COVID-19 exacerbates Oklahoma’s decades-old nursing shortage

Hospital nurses face quarantines, high out-of-state demand and higher nurse-to-patient ratios

• Catherine Sweeney
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  Catherine covers health for StateImpact Oklahoma. She grew up in Muskogee and went to Oklahoma State University. She has covered politics and policy in Colorado's high plains, Oklahoma City and Washington, D.C. You can reach her at catherine@stateimpactoklahoma.org, @cathjsweeney on Twitter or 405-673-5226 on Signal.

Oklahoma has been in a nursing shortage for decades, and the pandemic has only exacerbated the problem. StateImpact’s Catherine Sweeney reports on the unique strain COVID-19 has placed on hospital nursing teams.

When Oklahoma first identified its nursing shortage, George W. Bush was still president. The United States entered a nationwide nursing shortage in 2001, and Oklahoma has been in one since. 

“I’ve been in this role since 2002, and that was one of the first things I worked on,” said Jane Nelson, the  CEO of the Oklahoma Nurses Association.

She said  several barriers factor into the state’s inability to overcome the shortage. One is education.

“Nursing is an expensive program, so there’s only so many slots that you can fill,” she said.

Many graduates take jobs out of state. Retainment poses a challenge, too, especially when it comes to bedside nursing. And because it is such a physically demanding job, nurses tend to retire or leave the field in their early 50s.

A 2018 report by The Oklahoma Office of Workforce Development found the state has about seven hundred nurses per one hundred thousand people. Nationally, that number is eleven hundred and fifty. That was before we entered the worst pandemic in a century. Oklahoma began seeing its first COVID-19 cases in March. By April, Oklahoma hospitals were seeing case counts in the hundreds. Daily hospitalizations surpassed 600 several times in july and august. But OU Medicine’s chief nursing executive, Kammie Monarch, says it wasn’t the sheer volume of patients alone that put critical pressure on the system.  

“We have found in the last several weeks that there is a subgroup of that patient population whose care requirements are significantly more intense,” Monarch said. “And so we have carved out patients with those characteristics and are providing care for them at a one-to-one ratio.”

Demand is an obvious issue, but COVID-19 has hampered Oklahoma’s already stunted nursing supply, as well. Monarch says OU Medicine’s PPE practices have prevented any transmission from patients to staff in their facilities. But the hospital isn’t the only place staff  can be exposed. Community spread has led to dozens of nurses having to take two weeks off to quarantine. 

“We have had as many as mid-forties clinical staff in quarantine,” she said. “Down to the teens now, which is really nice. But all those people have been out of out of commission.”

Another strain on supply: Other states. Oklahoma’s not the only one facing a staffing crisis amid the pandemic. 

“When New York and Washington and now Texas had a considerable need for nurses, what did they do?” Monarch said. “They sent out a plea for nurses to come from all parts of the country. Well, guess what? Nurses from Oklahoma went.”

Monarch said that’s a good thing, of course, but it did put our hospitals in a tough spot. Others have tackled their nursing shortage with significant signing bonuses and other financial incentives.

“We just don’t want to get into that bidding war,” she said. “And we’d like for people to be at OU Medical center because they believe in our mission.”

Financial incentives aren’t off the table, though. OU Medicine has implemented something of a referral program.

“To incentivize them to invite somebody that they respect, a colleague to come to work at OU medical center,” she said. “And if they do that, there’s a substantial bonus that comes with it.”

Nelson from the Oklahoma Nurses Association says there are few other avenues hospitals have taken. The shutdown on elective surgeries led to many contract nurses being furloughed. Some hospitals are pulling those people in. Some are partnering with nursing schools for externships or other arrangements. That allows the students to come in as a support staff for registered nurses. 

“They were able to not only pick up those nursing students as employees to help the nurses that were staffing, but those nursing students also gained those clinical skills,” she said.

Some are holding job fairs, to show the workforce in the state what kinds of benefits their organizations can offer.

Over the past few weeks, COVID-19 hospitalizations have trended down, hovering around 500. The 7-day average of new cases has also been dropping, which could indicate a further decrease in hospitalizations in the future. However, public health officials have warned that the return to school could cause new cases spike again.