Hospitals are struggling to comply with the state’s nurse staffing requirements

In the past month, four emergency room nurses — exhausted by the onslaught of patients and emotional turmoil wrought by COVID-19 — have quit at the Eureka hospital where Matt Miele works.

Miele, who has been a trauma nurse for four years, is actively looking for a less stressful nursing position and has colleagues who are, too. 

“On the bad days, I think ‘What am I doing and is this what I want to be doing?’” Miele said. “It’s shifting me to my core.”

Around California — and the nation —  nurses are trading in high-pressure jobs for a career change, early retirement or less demanding assignments, leading to staffing shortages in many hospitals.

Hospitals are struggling to comply with the state’s nurse staffing requirements as pandemic-induced burnout has exacerbated an already chronic nursing shortage nationwide. 

But burnout isn’t the only thing compounding California’s nursing shortage: The state’s new vaccine mandate for health care workers is already causing headaches for understaffed hospitals before it is even implemented. Some traveling nurses — who are in high demand nationwide — are turning down California assignments because they don’t want to get vaccinated. 

Hospitals say they are reaching a crisis point, straining under the dual forces of more people seeking routine care and surging COVID-19 hospitalizations driven by the Delta variant.

Hospitals, some with more COVID-19 patients now than during the winter surge, say they are confronting unprecedented staffing shortages, particularly among nurses.

The staffing shortage is so severe that Scripps Health is considering temporarily consolidating some of its outpatient centers. Scripps, which has five hospitals and 28 outpatient clinics in the San Diego area, told CalMatters that it is serving nearly 20% more patients on average than before the pandemic. At the same time, job openings at the hospitals have increased 57% since August 2019. For nursing jobs alone, vacancies have increased 96%.

Emotional and physical exhaustion is the primary reason nurses are fleeing the bedside, experts say. It has been a long and brutal 18 months.

Hospital administrators worry that the state’s vaccine mandate for health care workers, which goes into effect Sept. 30, could drive some of their workers out. Already, some report resistance among employees.

Administrators are particularly concerned about low vaccination rates among support staff like janitors and food service workers. However, some nurses also are wary of the COVID-19 vaccine. Some nurses with large social media followings have participated in protests in Southern California, arguing that the mandates violate their personal freedom.

The vaccine order allows only for narrow religious and medical exemptions. Until Sept. 30, unvaccinated workers must undergo weekly COVID-19 testing. The state nursing association issued a statement saying “all eligible people should be vaccinated.”

While California was first in the nation to impose a vaccine mandate for health care workers, other states have since joined in, but their mandates aren’t as broad.

Cole of Scripps Health said the state’s testing requirement, imposed this week, already has discouraged some out-of-state, traveling nurses from taking temporary jobs at California hospitals.

“If they don’t want to get vaccinated, they are turning down California assignments,” he said.

To contend with local shortages, hospitals are increasingly turning to hiring temporary, traveling nurses from around the country. 

During the past 18 months, Janet Stovall, a traveling ICU nurse for more than 20 years, has worked in hospitals in the Imperial Valley town of Brawley, Visalia, Wichita, Kan., and now Folsom and Alameda, and all of them have been running on “very lean staffing.”

“Last night there were ambulances waiting just to get into the ER to be evaluated… They pulled a nurse from the ICU to help with the ER, and we worked without a charge nurse or a break nurse,” Stovall said.

Stovall said traveling nurses like her are in high demand. At one hospital, “we hadn’t even finished orientation when the VP of patient services called and said ‘You need to leave right now, test out of orientation, and be at work by 11 p.m.,’” Stovall said. “That’s how desperate they are.”