Angela Rivera feels a little calmer this year, but she’s still tired.
As Chief Nursing Officer at Beckley Appalachian Regional Healthcare (ARH) Hospital, Rivera led her team of nurses through the uncertainty and fear that Covid-19 brought in the early months of 2020 until to his ultimate push here at home.
Now that the Covid surge is over, Rivera says things are starting to calm down and the hospital is operating much like before the pandemic. However, employees are learning to adapt to a “new normal”.
This new normal includes continued nursing shortages, sicker patients, random supply chain issues and tighter budgets, Rivera said. However, despite all this negative normal news, there have been two unexpected positive changes for hospital staff: increased camaraderie and a better understanding of what it means to work together for the greater good.
There was a shortage of nurses before Covid-19, and the pandemic has made matters worse.
Earlier this year, the West Virginia Center for Nursing released information on the number of registered nurses (RNs) and advanced practice registered nurses (APRNs) licensed statewide in 2021.
Data shows the state has 29,817 IAs and 4,692 APRNs. Of these numbers, only 18,520 RNs and 2,607 APRNs are considered “licensed and working at WV”.
Thousands of licensed registered nurses and APRNs in West Virginia work out of state – with the majority employed in the border states of Ohio (1,580) and Pennsylvania (1,495) , the data continues to show it.
For unemployed RNs and APRNs who retain their license, the majority listed “taking care of home or family” as their primary reason for not working. Only 24 RNs and APRNs cited inadequate pay as a reason for their unemployment.
A separate dataset on licensed practical nurses (LPNs), also released by the WV Center for Nursing, shows that in fiscal year 2021, 6,673 LPNs listed West Virginia as their state of residence. Of these, 331 LPNs listed Raleigh County as their county of residence, 297 listed Fayette County, 196 listed Wyoming County, and 173 listed Greenbrier County. (These numbers do not reflect the actual county in which the LPN may work.)
Considering the state’s population is 1,793,716 at the 2020 census, that leaves a resident to RN to APRN ratio of 85:1. The resident to RPN ratio is even lower at 269:1.
Many nurses at Beckley ARH Hospital who were working when the pandemic began have decided to retire or simply leave the profession, according to Rivera.
“It was a very scary time,” recalls Rivera. “In our part of the country, we weren’t hit by Covid straight away. So our [patient] volumes went down because, of course, everything stopped. So we didn’t have a lot of work at the beginning. We haven’t seen many patients.
Then when the pandemic came and blew up, Beckley ARH Hospital didn’t have enough manpower to handle the crisis, Rivera noted.
As recently as January 2022, ten members of the WV National Guard were on hand at Beckley ARH Hospital to provide personnel support, according to an article published in The Register-Herald on January 25. It wasn’t until March that Gov. Jim Justice announced that the National Guard’s two-year mission to provide that support to hospitals across the state was complete.
Today, Rivera says the hospital is seeing about 10 Covid patients a month, up from about 20 patients a month earlier this summer. Fortunately, Rivera noted that the new Covid strain, while more contagious, doesn’t make people as sick.
Yet the hospital is still “understaffed from the perspective of West Virginia nurses working in West Virginia hospitals,” Rivera said.
“We need more of our nurses to stay here. Our ratios are a bit higher, with six patients to one nurse, but we have a lot of traveling nurses to help fill the gap for us.
Although traveling nurses have helped fill these vacancies, Rivera explained that the practice of using traveling nurses to address the nursing shortage cannot be sustained in the long term.
“It’s a financially draining problem to have to keep paying these traveling nurses, so we need to find a way to change the way we do shifts and get away from this expensive agency nurse.”
Additionally, Rivera said travel nursing is becoming “a real friction for our core nurses.”
“Hospitals pay for a service, and then the service pays the nurse,” Rivera said. “Not only is the salary a bit higher, but they get a travel allowance.”
Essentially what happens, Rivera explained, is that a travel nurse can live two hours from the hospital and choose to drive the distance.
“[They are] get that room and board allowance but not use it because they’re driving,” Rivera said.
On the other hand, travel nurses don’t have the stability that entry-level nurses have, or some of the same amenities, Rivera noted.
“It’s really a give and take,” she said. “I commend the nurses who stayed in their hometowns and worked instead of taking the travel jobs.”
In addition to the nursing shortage, a new normal sees patients admitted to hospital much sicker than before the pandemic, and not necessarily from Covid.
“The sharpness is so much higher,” Rivera said. “People are really waiting, or trying to take care of themselves at home or on an outpatient basis. So those who are admitted here are really sick. It’s stressful for the nurses. It’s just a different world for us now.
The good news is that the hospital is operating “exactly as we were before the pandemic,” Rivera said. “We are handling higher volumes than we had last year.”
All patient services, from the emergency room to operating rooms and the cath lab, are fully open, she continued. Family members are allowed to return to the hospital to visit loved ones, although they always try to limit this to one family member at a time, and patients are usually two to a room.
“We just have to take different precautions,” Rivera said.
“You have to take a Covid test before you come in for an outpatient procedure,” Rivera said. “It’s just to make sure you’re not in a window where you could spread Covid.”
Staff also wear masks and personal protective equipment (PPE).
Beckley ARH Hospital is following the county’s red, yellow and green Covid alert system, Rivera explained. So if Raleigh County is in the red, nurses in direct patient care should wear N-95 masks. At all other times, regular surgical masks are used.
“I don’t think it’s something that’s going to go away,” Rivera said. “I think we will continue to wear masks for a very long time.”
Tighter budgets and supply chain issues
Increased use of PPE, inflation and supply chain issues caused Rivera to start doing some serious “numbers running” in her department’s budget, she said.
“Our supplies are more expensive, so we’re spending more money to care for fewer patients. And not only are we spending more money to care for fewer patients, but we still can’t get some supplies. We so we need to be advised to find something to replace the supplies,” Rivera noted, adding that there are still backorders on various items.
Supply shortages are “completely random,” she noted. One week it might be a shortage of bandages and the next it might be a shortage of syringes.
“It’s not necessarily about drugs anymore; it seems to have stabilized,” Rivera said. “It’s just that the supplies can’t get here – there could be a factory down – so we just have to find another supplier to get those supplies.”
Rivera said his staff members are always busy and “dealing with burnout.”
“It’s tough. I’ve been a nurse for almost 25 years, and this is the worst I’ve seen. We’re tired. It’s better than before, but it’s not where we were. before the pandemic.
To address this issue, members of the hospital administration talk to staff to let them speak and try to provide as much help as possible, Rivera said. Overtime has gone down and travel nurses are helping out. Vacations are not denied and schedules become more flexible or modified if a nurse is on burnout.
“We have to take it one day at a time,” Rivera said. “Our patient population is changing, our patient acuity is changing, so we have to adapt as nurses. It’s one patient at a time. It’s one day at a time. We just have to keep working every shift and do our best for our patients. As long as we do that, we’re ahead of the game.”
From the days before Covid until now, Rivera said the biggest lesson learned was that of teamwork.
“We weren’t prepared for an onslaught of really sick patients,” Rivera recalls. “We weren’t prepared for the amount of PPE we would need for all of our staff – not just the nurses. We really had to learn to team up and get out of our silos. »
She said everyone has learned to work together and to work outside of their “reach” to care for patients.
“We had to depend on each other a little more,” Rivera said. “I think the people who are still here and have been through it all over the state – we’re a much more tight-knit team.”
She said she was always passionate about the teamwork that happens every day at Beckley ARH Hospital.
“Over time, everyone returns to normal outside these four walls. But once you enter this building, there are still sick patients. There is still the Covid. There is always a pandemic and it is always very stressful.
She asks that everyone continue to support those who “still come to work every day to take care of the patients”.