GRAND RAPIDS, Mich. (WOOD) — The pandemic left in its wake a dwindling and emotionally exhausted health care workforce.

In Michigan, almost 40% of nurses intend to leave their jobs in the next year, a study from the University of Michigan published in April found. That number is higher for young nurses: the study found that for nurses under the age of 25, 59% intend to leave within the next year.

Sixty percent of Michigan nurses reported inadequate staffing numbers and resources, while 84% said they’re emotionally exhausted.

The study’s lead author, Christopher Friese, Ph.D., R.N., AOCN, in a release about the study said those numbers “should set off alarm bells.”

“The fact that our youngest nurses are showing the highest likelihood of leaving tells us we can’t just add more nurses to the problem,” he said. “This rate of departures and vacancies is not sustainable and executives need to undertake urgent actions to improve working conditions.” 

He said he’s “surveyed nurses multiple times in my 25-year career in nursing and this is the highest number I’ve seen.”

Michigan’s numbers point to a nationwide trend. A study from the National Council of State Boards of Nursing released in April found that 100,000 registered nurses left their jobs in the health care system during the pandemic.

The nurses cited stress, burnout and retirements, the NCSBN said.

More than a quarter of all nurses said within the next five years they plan on leaving the field or retiring.

It also found that 89% of nurses “who maintain licensure” are working in the nursing field, and around 70% are working full-time.

Friese said the pandemic highlighted a problem that was already there.

“Many health care leaders think that the COVID pandemic will ease and the workforce burden will ease also,” he said in the release. “But nurses are telling us that they’re leaving because of the unsafe working conditions and chronic understaffing that predated the pandemic. It made an already bad and unsafe situation even worse.”

NURSES TRAVEL, QUIT

Lori Batzloff is a registered nurse at Ascension Borgess Hospital and the president of the local Michigan Nurses Association union. She’s been a nurse for more than 12 years and has worked in the neurological intensive care unit for more than six years.

Batzloff said prior to the pandemic, many facilities were already understaffed, and when the pandemic hit, many nurses left. Some left the profession completely over safety concerns, while others left their West Michigan jobs for more lucrative traveling jobs.

“Some nurses left to travel because many facilities recognized really quickly during the pandemic that years of understaffing and having nurses do more with less had now come back to bite them and they desperately needed nurses and were willing to pay premium wages to nurses,” she said. “There were a few colleagues who were very frank and said, ‘If I’m going to risk my life, I’m going to get paid to do it.’”

The University of Michigan study found that 18% of nurses want to seek a traveling nurse role.

Batzloff said some of the nurses who left during the pandemic have either not returned to their hospital or stayed out of the profession altogether.

Brian Peters, CEO of Michigan Health and Hospital Association, said workforce issues are a top priority for his organization.

“Our hospitals and health system throughout the state — whether they’re urban or rural, large or small — they’re all confronting the same sort of challenges, which are really the ability to provide enough frontline caregivers, but also nonclinical staff, to ensure their continued operations,” he said.

He said his organization is currently working to help hire 8,500 more nurses at hospitals throughout Michigan.

“Those are positions we’re trying very, very hard to fill, but for one reason or another, we have a real challenge in terms of getting those nurses back,” he said.

The cost of labor “skyrocketed” more than 20% for Michigan hospitals during the pandemic, he said, as they had to rely more on contract nurses.

SAFE PATIENT CARE ACT?

The Michigan Nurses Association and the Michigan Health and Hospital Association have possible solutions to the staffing issues.

“We have about 150,000 licensed registered nurses in the state of Michigan, but only about 100,000 of those nurses are actually working,” Batzloff said. “… The problem of not having enough nurses to keep patients safe in the hospital and provide quality care existed before the pandemic, but certainly the pandemic has exacerbated that.”

She said policies focused on attracting and retaining nurses is key.

“At the end of the day, the nurses are there,” she said. “You just have to bring them back to the bedside and allow them to do the quality work that we want to do every day.”

The Michigan Nurses Association is lobbying for a bill in Lansing called the Safe Patient Care Act. Batzloff said the bill would establish nurse to patient ratios, would require facilities to post their nurse to patient ratios where the public can see it and would limit mandatory overtime to times of emergency.

“There’s no law right now in Michigan that limits the number of hours a registered nurse can be forced to work,” she said. “We understand when there’s emergencies, nurses are the very first ones willing to step up and go the extra mile to keep our communities safe. But mandating someone to work 16 hour shifts or more is not a staffing solution. And it will not recruit and retain nurses, it scares nurses away.”

She said the bill would help get licensed registered nurses back into the field.

“This is a bill that will keep you safe while you’re in the hospital. It will keep your loved ones safe. It will attract and retain nurses to the nursing profession. This is exactly what we need right now,” she said. “I don’t want people to assume that this law is about lawmakers making decisions. This law was written … by nurses for your safety in the hospital. And it’s based on peer-reviewed data and research that has been ongoing for decades now.”

But Peters said the Michigan Health and Hospital Association is “gravely concerned” about the proposed Safe Patient Care Act. He said while it sounds good and looks to address a “legitimate issue,” it does so in “a very inappropriate way.”

“It would create new fines and penalties, sanctions against hospitals that don’t meet minimum staffing requirements,” he said. “But what you have to understand is we’ve been desperately trying to hire these nurses already, and in fact passing a bill out of Lansing does nothing to change the underlying dynamics that have created the shortage in the first place.”

He said it would force hospitals to choose between turning patients away or going over the required ratio.

“We’re either going to ignore the law and accept them, even if that would put us over that ratio requirement. Or we’re going to tell them, ‘Sorry, no room at the inn. You have to seek care at a different hospital.’ And by the way, that different hospital is going to be in exactly the same predicament,” he said.

EDUCATION, IMMIGRATION

Peters pointed to multiple factors that could improve staffing numbers for hospitals.

Michigan was part of the multi-state nurse licensure compact during the pandemic, allowing nurses from other states to more easily practice in the state. Peters said his organization would like Michigan to join the compact permanently.

He also said immigration policy is important.

“We have many nurses who are ready, willing and able to work in Michigan hospitals from other countries,” he said. “But the fact is we have an immigration policy at the federal level that makes that very difficult to facilitate in short order.”

The Michigan Health and Hospital Association is also working with universities and community colleges to educate future nurses, Peters said.

“(We) got new funding in last year’s state budget to really jumpstart the ability of our community colleges to provide four year nursing degrees,” he said. “We really think that’s going to positively impact the long term pipeline because reality is we have a shortage of staff today, but that shortage is not going to get better in the future unless we address the pipeline and that means working with the higher education community.”

Peters also pointed to scope of practice, saying it’s important to make sure health care workers are “able to practice at the top of their license.”

Violence against health care workers also needs to be addressed, Peters said.

“We stand with our nurses in terms of new legislation here in Michigan and at the federal level that would create increased fines and penalties against those who commit acts of violence against our frontline caregivers,” he said. “It’s a federal offense if you physically attack a commercial airline flight attendant, we think those same protections ought to exist for our nurses and Michigan hospitals.”

TECHNOLOGY AND THE FUTURE OF HEALTH CARE

Many health care providers turned to telehealth during the pandemic, and Peters doesn’t see that going away. Being able to provide medical care remotely is a “game changer,” he said.

“Many of our hospitals have been pioneering virtual nursing programs and certainly looking at telehealth more than ever before,” he said.

Hospitals need to continue to embrace technology, he said. As artificial intelligence gains prominence, Peters believes health care will be impacted more than any other sector over the next 20 years.

“We know that the care delivery model that’s been in place for many years is not the care delivery model of the future,” he said. “And in fact, as we have new technologies that come into play, as we have certainly new prescription drug therapies that are introduced to the marketplace, as we have changes in the dynamic that exists between patients and hospitals, the care delivery model is going to change.”

Peters encouraged young people who are interested in technology to consider a job in health care.

“If you are a young person thinking about your career path, thinking about where you can locate and engage with technology, health care is where it’s going to be, and we really believe that,” he said. “We think it’s going to be a good thing for our employees, but also for the patients we serve. And that really, at the end of the day, is what it should be all about.”

Those interested in a job in health care can visit mihospitalcareers.com, a website the Michigan Health and Hospital Association launched this year.

“I really want to recognize our frontline caregivers in particular as the heroes that they are,” Peters said. “They stepped up during the worst days of the pandemic. They came to work in an environment that was very uncertain for all of us as we were learning about the COVID-19 pandemic. And frankly, they continue to be heroes. They show up every single day. Their approach is to improve our lives and to save our lives in many instances.”