By Sara DiNatale

Mississippi Today 

Jessica Moore has become accustomed to the constant ping of her email inbox as recruiters offer to double her salary the same way she’s grown used to crying spells behind bathroom stall doors.

It’s part of a hospital nurse’s daily rhythm.

Moore, a nurse and manager at Singing River’s hospital in Gulfport, has chosen to stay put in her role. Mississippi is her home, she says. And so is Singing River.

But every day, the promise of more flexibility and more money is just an email or phone call away. Nursing staffing agencies, often called travel nurse companies, are constantly recruiting Mississippi nurses away from their bedside hospital jobs with offers of dramatic wage increases and $10,000 bonuses.

An increasing number of Mississippi’s nurses are taking these offers for the temporary gigs, as Mississippi hospitals struggle to fund meaningful pay raises for full-time staff. Moore has seen dozens of her coworkers and friends make the switch since the pandemic began.

“I’ve been through Katrina, I’ve been through storms, recessions, and you’ll have one or two nurses who leave for traveling jobs,” Moore said. “But with this pandemic, they’re leaving in droves.”

Hospital leaders aren’t just calling the current predicament a nurses shortage; they’re calling it an exodus.

It’s an untenable cycle that’s showing no signs of slowing. Singing River has lost a third of its nurses — about 290 — since March 2020.

In a few days, 900 nurses the state funded to help during the worst of the delta wave of the COVID-19 pandemic are leaving dozens of hospitals across the state. Their contracts end Oct. 31.

Without the extra nurses on hand, Moore will once again stretch her staff to its limits to fill intensive care unit shifts. The nurse-to-patient ratio could creep back up 1:8 — double what it should be.

Worse, Moore said, the added stress could continue to push more hospital nurses out the door.

Of Mississippi’s 114 hospital and speciality facilities, just 30 run as for-profit businesses, according to the Mississippi Hospital Association. That means the bulk of Mississippi’s hospitals are community owned or nonprofits.

By design, those hospitals don’t have large business margins. It leaves them without the ability to dole out the massive across-the-board raises to nurses, their largest employee group, needed to stay competitive in the market.

As a result, they rely on a patchwork of positions filled by travel companies — as they can afford them — to keep hospital beds open.

A Clarksdale hospital using staffing agency Adex, for example, is seeking an ICU nurse to start in as little as two weeks. The contract covers 13 weeks, 48 hours per week. The weekly salary, the post says, is about $4,800.

Meanwhile, Mississippi’s average hospital nurse is taking home $29 an hour, according to the state employment security office. That’s just under $1,400 for a 48-hour work week.

The Adex posting is not special. Dozens are just like it. Usually, the staffing companies also offer cash incentives for nurses who recruit others to join them.

Vivian, an online job board for health care work, has seen a massive uptick in the demand for nurses in Mississippi over the last couple months, a spokesman said. By mid-October, Vivian’s website had more than 350 postings seeking nurses to fill in at hospitals across the state.

Moore can’t blame nurses for leaving to better their finances. It has crossed her mind, too.

It’s a thought that steals a moment during a seven-day work week or sneaks in the minutes before catching a few hours of sleep ahead of back-to-back 12-hour shifts. When time with her two boys is little and the time she spends with her husband — also a nurse — nears nonexistent, it lingers.

But she can’t do it. She said the current cycle is ruining the hospital system, making it so nurses aren’t working together like the family she’s used to.

“It’s extremely difficult for a loyal nurse who stayed here to protect and save their community, that has roots here, and can’t travel, to work beside a contracted nurse that makes a lot more money than them,” said Singing River’s CEO Lee Bond.

Jessica Moore, a nurse at Singing River’s Gulfport hospital. (Photo courtesy: Singing River)

Gov. Tate Reeves’ executive order spread 920 temporary nurses across 61 Mississippi hospitals in September. It was never intended to solve the state’s staffing shortages, but it was a bandaid on a knife wound. For a moment, it helped slow the bleeding.

It gave hospitals the bandwidth to better handle the influx of patients being hospitalized with COVID-19 and crowding the ICU while the delta variant contributed to a record number of pandemic-related deaths across the state.

It also brought the nursing crisis within Mississippi’s hospital workforce to center stage.

The very staffing agencies winning over Mississippi nurses with higher pay are also the staffing agencies that filled Mississippi’s Emergency Management Agency contracts to bring in the hundreds of temporary, but desperately needed, nurses.

Nursing staffing agencies, which work similarly to temp agencies in the business world, have traditionally paid more than hospital jobs. But the pandemic and nursing shortage nationwide has caused the pay differentiation to skyrocket.

Early in the pandemic, travel nurses largely went to help in New York City’s hospitals. Now, they’re everywhere.

Before the state-funded travel nurses came into Singing River, Moore was often working seven days a week, covering the tasks of three jobs.

When the order to fund workers helping with COVID-19 patients ends this week, Singing River will instantly lose 53 high-paid temporary nurses it cannot afford to rehire.

Before the pandemic began, nurses were already abandoning hospitals. They opted for less stressful jobs at gastrointestinal clinics or surgery centers. They moved out of state to bigger cities with higher wages. The state was already projecting it would need 2,100 more nurses each year before the virus spread.

COVID-19 exacerbated the need.

“Our hospitals have a lot of uncompensated care,” said Kim Hoover, a registered nurse and leader at the Mississippi Hospital Association. “They’re not always in the best financial position to begin with. It’s difficult to weather a storm if you haven’t been able to bolster what you need to bolster.”

Hoover said only about 41% of the state’s registered nurses are reporting working for hospitals at all. About 2,000 fewer nurses are registered in the state at all compared to a year ago, according to nursing board data.

“It’s difficult to recruit and retain nurses in economically depressed areas, and Mississippi has quite a bit of that,” said Hoover, who heads the association’s education foundation. “But in this case, it doesn’t matter if you’re in the Delta or on the Coast, the nurses are just not here.”

Out of options, Mississippi health care leaders are asking the Legislature to create a new program that uses federal coronavirus aid to cover bonus checks to incentivise nurses to stay at the state’s struggling hospitals.

“Mississippi being less healthy, less wealthy, and not having the federal Medicaid dollars leaves it disproportionately affected,” said Bond, the hospital CEO.

The long-term consequences could be deadly.

“The one thing that could keep you from having your life saved is not having an RN,” Bond said.

Bond has put himself at the center of the nursing crisis. He and his team at Singing Rivers are leading the push for the state to use 25% of its $1.8 billion in American Rescue Plan funds to pay for health care workers incentive checks.

Bond’s plan calls for $20,000 — or about $833 each month — to go directly to each nurse or other in-demand bedside worker who signs a contract pledging to stay at a Mississippi hospital for at least two years.

Unless a special session is called, lawmakers won’t be able to take up the issue until the new year.

“Everybody is trying to compete when they don’t really have the resources they need to be truly competitive,” said Sondra Collins, senior economist with the Mississippi Institutions of Higher Learning.

Collins said one-time bonuses wouldn’t be nearly as effective as long-term raises. But having a $20,000 bonus spread across a two-year period could act similarly to a wage increase.

The reliance on staffing agencies is too pricey to serve as an indefinite solution.

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Before the pandemic, Bond said Singing River didn’t use any contracted nurses. In order to keep beds open, the hospital system now has about 8% of its 1,200 nurses through staffing agencies.

At the University of Mississippi Medical Center in Jackson, associate vice chancellor for clinical affairs Dr. Alan Jones said the hospital has done some base wage raises for its workers but it still can’t compete with what travel companies are offering.

On a recent Wednesday morning, Jones said that about 26 patients were stuck in the emergency room, even though they were admitted to the hospital.

There weren’t enough staffed beds opened for the patients to be transferred to the appropriate care units.

A nurse puts on protective equipment including gloves in preparation to flip a COVID-19 patient inside the ICU at Singing River Health System hospital in Ocean Springs on Tuesday, July 27, 2021. (Photo credit: Hannah Ruhoff/Sun Herald)
Moore’s days are marathons that begin the moment she wakes up at 5:30 a.m.

She spends workdays explaining care to patients in 10 minutes when she’d rather have twice that time — or at least enough time to ensure they understand what she’s saying.

She regularly reminds young nurses not to blame themselves for the staggering number of patient deaths they’ve encountered through the pandemic between teaching them to place difficult intravenous lines, or IVs.

She handles phone calls, apologizing to loved ones frustrated that their elderly parents were left on bedpans for 15 minutes, even though there is nothing she can do to remedy their concerns.

“What they don’t realize,” she said, “is while their mother was on the bedpan, we were in the room across the hall because a patient could not breathe. We were attempting to save their life. Unfortunately, there’s three of us on the floor, and it took all three hands to do that.”

She is relieved that the number of COVID-19 hospitalizations are dwindling. But last winter, a wave of infections of the virus pushed the hospital to its limits. She worries the same thing could happen this season and lead to even more burnout.

And if it does, she will manage the mounting stress the way she has over the last two years.

“You go to the bathroom,” she said. “You cry. You get over it.”

Then you go back to work.