Echoing a national issue
By Katherine Nettles
Specialized nurses have been hard to come by in recent years, and the shortage has affected the Gunnison Valley on several levels, from public health to senior care services. But healthcare directors are getting creative with outreach, collaboration and training efforts to work with what resources are available, and that might just be the key to success.
Gunnison County Health and Human Services (HHS) has struggled for months to fill two full-time equivalent positions, for a clinical services manager and a public health nurse. HHS director Joni Reynolds reported in a department update to the county commissioners on June 18 that she had yet to see any nurse applicants for the clinical services position and in fact had received only one applicant total so far. “I’m struggling a little bit to recruit nurses,” she concluded.
This issue is nothing new, unfortunately. “We’ve seen it the most challenging for us in the last two years,” says Reynolds. “In 2017 we would literally have the same position for weeks or months and not be able to provide services for families. We didn’t see as many applicants, but in 2018 is where we would see no applicants for weeks. That was really different for us.”
The HHS department has branched out to include some outreach to all the department’s volunteer nurse contacts who have helped at flu clinics in the past, and Reynolds wrote to all the licensed registered nurses (RNs) with addresses in the county who are listed in the state database.
“We are hoping that will help spread the word about the availability of these positions,” Reynolds says. She has also reached out to colleges that have nursing programs, such as Mesa State and the University of Colorado. The jobs are posted on some state job boards as well.
“It’s almost as bad as the senior care center, and home medical services … and every other healthcare provider in the area,” added local family practitioner and county health officer Dr. John Tarr.
“It’s a national issue,” said Reynolds. “We need some nurses.”
The Gunnison Valley Hospital (GVH) and the Senior Care Center also struggle to get certain positions filled. The Senior Care Center has had an especially difficult time.
“It’s been really hard,” says Mary Blattner, the nursing home administrator for the Senior Care Center. She explains, “We’ve been having to use agency nurses,” who are temporary contracted nurses and often stay in an area for several months before moving on to another location. Agency nurses are usually paid higher rates than those in their positions long-term, and additional costs go to the recruiting agency.
“It’s a financial burden. And you always want to have your own nurses, who are going to stay here and be here,” says Blattner of the need for nurses to have continuity and to build rapport within the workplace.
As to where the nurses are most in need, Blattner says, “It’s everything. RNs, LPNs [licensed practical nurses] and certified nurse’s aides.”
Blattner thinks she and her colleagues might be having similar problems due to the high cost of living and “because the unemployment rate is so low here.”
“So we’ve been really creative with our recruiting to try to bring people in. We have offered ‘sign and stay’ bonuses and referral bonuses to attract people, and we do our own nurse’s aid classes, to get the training done.”
The nurse’s aid courses are four weeks long, approximately 96 hours in the classroom and then clinical and on-the-floor training for two weeks.
A specific need at GVH is for specialized RNs. While many RNs are trained to assist in hospitals with patient care, says Reynolds, “What they don’t often have are skills to work in the specialized care departments, such as oncology.”
In public health, that need for specialization is important as well. “We do vaccinations for children at all ages, and knowing what vaccinations at what intervals are needed, and how they all interact and contraindicate is a specialty area,” says Reynolds.
Sherilyn Skokan, director of patient care services at GVH, says while recruitment in general is not much of an issue, finding RNs trained in obstetrics and other specialty areas definitely is an issue.
“We are fortunate with being the only hospital in the valley, so when nurses with experience move to the area this is the place they tend to come. We’ve had a lot of luck with that. Where we do have trouble is with specialized nurses.”
Skokan says it’s too difficult to train people in obstetrics, because there are so many variables to patient care and outcomes. “It’s different enough and our volume isn’t enough to train them in a short period of time, with the repetition and variation they need.”
Skokan says GVH has gotten creative with this problem, by outsourcing that needed training and experience to busier areas. “So what we do is send [trainees] to a higher volume hospital, such as Denver or Grand Junction. Then we know they are getting the experience they need. It’s a good growth path for our staff, and gives them good opportunities. And it helps us.”
The downside to that is that GVH has to make a significant investment in that training, and to determine that a nurse is committed and therefore worth the time and expense. Skokan says generally they wait until an employee has been there for a year or so before sending them out for more specialized training.
Skokan says, “We pay for the time and the training itself,” which is often around three months long. “It’s a huge engagement thing for our nursing staff… It’s different here than anywhere I’ve ever worked, and it’s a huge satisfier. The nurses love it. And it helps us too because it helps us fill those needs,” she says.
In addition to obstetrics, GVH offers in-house training for the areas of emergency room and surgical services.
An increasing demand
As the baby boomers age and an increasingly older population resides in Gunnison County, the demand for nurses may only increase as well. CDOT has predicted that Gunnison County’s highest rate of population growth in the next 20 years will be among people 65 years old and up, by 49 percent, and among 50 year olds to 64 year olds by 39 percent.
Blattner says the Senior Care Center is definitely seeing a squeeze.
“Our assisted living is 16 beds and they are always full. And we always have a waiting list,” Blattner says. The assisted living facility is for a more able population that doesn’t have as intensive needs as the much larger nursing home. That facility has 50 beds, and Blattner says, “Right now we have only four beds available.”
Reynolds says HHS has also talked with the hospital about sharing applicants, such as when one applicant for a position at HHS might be a better fit for the hospital, or vice versa. She says one issue with placing the right candidate with the right position is often shift work, or long blocks of hours that often go through the night. Shift work doesn’t work for some people, and many nurses quit while raising young children. Reynolds notes, “Sometimes part of the challenge is [the facilities] need 24/7 coverage. In public health, we have nine-to-five, Monday through Friday and on-call hours, so we don’t have as much of an issue with shift workers.”
This is a case where HHS can “share the limited pool of applicants that we might get with others in the valley,” says Reynolds.
At the state level, Reynolds says there are associations that can get vacancy announcements distributed to other counties. And reaching out to nursing schools is a continued effort, to potentially recruit new graduates.
Another factor in healthcare is a potential shortage in doctors, which Gunnison County has seen in the past.
“We’ve seen a big uptick in Gunnison with successful recruitment in the family practice. That really added to our physician cadre here. But there is [a physician] shortage nationally, and we were experiencing that here in the valley until last year,” says Reynolds. “They consolidated with the Crested Butte practice so they have [care] at both ends of the valley. Specialty clinics have alternating schedules, with cardiologists, ophthalmologists and ear, nose and throat doctors now coming in on a rotating basis—often visiting from Grand Junction.”
Blattner thinks the problems of recruitment in healthcare may get better with time, despite changes in demographics, as more people with previous careers and experience choose to move to the Gunnison Valley.
“It’s a matter of there being positions that are outnumbering the nurses right now. With a shallow pool, it’s tough to fill those. Eventually, you will have more people moving in here,” Blattner says.
The higher cost of living may also be a factor. “[Affordable housing] is obviously a draw. It’s always an issue when we hire people. I am always careful when broaching the cost of living with anyone, to make sure we are very upfront about that aspect,” says Blattner.
While GVH has already contracted to purchase affordable housing in the Stallion Park development in Crested Butte, affordable housing is an investment the county is looking into as well.