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Nurse Rachel Wilcoxon prepares to file several patient charts at the sixth floor nurse's station for cardiac surgery patients Friday at CHI Memorial. Staff photo by Tim Barber
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Nurse shortage

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The Chattanooga region is home to six different nursing programs producing nearly 500 graduates per year. But despite more than 6,500 registered nurses living in Hamilton County, according to Tennessee Board of Nursing data, local hospitals struggle to fill critical nursing roles.

It's a national problem, and Chattanooga's supply of nurses is better than many areas of the country, said Rhonda Hatfield, chief nursing officer at CHI Memorial. However, several factors, including an aging workforce, near record low unemployment, competition between hospitals, insurance companies, ambulatory surgery centers and physician practices both locally and in nearby Nashville and Atlanta, make recruiting and retaining hospital nurses in Chattanooga a challenge.

"There are so many options," Hatfield said. "As they get their two to three years experience, they look for that next advanced step."

Nurses are a critical aspect of hospital quality and safety, and studies show that an understaffed and overworked nursing force decreases hospital efficiency and increases the risk of medical errors. It's one of the issues contributing to overcrowding in Erlanger's emergency department and why California mandates hospitals maintain certain nurse to patient ratios.

"You ride these roller coasters of patient swings, and you have to look at your supply and demand," Hatfield said. "How do you keep your physicians happy, keep your patients happy, keep your nurses happy? You have to devote daily planning to that."

As a result, the hospitals employ a variety of strategies to build their nursing workforce.

"We need to do more to get nurses into the area, and I'm not just talking about Erlanger," said Jan Keys, chief nursing executive at Erlanger Health System. "These three hospitals here, we all have the same problem."

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CHI Memorial plans to offer a $20,000 sign-on bonus for some nurse positions starting in July, Hatfield said. Erlanger Health System pays retention bonuses and funds faculty positions to train more nurses. Parkridge Health System offers tuition reimbursement, student loan assistance and scholarships.

Still, Memorial officials say they're looking to fill between 50 and 100 bedside nursing positions, and Erlanger officials said there's currently "no limit" to available nursing jobs within the health system.

Keys said signs of a looming nurse shortage began about 10 years ago.

"We pushed so hard" for a bachelor's degree for nursing, she said. However, "what that does is take your nurse four years to get out of school, so they're not turning over nurses in two years."

Each hospital partners with area nursing programs — Chattanooga State Community College, Southern Adventist University, University of Tennessee at Chattanooga, Cleveland State Community College, Lee University, Dalton State College — to facilitate their training. Yet the region needs 2,711 additional registered nurses to replace retirees and meet projected growth within 10 years, according to the 2019 economic development report from the Southeast Tennessee Development District.

The need is greatest for registered hospital bedside nurses — often called medical-surgical nurses — that care for sick and recovering adult patients.

Chris Smith, director of the University of Tennessee at Chattanooga School of Nursing, said one of the issues is nursing has become more specialized, and students today gravitate toward specific areas: intensive care, emergency, labor and delivery, pediatrics.

"There are very few that actually want to work what we call 'at the bedside,'" Smith said, adding young graduates need high acuity experience in order to go onto graduate school — a growing trend that also siphons nurses away from the bedside as they move into the provider role.

Keys said Erlanger loses about 75 nurses every spring to nurse practitioner programs, and retaining nurses is just as important as recruiting.

"We want to hire and train nurses — that's our mission — but many times they get a year or two experience and go work somewhere else," she said, adding that young nurses today often seek a "work-life balance" that's hard to maintain when working at a hospital.

Hatfield said Memorial's nursing staff is 80% female, and keeping young mothers is especially challenging.

"We're a hospital that's 365, so that's nights, weekends and holidays. That wears on a family after a while," she said. "Our vulnerable points are being flexible enough to cover the work and fit the lifestyle of our employees."

Another challenge for hospital recruitment is travel nursing, which is where nurses sign with an agency rather than a hospital. It's particularly appealing for young graduates with student loan debt, Smith said.

"It pays extremely well and you get an opportunity to see different parts of the country," she said.

Compounding the issue is that all schools have limited slots for nursing students, said Martina Harris, director of nursing at Chattanooga State.

"We turn away more than we can admit, and our issue as an academic institution is we only have so many faculty to allow us to be a quality program and train students safely," Harris said.

As a result, Chattanooga State is trying to expand its nursing program to its Kimball site in Marion County. Harris said the move would create 40 additional slots and help meet the nurse education demand for students in outlying counties that currently commute to Chattanooga.

Beyond needing to increase the workforce, health care policies and trends — such as electronic medical records and doing more outpatient instead of inpatient procedures — present additional challenges for hospital nurses, Hatfield said.

"You may have less patients on your unit, but they're much sicker than they used to be," she said. "It changes how the hospital has to manage that patient and therefore changes how your clinical staff have to manage their time."

On top of it all, nursing is just plain hard, Hatfield said.

"Your competency and your physical and mental preparedness is a must-have for your job every day, because you have to be sure that you don't create a mistake, and that's a lot of pressure," she said. "It's a wonderful career, but it's also still a calling."

Contact Elizabeth Fite at efite@timesfreepress.com or 423-757-6673.

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