PORTLAND, Ore. — Chloe Littzen-Brown worked as a pediatric nurse and a pediatric intensive care nurse for five years before the stress of the job became too much for her body to handle.
"I actually left clinical practice because I was burnt out," she said. "I was 25, 26 years old and I ended up so burnt out and so sick that I actually ended up on disability. I was on disability on 6 months and it was because of how the work environment was set up."
In her early 30s now, she left the clinical nursing profession well before the pandemic started and now works as an assistant professor at the University of Portland's School of Nursing, where she hopes to better prepare the next generation of nurses for what's to come.
She and some of her colleagues at the University of Arizona looked into why nurses were leaving the profession early like she did. Her research found that 67% of nurses under 30 are considering leaving the job within the next two years.
The reason in large part has been brought on by the COVID-19 pandemic. She also found that managerial issues, a lack of peer support and moral distress are among the main factors.
According to the American Association of Critical-Care Nurses, "Moral distress occurs when you know the ethically correct action to take but you are constrained from taking it. Whether stemming from internal or external factors, moral distress profoundly threatens our core values. It is distinct from other forms of distress experienced by nurses, such as burnout and compassion fatigue, and is especially prevalent among nurses caring for critically ill patients."
"If we catch them early and we start talking to them about these important issues such as moral distress, preparing them for what they're going to see in practice," Littzen-Brown said. "Prepare them for how to advocate for themselves. Prepare them to be able to manage their well-being, when they go into practice they are less likely to have this reality shock in which they go in and they're absolutely unprepared to see nursing the way it really is."
National and local shortages
Nationally, hospitals have been experiencing a nursing shortage for years. The vacancy rate has continued to climb from 8.2% in 2017 to 9.9% in 2020.
KGW News reached out to various hospitals in the Metro region and found that OHSU has 257 nursing positions open as of November 1, 2021 compared to 114 at the same time of 2019.
Legacy Health has experienced double their normal vacancy rate, citing 437 RN staff nurse positions that are currently open. Most are full or part-time positions.
Kevin Mealy, a spokesperson for the Oregon Nurses Association, said this has been an issue they've been trying to mitigate for years, but the pandemic has ramped up the immediate need.
"We were looking at a leak of nurses, and we might be able to replace that leak. Now what we're facing is a flood of nurses leaving the profession," Mealy said.
Mealy said some nurses who were planning to retire pre-pandemic stayed on to work during it, but have either left or are planning to leave soon. Couple that with the issues Littzen-Brown's research found and it creates a perfect storm of a shortage of nurses.
"We're seeing not just new nurses, we're seeing new nurses and experienced nurses leaving a shift in tears having worked for 16 hours on their feet with COVID patients. It is a challenging job and that is not an environment that is built for retention or for future recruitment," Mealy said.
Travel nurse disparities
Hospitals are a 24-hour business and even with a lack of health care professionals, they can't close their doors. To make up for that loss, many hospitals are hiring temporary staff like traveling nurses. Traveling nurses are nurses that travel to various hospitals to fill-in, but charge more for their services than staffs nurse are paid.
"The cost for those staff have gone up exponentially during the pandemic, so hospitals are spending millions of dollars on staff, travelling staff, because we cannot retain staff within our communities," said Becky Hultberg, president and CEO of the Oregon Association of Hospital and Health Systems.
That amount of spending is creating low morale among nurses.
"Nurses are asking, why are these travel nurses being able to be paid thousands of dollars a week, but I can't even get a raise for the time that I've spent here for the last 5-10 maybe 15 years?" said Littzen-Brown.
Hultberg said hospitals are at a point of crisis with their workforce.
"We have an overburdened workforce," she said. "We have asked so much of our healthcare workers as a society over the last two years and some people have simply said, it's enough."
Hultberg said fixing the issues will require a multi-faceted approach.
"I think it's going to require efforts by hospitals, by state partners, by federal partners and by the community to fix the current staffing shortage," she said.
Mealy said it starts with communication and getting managers to listen to the needs of nurses on the front lines and better pay.
Expanding the pipeline
Universities that offer a nursing degree have seen an increase in applications for students wanting to get into the profession. In fact, there are more applications for the programs then there are spots available.
The University of Portland typically receives around 2,000 applications for only 260 spots. OHSU's undergraduate program received 1,887 applications and accepted 420 students. Linfield University received 787 applications to fill 200 spots.
Hultberg said the pipeline of skilled workers needs to expand.
"That means we understand what our capacity and our staffing needs are now and in the future, and we match the production of our education and training facilities to those needs," she said. "That will help us in the future."
OHSU plans to add a second group of accelerated baccalaureate students to its Ashland campus in 2022. OHSU’s Portland campus also recently expanded its number of accelerated baccalaureate nursing students, and now has three such groups which start in the summer, fall and winter terms.
Linfield is launching two new programs this year to help people pivot into nursing as a second career. One is a bachelor’s degree and the other is a Masters.
One reason nursing schools can't admit more students: they're limited by the availability of clinical placements and faculty.
To get ahead of the reasons behind why nurses are leaving the profession within the first few years on the job, the University of Portland's School of Nursing renamed 'Dead Week' — the week before finals week, which is usually meant for students to prepare for exams — to 'Wellness Week' to focus on student's well-being and mental health.
"We wanted to center students' wellness and their personal vitality or their well-being so that they actually understand that we value their well-being as much as we value their academics and both of those go hand in hand," Littzen-Brown said.