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Serving Northern St. Louis County, Minnesota

Pandemic worsens long term rural health care staffing woes

David Colburn
Posted 4/21/22

REGIONAL- Rural hospitals and health systems have long faced challenges in recruiting qualified staff relative to their urban counterparts, and the stress and burnout from the COVID-19 pandemic could …

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Pandemic worsens long term rural health care staffing woes

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REGIONAL- Rural hospitals and health systems have long faced challenges in recruiting qualified staff relative to their urban counterparts, and the stress and burnout from the COVID-19 pandemic could end up making that task even more difficult in the years to come.
That’s one of the takeaways from “Minnesota’s Health Care Workforce: Pandemic-provoked Workforce Exits, Burnout, and Shortages,” a survey-based report released last week by the Office of Rural Health and Primary Care at the Minnesota Department of Health.
The report focuses on the responses of licensed healthcare professionals such as physicians, registered nurses, physical therapists, alcohol and drug counselors, and others, to surveys they are required to complete when they renew their licenses.
The U.S. Health Resources and Services Administration currently classifies the Cook/Orr area as a medically underserved area and Ely as medically underserved for low-income populations, and the MDH report clearly illustrates the current disparity of providers between urban and rural areas of the state.
For all but licensed practical nurses, rural area healthcare professionals have far more potential patients than their urban counterparts. The least discrepancy is found among registered nurses, where there is one RN for every 52 people in urban areas and one for every 90 people in rural areas. For physicians, there is one doctor per 894 rural residents, more than three times the 245 per urban practitioner. Of particular relevance to the COVID pandemic is a shortage of respiratory therapists, or RTs. Urban areas have 2,700 people per RT, but that number more than doubles to 5,710 people per RT in rural areas.
Prior to the pandemic, these disparities in rural areas resulted in longer wait times to see providers, longer travel distances to access care, greater potential for hospital bed shortages, and hospitals and clinics shutting down some type of care altogether, the report noted.
Particularly disturbing for the future of rural healthcare is the reported increase of all licensed health professionals reporting their intentions to leave their respective fields within the next five years compared to pre-pandemic levels— as well as the reason why.
In past surveys, retirement was the most common reason cited for leaving, and with the average age of rural physicians being 58, as opposed to 48 in urban areas, it’s still a significant factor. But after two years of the COVID pandemic, burnout and job dissatisfaction garnered a larger piece of the pie across all disciplines. In particular, physician assistants and respiratory therapists are the two occupations most likely to cite those reasons for leaving their professions. Among nurses leaving the profession during the pandemic, the number of nurses under age 35 was greater than that of older nurses.
So, an already challenging situation has been made worse in both the short and long terms by the COVID pandemic. How will rural health care providers respond?
Recruit and retain
Cook Hospital Human Resources Director Stephanie Maki is well versed in the ins and outs of finding new staff and readily admits that recruitment is a difficult puzzle to solve.
As most rural health care providers have learned, some sort of local connection for prospective employees is an extra incentive to take a rural-based position, so Maki initiates searches with a couple of time-tested techniques, word-of-mouth and advertising openings in area newspapers, and also posts them to social media.
“We use Facebook here, and LinkedIn, those seem to be the go-to ones at this point,” Maki said. “And then it really depends on the position.”
Those techniques can work well for lower-level positions such as certified nurse aides, but Maki typically casts a wider net when looking for licensed professionals.
College health care degree programs are often good resources to tap for recruitment, and Maki uses an online career portal geared toward college graduates, known as Handshake, to zero in on possibilities.
“They have all the universities and colleges listed on their website, so I can go through and look to see which colleges graduate, for example, radiology staff. I’ll pick those colleges and send them flyers,” Maki said.
There are numerous profession-specific sites where Maki can go to place ads, although those typically come at a higher cost than ads on generic job posting sites, she said. Some have additional options, for additional cost, such as sending a broadcast email of a position announcement.
A newer wrinkle for tapping into potential employees is to make direct contact with people who are already certified or licensed. The pandemic led to a shortage in long-term care facilities of certified nurse assistants, a result in part from many CNAs leaving their jobs to care for children or other family members and those who needed a break from the added stress. Needing to find CNAs herself, Maki purchased a mailing list with the names and addresses of all of the CNAs living within a 50-mile radius of Cook and sent postcards to 775 current CNAs listed within that area.
For higher-level positions, Maki has sometimes needed to get help from a professional search firm, a more expensive option but one that can produce results.
“Some of them aren’t costly upfront, but once you hire somebody they will require payments on a percentage of that individual’s salary. We have done it in the past for the director of nursing position, and for dietary manager, because that was a really tough one.”
Many health care employers have resorted to offering signing bonuses for new employees, ranging for a few hundred to several thousand dollars depending on the position and urgency of need. Maki said Cook Hospital has used such bonuses sparingly, as they only work for a limited range of positions unless the hospital’s labor union approves them for others.
Of course, the best way to avoid the maze of the hiring process is to keep the staff you already have. Cook Hospital has as one of its benefits an employee assistance program that provides free counseling for personal and financial issues, things that have been sources of increased stress during the pandemic. Maki said the hospital has also offered in-house support by providing information to employees about different stress reduction techniques.
But for the foreseeable future, finding employees to bolster the rural health care workforce will remain a big challenge.
“I wish I knew a solution,” Maki said. “Our senior leadership is really focusing on recruiting and retaining staff. It’s very important to us to make this a facility that people love to work for.”