 that suggests Florida will indeed have a surplus of 53,700 nurses by 2030, Lee and her union argue there are enough nurses to care for patients, but hospitals are evicting them, by asking them to work in “unsafe” areas. Conditions in which each nurse tends to more patients than she can handle, in addition to other duties.

Burnout and anxiety are the problem, not a shortage, she said.

“They expect the nurses not only to do their nursing duties, but also to involve the housekeeper, the nutritionist and the secretary,” Lee said. “A lot of nurses left during the pandemic because they knew, ‘I can take a travel assignment. I can be in one place for 13 weeks. If I don’t like this place, I’ll move on.’”

Conservation may require creative thinking and a more radical change in the care status quo. Among other things, Lee advocates retention bonuses and mandatory minimum staffing ratios between nurses and patients.

HCA has made recruitment and retention top priorities, said Peter Lindquist, Division Chief Nursing Executive at HCA Healthcare North Florida Division.

“Unions have their own agendas; I can only talk to us,” he said. “We care about our nurses and we take steps to show them what we do to support them in and out of the workplace. … We will continue to drive a culture that prioritizes the protection of our patients and our staff, regardless of the challenges the industry faces.”

Along with AdventHealth and Orlando Health, HCA has provided mental health resources and is hiring LPNs and patient care technicians, as well as staff in other specialties, so nurses don’t have to take on responsibilities that could be done by someone else. Lindquist added that frontline employees help HCA make decisions and this has led to changes in staffing models and technology. The system recently invested $50 million in its nurses, he said.

Orlando Health and AdventHealth have turned to virtual nursing. Experienced, licensed nurses can talk to staff or patients through screens and complete any tasks that can be done remotely.

This could attract nurses back into the profession who are physically unable to work in person, said Linnette Johnson, AdventHealth’s Central Florida Division-South chief nursing officer.

“There are nurses out there, they are retired. And in a nutshell, they’re saying, “We don’t want to work 12-hour days, that’s some long days on our feet.” But boy would they love a virtual nurse position,” she said. “What I love about this rapid brainstorming, whether it’s technology or unconventional thinking, is that I think it broadens the horizons for caregivers.”

AdventHealth is testing the service at its DeLand campus, where employees say it has given them more time to complete tasks that can only be done in person and improved patient safety.

The hospital hasn’t tumbled patients in about two months because virtual nurses can call the nurses if they see at-risk patients trying to get out of their beds, Jun Baniqued, a registered nurse at AdventHealth DeLand, said Thursday.

“I think that’s the evolution of what the future of nursing is,” Baniqued said. “Bedside nursing isn’t going away, but it’s being enhanced by technology — virtual nursing, robotics, everything. Those are the things we should look forward to.”

Now that COVID-19 is no longer pushing hospitals to their limits, nurses who have traveled are returning. Moore said about 10% of employees who left Orlando Health are returning.

Another component of many healthcare systems’ retention strategies is an attempt to create a community that employees will not want to leave.

Lindquist pointed to HCA Healthcare’s charity events. For example, in December, nurses got together to host a Christmas party for foster children.

Lindquist said nurses told him, “That’s why I became a nurse, and that more than anything has helped me recover as a nurse, restore my well-being.”

Jeffrey Wells, assistant nurse manager at AdventHealth DeLand, said he was there as a traveling nurse nearly five years ago and decided to stay on full-time.

“It’s good to move or something, but after a while you want to find a core group of people to work with,” Wells said. “Here on this floor we are like a family.”

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