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Springfield’s two main hospitals, CoxHealth and Mercy, have nearly 2,000 jobs currently open, with clashing opinions on if that number is as daunting as it seems.
Similarly to many other industries in the aftermath of the COVID-19, hospitals, including those in Springfield, have dealt with a labor shortage.
Local health care experts are optimistic the worst is behind them. Others urge caution, saying that, for reasons other than the pandemic, the labor crunch in hospitals could continue for years to come.
“I think we’re going to see it for some time,” said Mary Becker, the senior vice president of strategic partnerships and communications at the Missouri Hospital Association (MHA).
Why Care? Health care workforce shortages have been a problem for some time, but in a post-COVID world, its impact is becoming more evident. New recruitment and retention strategies are needed to keep hospitals staffed, and health care leaders are noticing. But is it too late?
Hospital vacancies represent future growth as well as shortages
Both CoxHealth and Mercy Springfield Communities are dealing with steep numbers of open positions.
Mercy Springfield Communities, which includes facilities in Aurora, Lebanon, Cassville and Mountain View, employs 10,544 people, with the vast majority in Springfield. They are looking to hire about 1,100 more and 950 in Springfield alone.
CoxHealth, meanwhile, also has about 12,500 employees company-wide and are looking to fill about 1,000 open positions.
Andy Hedgpeth, the vice president of human resources at CoxHealth, said that, at least on behalf of CoxHealth’s vacancies, the numbers can be somewhat misleading.
“Our vacancy rate is 8 percent,” Hedgpeth said. “That’s down for us, relative to where it was during the pandemic…A lot of those numbers are for projected growth needs…We always want to continue to grow and add more [employees].”
Data show inconsistency, high vacancy across occupations and regions in Missouri
The 2022 Workforce Report from the MHA found that Missouri, overall, had a 17 percent vacancy rate in hospitals across the states. However, it shouldn’t be compared to CoxHealth and Mercy’s current vacancy rates, because the workforce data was compiled during a different period of time (the MHA data was collected in January 2022).
Nonetheless, an 8 percent vacancy rate for Springfield’s two main hospitals indicates a decrease, and ultimately a positive shift from statewide data during this time last year.
The Workforce Report broke down the various clinical and non-clinical positions statewide and regionally, showing their individual vacancy and turnover rates.
The Ozark region, which encompasses Christian, Dallas, Greene, Polk, Stone, Taney and Webster counties, had an 18.2 percent vacancy rate and 19.5 percent turnover rate for registered nurses, compared to the statewide average of 19.8 percent and 22.1 percent, respectively.
Staff registered nurses is the largest profession in hospitals in Springfield and across the state, according to the report.
Meanwhile, housekeepers and food service workers had vacancy rates of 6.7 percent and 6.5 percent, respectively, in the Ozark region, a far cry from the statewide rates of 15.2 percent and 13.4 percent. Both in the Ozark region and across the state, both of those positions had turnover rates north of 42 percent.
According to the report, the hospital professions with the highest vacancies in the Ozarks region, where CoxHealth and Mercy are by far the largest health care employers, were, in order:
- Licensed practical nurses (46.2 percent)
- Nurse assistants (19.6 percent)
- Staff registered nurses (18.2 percent)
- Registered respiratory therapists (17.6 percent)
- Registered dieticians (14.8 percent)
- Physical therapists (14.2 percent)
- CT technologists (11.8 percent)
- Pharmacy technicians (11.2 percent)
- Occupational therapists (10.1 percent)
- Sterile processing technicians (8.9 percent)
The Ozarks region vacancy rates for specific occupations in hospitals vary widely from the statewide data, with some significantly higher and others considerably lower. For example, the statewide vacancy rate for practical nurses was only 25.7 percent, whereas the rate for CT technologists was 15.7 percent.
Not enough nurses to fill the gap: ‘It’s kind of like a snake eating its own tail’
Based on the 2022 report, the Ozarks region needs 723 staff registered nurses, and the state needs 8,334 to fill all the vacant positions. While those numbers will likely look different when the MHA releases its 2023 Workforce Report in April, vacancies, to some extent, will persist.
A significant reason for that, at least as it relates to nurses, is that the labor pool is limited.
The 2022 Missouri Nursing Workforce Report, by the University of Missouri Center for Health Policy, the Office of Health, Outreach, Policy and Education and the Missouri State Board of Nursing, found that the majority of nurses licensed in Missouri are actively employed in an occupation that requires their nursing license.
The report, announced in a release from the Missouri Department of Commerce and Insurance on Jan. 20, found that very few unemployed licensed nurses were looking for work as a nurse.
A higher percentage — as much as three times as much — of specialized licensed nurses “are unavailable to meet current needs, because they are employed in a field other than nursing, unemployed and looking for work outside of nursing, or retired.”
Retirement has long been a factor in hospitals’ workforce woes, especially since the onset of COVID-19, and it doesn’t look to ease up anytime soon.
The report identifies concerningly high rates of RNs, APRNs (advanced practice registered nurse) and LPNs (licensed practical nurses) near retirement age (ages 55 and older) at 28.5 percent, 22.7 percent and 28.1 percent, in some employment settings and counties in the state.
“Having sufficient nurses plays a critical role in patient safety,” said Lori Scheidt, the executive director of the Board of Nursing, in the release. “A one-size-fits-all approach to addressing the nursing shortage is not effective. As the nursing shortage differs by geographic location, a variety of solutions are required.”
It can’t be a one-size-fits-all approach because there are a lot of reasons for nursing vacancies.
“The demand is higher than the supply of nurses in the state,” said Heidi Lucas, the executive director of the Missouri Nurses Association, in an interview with the Springfield Daily Citizen. “And there’s a lot of reasons for that…It’s kind of like a snake eating its own tail.”
Lucas said reasons people are choosing to outright leave the profession include the lack of respect, not being valued by the hospital, workplace violence and they don’t feel as though their concerns are being heard.
Additionally, due to greater workloads during the height of the COVID-19 pandemic, many older nurses chose to retire early. And as the baby boomer generation ages out of the workforce, this problem will persist.
While the inevitable retirement of older nurses will have a significant impact on hospitals, Lucas urged that they need to put more focus on the retention of younger nurses for long-term stability and success.
“Another big issue is that nurses who are new to the profession…it’s not turning out to be what they expected it to be,” Lucas said. “…We lose a lot of nurses within the first five to seven years of their career.
“So we have a bunch of nurses at the beginning of their career and a bunch of nurses at the end of the career, and then we have a big drop in the number of nurses that we have in the profession. That’s really going to be a massive problem — it already is. We’re already feeling it. It’s just getting worse.”
It’s not just nurses — hospitals have to take different approaches for different jobs
Hospitals are very diverse, and, as seen in the MHA report, the workforce shortage doesn’t spare any profession, though some are affected less significantly than others.
CoxHealth and Mercy Springfield employ thousands of people, for a wide variety of clinical and nonclinical occupations.
“I always like to compare a hospital to a small city,” Becker said. “…Whether it’s patient care or a number of opportunities; we need accountants, we need people, we need engineers, we need all kinds of workers.”
While more education can often equate to higher wages, hospitals have had to raise pay for some of their positions that require less training and education simply because of high demands for labor.
“There are a number of positions that don’t necessarily require an inordinate amount of advanced education in order to do the job,” Hedgpeth said. “But they can pay really, really well because they’re very in-demand fields.”
However, pay alone isn’t enough to curb vacancy rates. Hospitals have had to retool their recruitment strategies and find other ways to incentivize people to apply for jobs — and make them want to stay.
From sign-on bonuses to child care to flexible scheduling, hospitals are adopting new benefits in hopes of filling vacancies.
“All of that is changing at the same time,” Becker said. “You’re going to see a lot more innovation related to work just as you are throughout the rest of the economy. COVID changed a lot about how people want to work today.”
Hospitals are also working to recruit in secondary education. CoxHealth has partnered with the Ozark School District to generate interest for high schoolers in allied health careers, which primarily encompass non-nurse and non-physician health care provider professions.
“This is a really awesome collaboration,” Hedgpeth said. “We have to do a better job in this industry of helping kids understand what careers exist for them. If we do a really good job of helping kids get excited and passionate about health care, about helping others and showing them that there is a very seamless way that they can get into that field, we stand a much better chance of generating interest in those fields.”
Hedgpeth thinks the collaboration between CoxHealth and Ozark, and the nearly 400 students who have expressed interest in health care as a career path, is a great example — and opportunity — for a private industry to work with a public institution.
“Now we could look at that and say, ‘Well, maybe they would have gotten into health care either way,’” he said. “But that’s leaving a lot to chance, and we, frankly, don’t want to leave things to chance. We want kids to understand that there’s more to health care than just a doctor or nurse, even though those are critically important roles for us. There are other really important roles too.”
Higher education is a part of the problem and the solution to hospital staffing shortages
Even as CoxHealth seeks to draw interest in health care from high schoolers, higher education remains crucial for long-term stability for hospitals’ workforce.
But education — or the lack thereof — is contributing to the labor shortage.
Of the college students interested in a career in health care, not all of them get accepted into their preferred programs. Not necessarily because they don’t meet the qualifications, but because there simply are not enough educators to teach all of them.
“It’s not like you can just open up new slots at nursing schools,” Lucas said. “You have to be able to have the instructors to back that up.”
While there’s plenty of upsides to working as a health care educator, the lower pay compared to that of those who work in a hospital setting often causes many to not choose that as a career path, according to Lucas.
Additionally, many health care faculty that do teach, particularly in nursing, are, like their peers in hospitals, aging out of the workforce and not being replaced fast enough.
“That’s something that we’ve really been raising a lot of awareness about, because there really needs to be concentration on how are we going to get people interested in nursing education,” Becker said. “Part of the issue is that, for example, in order to teach at a baccalaureate level, you need to have your master’s degree and in order to teach a master’s program, you need to have your Ph.D. and it takes a long time to get that type of education.”
At Ozarks Technical Community College, Dean of Health Sciences Dr. Aaron Light experienced these constraints firsthand.
“It’s space, it’s clinical locations and then also finding qualified faculty and making ourselves attractive enough to pull them out of clinical practice to come over and teach because right now in clinical practice there’s such a shortage,” Light said.
Finding slots in clinical locations — such as hospitals — has been a major roadblock OTC has faced in getting more students through their health care programs.
“A lot of times, the biggest limiting factor is just having enough slots at the clinical locations to get them the clinical component that they need to complete their training,” Light said.
But decreased enrollment in some of these programs has also contributed to the problem, according to Light, in part as a result of their limited recruitment during the height of the pandemic.
Both CoxHealth and Mercy emphasized the importance of their relationships with educational institutions, their local colleges such as OTC, Missouri State University, Cox College and Southern Baptist University.
“We’re kind of leveraging our relationships with our local educational partners…and really continue to build strategies for the long term as well as the short term,” said Mark Moir, Mercy’s vice president of human resources.
Moir highlighted one strategy they take to encourage students looking to study health care to consider fields that may be in more demand, such as nursing.
“Like, how do we continue to grow talent?” he said. “For example, that might be within the Mercy system that is not maybe a clinically oriented position and figuring out how to woo people with opportunities to grow into nursing or maybe they’re a licensed assistant personnel type of individual who is doing clinical support work and maybe putting them on a pathway to become an RN.”
Mercy has also found success in “earn as you learn” programs, which are similar to a classic apprenticeship model, according to Moir. It allows employees to build their education while earning income, thus eliminating the need for them to balance having another job.
How are patients affected by hospital vacancies
Amid staffing shortages, staff in hospitals have had to deal with an increased burden to continue caring for a large number of patients.
It wasn’t uncommon during the pandemic to hear about hospitals running out of beds, but, in reality, that wasn’t the case.
“It’s not really the beds that were missing,” said Lucas, the executive director of the Missouri Nurses Association. “You can go and buy beds, you can buy more supplies, you can have a person in a bed. The problem is having a nurse to staff that bed. ”
And for the beds they do fill, it’s difficult to maintain an ideal patient-to-nurse ratio, according to Lucas. Instead of covering two to three patients, nurses can be forced into covering five to six patients.
“[Nurses] don’t want to hurt patients,” she said. “They don’t want to feel like they’re offering substandard care. They’re just stretched really thin.”
Lucas said that these staffing shortages, especially those that relate to patient care, could potentially have detrimental outcomes, whether because patients aren’t receiving a higher level of care or they’re being diverted to different facilities, among other possible scenarios.
Becker assured that hospitals were still maintaining staff levels to care safely for patients in beds, but it increased stress on the existing staff. The problem is also evident, she said, in patients having to wait long periods of time for doctor’s appointments.
Both Hedgpeth and Moir both said that this has not been an issue at CoxHealth or Mercy.
“We have sufficient staffing to meet our patient demand,” Moir said. “I think there can be situations where certain critical cases possibly come up, but our general day-to-day operations can be supported by our current staffing.”
Hedgpeth, too, said that CoxHealth continued to meet patient needs and that their current vacancies represented their ability to grow and care easily for future patients.
Optimism, and questions for the future of hospitals’ workforce
The current vacancy rates in hospitals, and the many problems that are contributing to it, put the future of health care’s workforce into question.
Hedgpeth and Moir are both bullish on the future of their respective hospitals’ ability to recruit and retain workers.
“COVID collapsed everyone’s views into a phone booth,” Moir said. “We were thinking from minute to minute, hour to hour, day to day and so I think coming out of COVID has allowed us to elongate are thinking again, and so I think there’s strengthening partnerships between educational institutions and Mercy Health’s of the world to try to think about how do we attract and create viable, sustainable careers for our coworkers. I think there’s optimism there.”
Hedgpeth also emphasized the need to continue fostering partnerships and focus on finding innovative ways to avoid a labor crunch. He said it would require a good amount of teamwork and collaboration, and looking at things differently than they have in the past.
Light is also optimistic that things will get better and thinks that staffing problems in health care have “reached our low.” He is especially happy for students because of the opportunities they will have in their respective health care fields.
Lucas, on the other hand, was less optimistic that things were headed in the right direction, simply due to the inevitable continued, and perhaps worsening, shortage.
“It’s just going to get worse as the baby boomers continue to age,” she said. “…We’re going to need millions of new nurses to fill the need over the next couple of years…Something drastic needs to happen. I do think hospitals are aware of that fact that something needs to happen. Otherwise, we’re all in trouble.”
Becker was restrained in her optimism of the future of hospitals’ workforce. She said that as the problem of staffing shortages persist, more attention will be paid at the state and federal level.
Regardless, due to the nature of the problems at hand and the time it takes to build up an educated workforce, Becker said that the labor shortage in hospitals will likely continue for the near future.
“If we can get a real focus from many stakeholders on this issue, I think we’ll begin to see the change,” Becker said. “But we’re just going to have to tackle it from all angles. There’s really not one answer and so they’ll continue to be challenged, as I’m sure for some time.
“But we’ll also see at the same time different ways of delivering health care that may make a difference and make those shortages a little easier to manage.”
Editor’s Note: The story was corrected, with the number of employees in Mercy Springfield Communities being 10,544.