Nearly two years of pandemic working conditions have wiped out major gains in Minnesota’s health care workforce, leaving the state with a critical shortage that has no end in sight.
Between 2010 and 2020, the number of people licensed to work as nurses in the state grew by 43,400, or 35 percent. But as the coronavirus pandemic has dragged on, huge numbers of health care workers have left the bedside, leaving the state with thousands of job openings as patient numbers have swelled.
“In certain areas, the situation is very dire,” said Anthony Schaffhauser, workforce development director for HealthForce Minnesota, which the Minnesota State higher education system created in 2005 to grow the state’s health care workforce to meet the needs of an aging population.
“The long-term care industry is in crisis, without a doubt,” he said. “It is to the point where they deployed the National Guard.”
Hospitals have needed help, too.
At least four teams of doctors and nurses from the U.S. Department of Defense have been in the state to help overburdened hospitals care for patients. Last month, Gov. Tim Walz agreed to a $40 million contract with a temporary staffing agency to bring 200 nurses and 50 other medical workers to the state.
Staffing shortages are so troubling that hospital leaders pleaded with Minnesotans in December to do everything they could to preserve treatment capacity during the latest pandemic surge, saying facilities were “literally full.”
More than a month later, the situation has improved, yet more than 1,250 patients with COVID-19 still were hospitalized statewide. Half the state’s hospitals have no beds available for adult intensive care and one-third have no regular beds.
Schaffhauser compared medical worker shortages to recent supply-chain struggles for products during the pandemic.
“In health care, our main supply issue is human resources — that’s what you need,” he said. “If there are supply-chain issues, it is a lot more dire than ‘I’m not going to get my new iPhone for a few weeks.’ ”
Walz already has pledged tens of millions of dollars to help the industry limp through the pandemic, and state lawmakers say they’re looking for more substantial changes to help hire and retain workers. But so far, there is no consensus on what to do.
THE STATE OF STAFFING
Jenna Sheldon, spokeswoman for the Minnesota Hospital Association, said health providers have faced unprecedented worker departures during the pandemic. She cited a Morning Consult poll from October that found nearly one in five health workers nationwide had left the field during the pandemic.
Minnesota has experienced similar attrition as workers have left grueling jobs at hospitals and in long-term care for less taxing work.
There are currently almost 2,000 open positions at Minnesota hospitals and clinics alone, Sheldon said.
“This is for multiple reasons, including early retirement, burnout and stress,” she said.
Roughly one in five open jobs in Minnesota is in the health care industry, according to the Department of Employment and Economic Development. That includes 9,250 openings for home health and personal care aides, 6,000 for certified nursing assistants and 4,800 for registered nurses.
Schaffhauser said nurses have lots of work options outside of hospitals that are more appealing during a pandemic.
The long-term care industry has long faced worker shortages due to low pay and difficult working conditions. Industry advocates say the problem is exacerbated by low reimbursement rates for patients on public assistance that push down wages.
Some 350 National Guard members were deployed this fall when roughly 40 percent of long-term care facilities said they could not accept new patients because of staffing shortages. That led to a bottleneck of recovering hospital patients with nowhere to convalesce.
Patti Cullen, president of Care Providers of Minnesota, said the National Guard has provided short-term help for overwhelmed long-term care facilities.
“They have just been used as a bridge and as staff ‘respite,’ and those utilizing them had to come up with plans to improve staffing and wean off of the Guard,” she said.
Industry leaders say vaccine mandates have not been a major factor in the shortages, but they’ve made a bigger dent in staffing for long-term care than in hospitals.
BURNOUT AND SAFETY
Members of the Minnesota Nurses Association have held numerous events in recent months to highlight what they say are unsafe working conditions at hospitals across the state. They say such problems as low nurse-to-patient ratios were driving nurses away from bedsides prior to the pandemic and have only gotten worse.
On top of those challenges, nurses say they increasingly are burned out by the pandemic and exasperated at the public’s reluctance to get vaccinated. They also have increased concerns for their physical safety with several reporting routine threats of violence.
“We have gone from fatigue to despair,” Rachel Hanneman, a registered nurse, told the Minnesota House health policy committee last month. “We are simply overwhelmed.”
Hospital officials say they’ve done everything they can to recruit new staff and protect the workers they have. They say hospitals are experiencing unparalleled demand for services because of COVID-19 on top of people who have delayed care because of the ongoing pandemic.
“Everyone should feel safe at work,” said Aimee Jordan, spokeswoman for M Health Fairview.
To reduce burnout, Jordan said, the health system has “embarked on the biggest hiring/recruitment effort in the history of the organization, even expanding our search for skilled and talented nurses abroad.”
SOLUTIONS AND DEBATES
As a temporary fix, Gov. Walz has tapped federal pandemic aid to recruit and retain medical workers. That includes an ongoing effort to quickly train 1,000 certified nursing assistants to help fill shortfalls in long-term care and hospitals.
Schaffhauser says offering nursing assistant training tuition-free quickly filled classrooms in schools that had struggled to find students, and he hopes the state can keep that going.
“We are going to run out of money soon,” he said.
Schaffhauser said the industry also faces a shortage of qualified instructors to teach the next generation of caregivers. Minnesota colleges and universities now have over 325 vacancies for teaching positions in the nursing and health sciences.
Minnesota leaders still can’t agree on the best way to reward workers who’ve toiled through the pandemic.
Lawmakers have been at loggerheads since fall over the best way to provide bonus pay to frontline workers. Initially, they agreed to spend $250 million rewarding workers but disagreed on the details.
With the state now facing a $7.7 billion budget surplus, Democrats are calling for $1 billion in bonuses.
Efforts to triage the health care industry may get Minnesota through the worst of the pandemic, but more will be needed to fully recover, making it a key issue in the legislative session now underway.
Senate Republicans have expressed support for streamlining licensing and other bureaucratic hurdles to make it easier to hire medical workers from other states.
Democratic lawmakers joined nurses this week to propose legislation that would give nurses better access to support systems, such as mental heath care. It also would put new money into retention, recruitment and student loan forgiveness.
But the key piece of the proposal would give nurses greater say on staffing levels, which hospital leaders have resisted.
Mary Turner, president of the nurses union, said nurses will return to the most arduous work when they feel safe and supported.
“Nurses have made a clear call for action on this crisis so nurses can return and remain at the bedside, where they want to be,” she said.