A growing shortage of health care workers in Maine is putting a strain on medical institutions and their employees while threatening patients’ future quality of care.
Colleges, hospitals and other health care organizations in the state say they are stepping up efforts to recruit and train more hospital, nursing home and home health care workers, but the gap between supply and demand continues to grow.
Health care professionals say the problem is expected to get worse before it gets better. One study put the shortage of licensed nurses at 600 in 2015 and predicted it would grow fivefold by 2025, resulting in more than 3,000 job vacancies statewide.
The shortage already is costing medical institutions millions of dollars in overtime and temporary worker pay while making a challenging job even more difficult for medical professionals as they struggle to maintain quality patient care inside organizations where multiple unfilled positions have become the norm.
In Portland, the Barron Center, a city-owned nursing home, paid about $1.1 million in overtime pay, up from about $780,000 three years earlier. The increase was reflected in a city report on overtime during the most recent fiscal year, which ended June 30.
Most nursing homes in Maine do not have to disclose their overtime costs, but Maine Health Care Association President and CEO Richard Erb said the 219-bed Barron Center is by no means the only health care facility facing increased costs because of the worker shortage.
“I would guarantee that every one of the nursing centers in Maine is having the same problems,” he said.
In addition to the added costs, the worker shortage makes it more difficult – and stressful – for health care providers to do their jobs. Often overworked and spread too thinly among too many patients, nurses and other health care workers said the ongoing shortage is a constant source of frustration.
“It’s not possible to spend as much time with each patient as you’d like to,” said Crystal Salinas, a registered nurse in the neonatal intensive care unit at Eastern Maine Medical Center in Bangor. “It’s hard to go home at night and think, ‘Jeez, did I get that person’s water? Should I have brought them another blanket?’ ”
The shortage affects patients, too, said Portia Judson, a registered nurse in the medical-surgical and telemetry unit at Mount Desert Island Hospital. Some patients must be diverted to other medical centers because there aren’t enough staff to admit them, she said. Other patients have a harder time relaxing and focusing on recovery.
“It can be stressful for the patient if the nurses are really understaffed and they’re trying to do more than they’re really (capable) of doing,” Judson said. “They sense the tension in the nurses.”
AGING POPULATION, ADVANCES IN TECHNOLOGY
Demand for health care workers in Maine is expected to continue to surge in the coming years, and industry leaders say they already are facing worker shortages ranging from entry-level caretakers to top administrators.
Meanwhile, Maine’s overall labor force is expected to shrink slightly.
A report issued in September by the Maine Department of Labor anticipates a need for at least 3,700 more workers in ambulatory health care services, 2,300 more in hospitals and 1,900 more in nursing and residential care facilities over the 10-year period ending in 2024.
Health care and social assistance jobs already employ more Mainers than any other industry, according to the report. In 2014, the state had more than 100,000 of those jobs. By 2024, about 9,000 more will be needed, it says.
There are two primary reasons: Maine’s population will continue to age, and new medical technologies and treatments will require more specialists to administer them.
Another report by Brewer-based Eastern Maine Healthcare Systems that looked specifically at nurses in Maine found that the shortage of licensed practical nurses, registered nurses and advanced practice registered nurses – or APRN, those with a post-graduate education in nursing – is expected to increase from 600 in 2015 to 3,200 by 2025.
The median age of working RNs and APRNs in Maine is 49, according to the report, and about one-third are within 10 years of retirement age. More than half of Maine’s RNs and APRNs are age 50 or older, it said.
As those older and more experienced nurses retire, there are not enough younger nurses in Maine to take their place, according to the report.
Erb said that as of a few years ago, the shortage of nurses and other essential medical staff already had become worse than he had ever seen it. There really are only two short-term solutions for health care institutions, he said, and both are expensive.
“Either they are offering overtime, or they are using agency staffing,” Erb said.
OVERTIME NOT A CURE-ALL
Portland’s Barron Center has been struggling to maintain a full staff to oversee its long-term care patients in recent years, said Director of Nursing Ed Latham. Its strategy has been to pay overtime to existing workers and reduce patient intake, but it hasn’t completely solved the problem, Latham said.
Despite spending $1.1 million extra to pay workers for overtime shifts, the nursing home still came in at $700,000 under its budget for the most recent fiscal year because it had up to 20 open positions at any given time, he said.
“We would gladly have spent the $700,000 on regular salaries, in which case the overtime costs would have been under budget, but the reason it resulted in savings is because we paid overtime in order to be at the minimum staffing level, not the preferred level,” Latham said.
For example, he said, in order to do an excellent job, the Barron Center needs six aides working on a 40-bed unit during the day shift, which runs from 7 a.m. to 3 p.m. What has happened is that on days when there are only three aides scheduled because of staff vacancies, the center scrambles to bring on a fourth aide using overtime pay because four is the bare minimum at which the unit can function.
In response to the worker shortage, the Barron Center also has reduced the number of patients it will accept at any given time to under 200 despite having 219 beds, Latham said. That means more patients being turned away, as well as a loss of revenue for the facility, he said. Those working extra hours at the center also tend to get fatigued because it is a physically taxing job.
“So … the labor shortage absolutely results in higher costs and wreaks havoc with the health care system in other ways as well,” Latham said.
HOSPITALS RELY ON TRAVELING NURSES
Another short-term strategy is to bring in temporary “traveling” workers from out of state.
Both Mercy Hospital and Maine Medical Center in Portland rely on traveling nurses to fill vacancies in their nursing staffs, according to the hospitals’ executives.
But traveling nurses charge significantly more for their services than permanent staff nurses, and they usually only stay on for three months at a time. The median wage for a registered nurse in Maine is just under $30 an hour, while traveling nurses can receive as much as $70 an hour. According to the EMHS report, about 6 percent of nurses working in Maine live out of state.
Bette Neville, vice president of nursing and patient services at Mercy, said the hospital prefers travelers to overtime because of concerns that overworked nurses and other staff would become too tired and start making mistakes.
But bringing in travelers requires additional time and money, Neville said.
For instance, hospital managers must carefully screen each traveler candidate to ensure they are the right fit for the job, she said.
“The goal is to have your own staff,” Neville said. “You don’t want agency staff here.”
Most traveler contracts are only for 12 to 13 weeks, she said, so the hiring process must be repeated frequently until the position can be filled with a permanent hire.
Maine Med also has contracts with outside agencies that provide traveling nurses, said Judith West, senior vice president and chief human resources officer.
West noted that Maine Med’s primary focus is on retaining existing staff, and that it has been designated a “magnet hospital” by the American Nurses Credentialing Center, an independent organization within the American Nurses Association. The magnet designation is a sign of excellence and is helpful in recruiting and retaining nurses, she said.
Still, the hospital is not always able to maintain a full staff without the use of outside help. In particular, West said, the opioid crisis has hurt employee retention among emergency room staff, and hospitals in Maine have lost workers as a result.
“We do use travelers because it’s all about making sure we have enough staff,” she said. “It’s not our ideal situation.”
LONG-TERM SOLUTIONS
Both Mercy and Maine Med are working on long-term solutions to the staffing problem, the executives said.
For example, Maine Med parent organization MaineHealth has initiated a pilot program that involves partnering with other local employers that recruit workers from out of state, West said. The goal is to recruit the spouses of those workers if they have health care experience.
“We’re also doing much more extensive work with colleges” to increase training and internship opportunities, she said.
West said MaineMed has begun to “over-hire” nursing school graduates coming out of Maine schools to ensure adequate staffing in the event that some don’t stay for the long term. It now keeps 30 to 40 more nurses on staff than are immediately needed for that reason.
“Only in the last year, we’ve almost doubled the number of new grads (we hire),” she said.
Nursing schools in Maine also have stepped up their game to help reduce the shortage, but they face challenges, too.
The University of New England’s Department of Nursing has increased its enrollment by 50 percent over the past five years, said department chairwoman Jennifer Morton. The current class includes more than 350 students, she said.
UNE has split its nursing program into three separate tracks – one for students fresh out of high school, one for nurses with two-year degrees who are seeking a four-year nursing degree, and one for holders of bachelor’s degrees in other fields who have decided to change careers.
That third group now comprises nearly one-third of all UNE nursing students, Morton said.
“That’s actually the fastest-growing model in the United States” for creating new nurses, she said about the accelerated, 10-month program for bachelor’s degree holders.
The nursing school has a graduation rate of about 95 percent, Morton said. About 40 percent of the students are from Maine, and they tend to remain in the state after graduation. Among the other 60 percent who are from out of state, about one-fourth end up staying in Maine.
The biggest barriers to further growth for Maine nursing schools are a shortage of clinical sites for residencies and too few qualified instructors to teach the classes. The waiting period for enrollment in a nursing program in Maine can be as long as three years.
“You can only teach as many students as you have educators,” Morton said.
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