Nursing shortage at hospitals leads to multimillion-dollar costs

A widespread shortage of nurses at Massachusetts hospitals is only getting more extreme, with an estimated 5,000 vacancies across the state and institutions hemorrhaging cash as they are forced to hire temporary staff at much higher rates.

In June, the Massachusetts Health and Hospital Association conducted a survey of 36 of the state’s 61 acute care hospitals. According to findings released this week, the vacancy rate for nurse positions has more than doubled since before the pandemic, growing from 6.4 percent in 2019 to 13.6 percent in 2022.

The severe staffing crunch presents a financial blow to hospitals, which have turned to temporary workers who often cost double that of an in-house staff member. According to a second survey conducted by MHA of 41 acute care hospitals, which combined have most of the staffed acute care beds in the state, hospitals spent $445 million on temporary staffing through the first six months of the fiscal year that ended March 31. That’s well more than the $328 million those hospitals spent in all of the previous fiscal year on temporary staffing.

“When you’re losing money from month to month to month with no change in sight, there will be some hard decisions in the months ahead that hospitals will have to make,” said Michael Sroczynski, senior vice president of government advocacy and general counsel for the MHA. “It will run the gamut from closures of services, to inhibiting the ability [for hospitals] to modernize.”

The association said that although hospitals have received billions of dollars in state and federal funds, more is needed. State representatives recently proposed sending $350 million in federal funding to hospitals to help with shortfalls, and the MHA was advocating for another round of federal support to assist.

“We don’t see any end to the financial challenges,” said Daniel McHale, vice president of health care finance and policy for the MHA.

Hospitals have already taken unusual steps to relieve the financial pressures. UMass Memorial Health is trying to fill 2,000 vacancies, one-fourth of which are for nurses. As a result, the health system has hired 700 traveling nurses on top of its 3,000 staffed nurses, costing an additional $10 million a month.

The financial pressures forced UMass Memorial to sell part of its stake in a joint venture for $180 million, which is helping to offset $10 million to $20 million in monthly losses.

Dr. Eric Dickson, chief executive of UMass Memorial Health, said that unlike other parts of the health care industry, such as nursing homes or psychiatric hospitals, which can take beds out of commission if they don’t have adequate staff, hospitals have to hire temporary staff to keep the beds open.

“The buck stops here, at the hospitals,” Dickson said. “Everyone else can do a calculation and decide if they can be open. Hospitals can’t. The patients don’t stop coming to the ER. That’s why you’re seeing the hospitals in particular in such bad shape right now.”

Moreover, the bed closures by nursing homes or mental health facilities only exacerbate the problems at hospitals. They cannot discharge patients destined for nursing homes or psychiatric centers, and end up having to hire even more temporary staff to manage.

The Massachusetts Nurses Association has said the pandemic didn’t cause the staffing crisis. Rather, it worsened an existing shortage largely caused by the hospitals themselves. Katie Murphy, president of the MNA, said that, instead of hiring more workers, hospitals had relied on mandatory overtime and other means to staff shifts, creating minimal staffing levels.

Low levels of staffing added to the pressure on nurses even before the pandemic, as more procedures moved to outpatient settings, leaving hospitals with a sicker inpatient population.

“With the stresses of the pandemic, people found it became unbearable,” Murphy said.

While a number of nurses have left the profession or left jobs at the bedside, Murphy said there are more licensed nurses in Massachusetts than before the pandemic. According to numbers provided by the MNA, there were 148,518 licensed registered nurses in the state in 2022, up from 127,171 in 2020.

Those figures may include nurses who left staff jobs to become traveling nurses. However, they don’t include traveling nurses who came from out of state or were re-licensed under COVID emergency regulations. In 2022, there were 12,000 of these temporary RN licenses.

“The nurses are there, but [hospitals] don’t want to hire them full time with good benefits,” Murphy said.

She added that many hospitals selectively post jobs that are part-time or without benefits.

Sroczynski, the MHA general counsel, said his organization was surveying hospitals again to understand the kinds of vacancies that exist.

“It’s a hard question for us to answer,” he said. “It’s a highly stressful job, but we know we pay amongst the highest salary for RNs in the country, and there is a diligent effort underway to improve the culture of the workforce. There is probably more footwork to be done around the numbers of licensed workers and where they are.”