A Nurse Shortage vs Nurses Furloughed

As the U.S. battled the COVID-19 pandemic, government officials and hospital administrators stressed their growing need for nurses, especially early on, in places like New York City and other epicenters. News articles depicted both the dire need and difficult work environments through images of exhausted and weary nurses sleeping on their feet or across their workstation.

But in other parts of the U.S., the images looked much different. The scenes in New York City were contrasted with scenes in smaller cities and towns of nurses called off shifts or temporarily furloughed.

A persistent nursing shortage has been widely acknowledged and experienced across the U.S. in the past couple of decades. So why have nurses been furloughed during a nursing shortage and pandemic?

From March to April, many states suspended elective surgeries and issued varying degrees of shelter-at-home orders. While successful in helping flatten the curve and minimizing the spread of COVID-19, the effect on hospital revenue and nurse staffing was significant.

In May, the American Hospital Association (AHA) issued a brief stating that in the first 4 months of the pandemic it was estimated that hospitals and health systems lost $202.6 billion in revenue. In July, the AHA projected a total of $323 billion in losses for hospitals and health systems by the end of 2020.

These losses are due to the hold on elective surgeries, a slow restart of surgeries, the 19.5% average decrease in inpatient admissions seen across hospitals, and a decrease of 34.5% of outpatient visits. Even ED visits were impacted with a 10%-42% decrease in patient volumes.

Decreased patient volumes naturally lead to decreased staffing needs. Elective surgeries being cancelled led to closed ambulatory surgery centers, limited need for pre-operative, intra-operative, and post-operative staff and nurses in the hospital. This led to entire units being shut down due to lack of volume.

With decreased procedures, patient volumes, and need for staff, hospital administrators had to consider cost-saving measures.

How Did Hospitals Respond?

All U.S. hospitals had to adapt to creative solutions to staff their hospitals appropriately, maintain quality patient care, prepare plans for a COVID-19 surge, prepare for extended time periods of low patient volume, and restart elective surgeries.

This is a difficult task requiring difficult decisions.

Hospitals and health systems outside of the epicenters took many approaches to manage the staffing difficulties and cost containment including hiring freezes, cross training and shifting of staff, temporary furloughs, reduction in hours, layoffs, pay cuts, and elimination of administrative and executive positions.

This created a unique and frustrating situation where nurses were left reading articles about the need for nurses amidst the pandemic while being sent home due to a lack of patient volumes.

Some nurses expressed gratitude for this reprieve to spend time with family and decrease their risk for transmission of COVID-19, while others expressed distress because of lost wages and lost opportunities to serve during the pandemic. Both groups were rightly worried about keeping their families safe and financially sustaining their households.

Nurses and Hospital Visits Steadily Increasing

Now that elective surgeries are around 90% of where they’d normally be and COVID-19 is widespread across the U.S., where does that leave nurse staffing?

News articles from March, April, and May highlighted furloughs and layoffs, but today we read more articles highlighting nurses called back to work.

While U.S. patients are not ready to seek care at the same pace they did prior to the pandemic, they have started to seek care again. Hospitals and Health systems are focusing on bringing back staff and hiring new staff.

These leaders recognize the need to look to the future and ensure they have the nurses needed to care for patients as they return to normal health care engagement patterns. Because even with an irregular staffing pattern this year, a nursing shortage remains constant.