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Turnover, competition, and dissatisfaction push North Country healthcare vacancies to new highs

CVPH union sign
Ryan Finnerty

The red signs stand in sharp contrast to gray skies and white snow of the North Country winter. They can be seen on front lawns and along sidewalks throughout the Upstate New York town of Plattsburgh.

A Rosie the Riveter lookalike, clad in medical scrubs and a surgical mask, urges the viewer to support workers at the nearby Champlain Valley Physicians Hospital in their push for a new contract.

Since the first year of the coronavirus pandemic, unionized healthcare workers at the facility, which is part of the University of Vermont Health Network, have been trying to renegotiate the terms of their employment.

Like hospitals across the region, CVPH is dramatically short of workers across a range of specialties. That comes as patient volume hit historically high levels, a combination of COVID-19 related illness and more run of the mill procedures that were put off over two years of global disruption.

Workers like CVPH lab technician Sally Osborne say that chronic staff shortages have left those who are still working burned out and considering alternative options.

There’s a lot of people working a lot of double shifts,” Osborne told NCPR. “You may have to come in early or you have to stay late. And that’s a daily occurrence.

Osborne has worked at CVPH for 25 years and says her lab traditionally retained employees for the long term. But right now the hospital has almost 300 job vacancies, and more employees are retiring or leaving for other jobs.

We’ve had trouble holding on to new people. We train them and they move on,” Osborne laments. “We just had a micro tech leave and she went to a different hospital; she felt that she wasn’t being heard and she wasn’t being respected.”

Pay has been a major focus in the national discussion of the healthcare worker shortage; particularly the sky-high earning potential for nurses and other skilled technicians willing to travel around the country.

Contracts for so-called travel nurses have been seen for amounts as high as high as $10,000 per week.

Workers at CVPH say compensation is definitely a factor in their staffing woes, but more than lack of pay they say that they feel disrespected by hospital management.

“Everybody is mentally, physically, and emotionally at the bottom of their barrels,” said Bobbi-Jo Otis, who has worked as a surgical and oncology nurse at CVPH for almost 20 years.

Otis said in an interview that chronic understaffing has left nurses caring for too many patients, which has caused care to suffer. That hits her hard as a lifelong Plattsburgh resident.

“I’m ashamed somedays, ” she admits, recounting issues her neighbors receiving care at the hospital have reported to her.

Otis, whose family has deep ties to the community, revealed a recent personal decision during the interview.

“After 19 years I've decided to go into travel nursing, because I have to look at what is best for me and my family right now,” she revealed. “I can travel nurse and pay off my mortgage.”

The toll of the past two years has left Otis uncertain about her future in the healthcare industry after her planned stint on a travel contract, referred to as “travelling” by nurses.

“I've shared with my family when I come back I'm not sure that I will stay in health care,” Otis said.

While it would be easy to write off that kind of angst as just a side effect of pandemic tumult, both Otis and Osbourne say the current labor problems are not just a factor of COVID-19 stress.

They blame much of the turnover at CVPH on a workforce restructuring initiative hospital management rolled out before the pandemic to cut costs and bring the facility to profitability.

Hospital president Michelle LeBeau, herself a nurse by training, told NCPR the goal was to actually to reduce the number of patients each nurse cares for, in large part by relying on more nursing assistants.

That plan was developed with pre-pandemic conditions in mind, but has proven problematic. LeBeau stands by the original intent, but acknowledges that things have not worked out as intended.

She is blunt about the prognosis for rectifying the current staffing crunch.

There’s not a short term solution to this,” she said in an interview. “That’s going to be the challenge for us.”

When asked about the alleged decline in care quality that Otis reported, LeBeau was quick to praise CVPH staff saying “the quality of care the staff are providing is everything they can bring to the table.”

She maintained that community feedback the hospital receives has been more positive than negative, but acknowledged that staff have less resources than many would like.

In the short term, LeBeau said management is working with staff to make the hospital a more attractive place to work, trying to develop more flexible schedules, hours, and time off.

While CVPH tries to dig itself out of a staffing deficit, a hospital on the other side of the North Country is taking preemptive action in the hopes of preventing a similar situation.

In 2021, Samaritan Medical Center in Watertown committed $8 million to provide a 14% pay raise for staff. The hospital also began offering signing bonuses for jobs it had not previously.

It became clear that we were not competitive with nursing wages in our region,” said Samaritan Communications Director Leslie DiStefano.

The need to increase pay was discovered during what DiStefano described as a routine annual survey of the regional market to assess the competitiveness of Samaritan’s pay levels. More in-depth analysis indicated that compensation across a range of specialties, not just nursing, had not kept up with other health systems in the region.

DiStefano said in an interview that Samaritan still has a high number of vacancies, but there are signs the plan is having the intended effect.

“We've seen the benefits from it,” she noted. “We've seen decreases in our open positions, although we still have many. I looked this morning and we have 426 job openings across the system.”

Hospital workers and administrators alike are quick to say their industry had a skilled labor shortage in Upstate New York long before the pandemic. However, the problem is now more acute than ever.

The Iroquois Health Association says the average vacancy rate at upstate hospitals is now double what it was before the pandemic.

That problem extends far beyond New York State, according to National Rural Health Association CEO Alan Morgan.

“Rural health is really the study of workforce shortages,” Morgan notes.

He indicated that the labor woes plaguing small town medical systems are structural, and pre-date the pandemic. The problem often starts with how skilled healthcare workers are recruited and trained.

“Oftentimes we take students who do well on testing, usually urban kids from upper income families, we train them in urban areas, and then we’re dumbfounded that they don’t want to work in a rural community,” Morgan explains.

As in most industries, the pay gap between rural and urban employers is also a factor.

Morgan said a recent survey of his NRHA members indicated that better pay was the number one reason for leaving a job in recent months.

“When you’re talking about a small town and lower salaries throughout those smaller rural communities, competing against urban locations has always been problematic,” he noted.

That dynamic has been exacerbated by the feverish competition for workers and the deep pockets large, urban employers can dip into.

“Now with the pandemic there is literally a nationwide recruitment effort going on and unfortunately, rural often loses in those battles,” Morgan said.

With hospital systems around the country competing for the same limited pool of skilled workers, no one in the industry seems to think the labor crunch will abate anytime soon.

Hospital administrators and advocates like Morgan say the key will be recruiting more young people from rural communities and providing affordable paths to education.

Now, states governments are starting stepping in to try and stabilize labor forces in their regions.

Vermont Governor Phil Scott recently announced plans to spend more than $30 million to retain and recruit healthcare workers.

In Albany, New York Governor Kathy Hochul outlined a plan in her State of the State Address to spend $10 billion on boosting pay and providing bonuses for medical staff. Her plan would also provide funds to cover the cost education, and provide loan forgiveness in exchange for working in underserved areas.