Photo: Grow Your Own LNA program at RRMC. Courtesy photo.
Rutland Regional Medical Center addresses workforce shortages amid high demand
by Olga Peters, Vermont Business Magazine Of Rutland Regional Medical Center’s 450 nursing positions, 50 to 60 are filled by traveling nurses. This means, when the hospital is short-staffed, it contracts with an agency to hire temporary nurses or doctors who travel from one facility to another.
Rutland Regional is not unique in Vermont. Hospital officials have discussed how needing to rely on traveling health care professionals to fill vacancies has added significantly to the facility’s operating expenses.
RRMC President and Chief Executive Officer Claudio Fort said, “We have more nursing vacancies than we've ever had at Rutland Regional.”
Meanwhile, RRMC’s services are in high demand. The region is experiencing a resurgence of COVID-19. People who delayed care early in the pandemic are still catching up on in-patient and out-patient care.
“We’re doing what every hospital seems to be doing: bringing in temporary or traveler nurses to fill the gap,” Fort said.
Over the past couple of years, the hospital has attempted to boost its staffing. In 2021, leadership raised wages, including establishing a $15-an-hour minimum wage.
“Bringing our wages and salaries up to a minimum of $15 has helped us recruit and retain critical food-service workers, environmental-service workers — folks that we can't run the hospital without,” Fort said. “In that area, we have seen some effectiveness.”
Photo: Grow Your Own LNA program at RRMC. Courtesy photo
Raising wages is only a part of the solution. The Grow Your Own LNA program, a novel initiative started in 2020 by the hospital’s nursing excellence department, in collaboration with Stafford Technical Center, encourages staff from other departments in the hospital to become licensed nursing assistants. The staff-in-training partner with nursing colleagues to obtain work experience. The program has graduated 11 LNA students in its first two years.
Fort views professional-development opportunities as a positive recruitment and retention tool that contributes to better health outcomes for patients. Rutland Regional collaborates with Castleton University, Vermont Technical College and Stafford Technical Center in Rutland in those efforts.
“There is a win-win-win on that,” he said.
Fort believes collaborating with local education centers helps attract and retain young people in the area, which in turn produces more quality jobs.
“And,” Fort added, “it brings down the cost of health care because we pay a significant premium for temporary traveling staff.”
In Fort’s opinion, Rutland Regional has entered the third stage of the COVID-19 pandemic.
In the first stage, which began in 2020, the hospital prepared for a surge in infections; elective procedures were canceled, and more negative-pressure rooms were created.
In 2021, the arrival of vaccines thrust the hospital into the second phase. Rutland Regional delivered more than 60,000 shots, increased COVID testing and tried to return to normal operations, only to ramp back down in the fall as the rate of infections began to spike.
Now, in 2022, a new wave of COVID infections in the region has led the hospital to establish a dedicated negative-pressure wing of its medical floor.
“On any given day,” Fort said, “we have 20 to 30 staff out with COVID, and we have 10 to 15 patients in the hospital with COVID. That's pretty significant.”
On a positive note, he added, these third-phase infections are less severe than those seen in previous phases. Most patients can go home without needing ICU-level care.
“Although the patients aren't as sick, they're still infectious,” Fort said. “And we still have to use higher-level precautions, which is very labor-intensive.”
Hospital expenses have also climbed; Rutland Regional estimates it will lose $7 million this year. “We are seeing a very dramatic and very unprecedented level of health care inflation,” Fort said.
Labor accounts for the bulk of these increases, but the center also faces rising costs for supplies, pharmaceuticals, personal protective equipment and visitor screening.
Earlier this year, the hospital sought permission from the Green Mountain Care Board to raise its fees by 9%, but the request was denied.
“If we don't get some relief, we're not going to be able to continue to hemorrhage money and provide the level of services that we're providing,” Fort said.
Even without factoring in COVID, Ford explained, the hospital has experienced an increased demand for services. As other hospitals across the Northeast reach patient capacity, RRMC has stepped in to offer treatment.
Fort worries the hospital might need to cut services if it is unsuccessful in raising revenues. While the hospital appears to have exhausted all the federal and state relief programs it can access, it can seek higher reimbursements from Medicaid or private insurers such as Blue Cross Blue Shield, he said.
Health care in Vermont is at a tipping point, Fort said.
“Vermonters can’t afford $5 per gallon of gas,” he said. “But if the gas stations were forced to sell at $3.50 a gallon, they’d stop selling it.”
Despite the dire arithmetic facing most Vermont hospitals, Fort is heartened by the way the state and medical centers partnered to combat the pandemic. In that respect, Vermont was at the top of its game — and could be again if everyone works together, he said.
“COVID is one of those turning points in health care,” said Fort. “We don't know what the new baseline for some of these things is because every time we take two steps forward, we take one step back.
“The pandemic,” he said ominously, “is not done with us.”
Olga Peters is a freelance writer from southern Vermont.