Nursing Shortage Affects Independent Practices Differently

By Deborah Jeanne Sergeant

Jacob Fisher, PhD, master’s trained nurse, assistant dean of nursing and faculty with Trocaire College in Buffalo

The shortage of nurses to work in hospitals pre-existed the pandemic. However, the health crisis made the problem worse. The nursing shortage has affected independent practices similarly.

“We are having a hard time hiring nurses,” said Deb Palmeri, clinical service manager at Visiting Nursing Association of WNY in Cheektowaga. “We aren’t hearing from applicants.”

The pandemic has made home healthcare a less desirable field for nurses than it used to be. Palmeri said that patients of home healthcare are sicker than they used to be, as hospitals push to discharge patients sooner than they used to.

Increase in violence against nurses has made the field more stressful, especially in non institutional settings like home healthcare (although violence against hospital nurses is up).

“There’s a lot of family dynamics you don’t see in the hospital,” Palmeri said. “In the hospital, it’s a controlled environment. They’re struggling to get around. We walk into the home for short-term intermittent care. Is it safe for us to be in the home?”

Palmeri also said that several VNA nurses experienced burnout during the pandemic and segued to less stressful roles such as case management for insurance companies.

Palmeri does not believe better pay is necessarily the answer to the nursing shortage.

To attract more nurses, VNA offers sign-on bonuses and has tried to offer more Monday through Friday daytime shifts to provide better work-life balance, but that’s impossible to offer all employees because patients need care outside of banking hours. Offering weekend-only shifts or 10- or 12-hour shifts for fewer days per week fits some employees’ needs better.

VNA is also more widely publicizing its need for nurses by posting on social media, hosting open houses, and participating in college job fairs. Still, out of the near dozen students in clinical rotation who began at VNA in July 2020, only two are left, as they “found homecare isn’t for them,” Palmeri said. “It can be challenging as a young nurse. Most have gone other paths in their nursing profession, so that’s encouraging.”

Martha Kershaw, doctorate in education, and is a registered nurse and associate professor of nursing with Daemen University in Amherst, She said that although the nursing shortage includes private healthcare organizations, it’s more dire at hospitals because “work-life balance is a big thing, and the younger generation is definitely looking for it. There are many areas for nurses to work like hospitals, community, wellness centers, as educators, and in schools as nurses. But from what I’m seeing there’s a need across the board for nurses.”

Daemen is trying to increase the number of enrollments in its nursing school and find more nurse educators. Without sufficient educators, an educational institution cannot train new nurses.

Jacob Fisher, P.h.D., is a master’s trained nurse, and assistant dean of nursing and faculty with Trocaire College in Buffalo, thinks that independent practices could retain and recruit more nurses by mimicking what large organizations are doing like providing sign-on bonuses and developing more flexible schedules.

“They maybe can’t offer as high of a sign-on bonus, but the expectation of the schedule is part of the package,” Fisher said. “An educational assistance can help them in obtaining a higher level of nursing. Part of that is helping them see how they fit into the organization now and how can the organization help them to get to their end path, like a BSN.”

Many large healthcare organizations reimburse or pay upfront for employees’ education, but with a stipulation that they work for them for six months to three years, depending upon the organization and the level of education. Although this brings many more nurses into the workforce, it also keeps away from choosing small, independent practices and instead working in the larger healthcare systems, such as those operating larger hospitals and the freestanding offices owned by the same healthcare systems. The strategy is often successful in keeping nurses in the same organizations for years after they have fulfilled their obligation.

Fisher wants to see more healthcare organizations work with each other in collaboration — even if as business they’re competitors — and with educators as well.

“This can meet the needs of students so they’re ready to enter the workforce,” Fisher said. “Most of our grads stay in the Western New York area. We tell our students every day in clinical that it’s an on-the-job interview. They may want you to join them when you’re done with school, or a nurse assistant position could segue into a nursing position once you have the credentials.”