Natalie M. Powell, a licensed practical nurse from Miramar, left her job eight months ago to join a health care staffing agency and never looked back.
For years, she worked 60-hour weeks at rehabilitation and group home facilities. As her colleagues de ella burned out, left for staffing agencies or quit the profession altogether during the pandemic, she tried to fill the gap by working upwards of 80 hours a week. She considered leaving the profession completely.
“[You’re] stressed. Tired all the time, no matter how much sleep you would get, especially because you’re putting in all these hours,” she said. “Everything is about the patient. It’s no longer about your family or your kids — you’re taking care of other people who are in distress. … It becomes overbearing.”
Now, she travels throughout South and Central Florida to fill temporary openings at health care facilities that request nurses from StaffHealth.com, her agency. She’s making $6 more per hour, gets paid the same day she works and makes her own schedule, often choosing to be with her children during the week and work on weekends, she said.
An estimated one in five health care workers quit their job during the pandemic, according to data intelligence company Morning Consult. The Florida Hospital Association in October 2021 predicted a 59,100-nurse shortfall in Florida by 2035 using pre-pandemic data. That number could now be even bigger.
Health care facilities across the Orlando area are testing new methods and technologies to fill the gaps.
AdventHealth has 266 vacant nursing positions across Central Florida, including openings for part-time and travel nurses, according to its website. Orlando Health has over 600 nurse openings in the Orlando area, according to its website. HCA Florida Healthcare has a smaller presence in the region and has 27 openings, 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 turn away qualified applicants because they don’t have enough seats, a problem attributed to scarce nursing faculty and a lack of funds for expansion.
HCA Florida Healthcare, AdventHealth Central Florida and Orlando Health are offering tuition reimbursement, signing bonuses, and opportunities for career growth in order to attract nurses from the limited pool of graduates. The hospital systems have expanded partnerships with nursing schools and added more clinical sites.
But adding new nurses is only part of the solution, said Teri Moore, nurse operations manager of the critical care unit at Orlando Health 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 experience because a lot of that experience retired, or left, or got burned out. And so, experience is definitely something that we’re focused on, trying to create ways to really retain experienced nurses at the bedside.”
Matthew Mawby, the co-founder of StaffHealth.com, said his company has tripled in size during the pandemic. StaffHealth.com surveyed about 300 of its nurses asking why they switched to working for an agency: 82% pointed to low wages and 84% said their job duties increased, Mawby said.
Marissa Lee, vice president of the National Nurses United union and a nurse at HCA Florida Osceola Hospital, attests that hospitals are to blame for their lack of nursing staff.
Citing 2017 federal data suggesting Florida will actually have a 53,700-nurse surplus by 2030, Lee and her union argue that enough nurses exist to care for patients, but hospitals are driving them away by asking them to work in “unsafe” conditions where each nurse is taking care of more patients than they can handle, on top of other responsibilities.
Burnout and fear are the issue, not a shortage, she said.
“They’re expecting the nurses to do not only their nursing duties but also to include the housekeeper, the dietary, secretary,” Lee said. “A lot of nurses during the pandemic left because they knew, ‘I can take a travel assignment. I can be in one place for 13 weeks. If I don’t like that place, I’m moving on.’”
Retention may require creative thinking and a more radical shift in the nursing status quo. Lee advocates for retention bonuses and mandated minimum nurse-to-patient staffing ratios, among other resources.
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 speak to ours,” he said. “We care about our nurses and take action to show them what we’re doing to support them inside and outside of the workplace. … We will continue advancing a culture that prioritizes protecting our patients and our people no matter the challenges the industry is faced with.”
Along with AdventHealth and Orlando Health, HCA has offered mental health resources and is hiring LPNs and patient care technicians, as well as staff in other specialties so nurses don’t have to do jobs that could be done by someone else. Lindquist added that frontline workers 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 via screen, and do any tasks that can be done remotely.
This may attract nurses back into the profession who are physically unable to work in-person, said Linnette Johnson, chief nursing officer of AdventHealth’s Central Florida Division-South.
“There are nurses out there, they’re retired. And to their point, they’re like, ‘We don’t want to work 12-hour days, those are some long days on our feet.’ But boy, they would love a virtual nurse position,” she said. “What I love about this rapid ideation, whether it’s technology or whether it’s out-of-the-box thinking, is that I think it broadens the horizon for nurses.”
AdventHealth is piloting the service at its DeLand campus, where staff say it has given them more time to do tasks that can only be done in person and it has improved patient safety.
The hospital has not had any patients fall in about two months because virtual nurses can call the in-person nurses if they see vulnerable patients trying to get out of their beds, said Jun Baniqued, a nurse at AdventHealth DeLand, on Thursday.
“I think this is the evolution of what nursing’s future is,” Baniqued said. “Bedside nursing will not go away, but it will be improved by the technology—virtual nursing, robotics, everything. These are the things that we should look forward to.”
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Now that COVID-19 is no longer stretching hospitals to their limits, nurses who left to travel are coming back. Moore said about 10% of staff who left Orlando Health are returning.
Another part of many health care systems’ retention strategies is to try to create a community that employees don’t want to leave.
Lindquist pointed to HCA Healthcare’s charity events. For example, in December nurses came together to host a Christmas celebration for foster children.
Lindquist said nurses told him, “This is why I became a nurse, and that helped restore me as a nurse, restored my wellness, more than anything.”
At AdventHealth DeLand, assistant nurse manager Jeffrey Wells said he visited as a travel nurse almost five years ago and decided to stay full-time.
“It’s good to move around or whatnot, but after a while, you want to find a core group of people that you work with,” Wells said. “Right here on this floor, we’re like a family.”