Staffing problems are bringing hospitals to the brink of financial collapse

When Troy Nations came out of his coma last September, he had been in hospital for a month, but he was not in the original bed or the emergency room he was admitted to. He was with me for half an hour down the road King’s Daughters Medical Centerr, a facility in rural Brookhaven, Mississippi.

Nations, who is in his mid-30s but was unvaccinated at the time, had developed a case of COVID-19 so severe his lungs felt like they were about to collapse. Time was of the essence, but beds were sparse during the deadly Gulf South delta wave. Then the king’s daughters entered and found a place to treat him.

“They had double beds in all the ERs, [patients] everything on ventilators. All the beds in the intensive care unit were full. It really looked like a war zone,” said Caroline Nations, Troy’s wife. “And they were determined to make all of their patients healthy.”

Caroline Nations believes her husband would not have survived if he hadn’t ended up in a small town hospital.

Caroline and Troy Nations say that without King’s Daughters Medical Center, they are not sure they would have received medical assistance during the January 23, 2022 delta wave.

King’s Daughters, a small business with about 99 beds, is one of the largest employers in Brookhaven – a sleepy little town 55 miles south of Jackson with a population of about 12,500. The city is divided in half by railroad tracks, which are dotted with small shops, arcades and corner restaurants.

Most hospitals outside of Brookhaven are at least 30 minutes’ drive away, making the facility vital to the community and literally life-saving to patients and nations from surrounding areas.

But while some states are emerging from the Omicron surge, Mississippi’s hospitals are still in crisis, including King’s Daughters.

The number of people seeking care continues to grow, but hospitals across the state are reducing their bed count because there is no one to care for them. At the same time, an influx of federal money into the travel nursing market is likely to drive up the cost of hiring temporary workers needed to fill staffing gaps. In addition to patient and staff issues, bills mount while resources remain limited.

Now, like many small-town safety net facilities across the country, King’s Daughters faces an uncertain future.

“For the past two years, I’ve been looking at a worst-case scenario, which just keeps getting worse.” Alvin HooverCEO of King’s Daughters Medical Center said.

Alvin Hoover, CEO of King's Daughters Medical Center, poses for a photo at his office in Brookhaven, Mississippi.
King’s Daughters CEO Alvin Hoover says hospital is struggling to pay for essential staff, Jan. 23, 2022.

Coping with unprecedented financial pressures

Dealing with the Delta Wave was hard enough for King’s Daughters. The omicron variant has added to this burden as the hospital is a third full due to simply not having enough staff.

In the US, nurses either quit and retire, or they become ill and have to miss work. According to the personnel agency Aya healthcarethe number of open nursing positions has doubled from 100,000 to around 200,000 during the pandemic.

“Now the best you can do is sometimes less than the best you would have done before,” Hoover said. “Patients come into the ER, they wait and wait because we don’t have a room, we don’t have a nurse or doctor willing to see them.”

“It’s frustrating for all of us in healthcare that our resources are so tight.”

Hoover says the hospital would likely need to hire about thirty people in the nursing department alone to get it running smoothly again. However, no one applies.

“If they come in today and say, ‘I’m quitting,’ then I don’t necessarily want that nurse back. But you know, if they come back and say, ‘We’d love to work here again,’ we’d hire them,” he said.

For a limited time, Hoover offered some of his nurses small bonuses and even triple hourly rates.

COVID-positive patient Amy Mullins sits in a hospital bed to be treated by a nurse at King's Daughters Medical Center in Brookhaven, Mississippi.
COVID-positive patient Amy Mullins is pleased to be able to receive medical assistance on January 23, 2022 in Brookhaven, where her family lives

“Hundreds of thousands of dollars being spent on overtime, bonuses, bonuses and bonuses. Now, as the pandemic progresses, you could say millions of dollars,” Hoover said.

For this hospital, which typically has an operating margin of $1 million to $2 million a year, these payments are creating unprecedented financial pressure. He’s gotten some help from the government, but he’s not sure how long that will take.

How travel nurses — and how much they get paid — consider

Traveling nurses were another issue that compounded the budget problems faced by King’s Daughters and other hospitals.

The demand for travel nurses has increased due to the labor shortage. Data from Aya Healthcare shows that before the pandemic, hospitals were attempting to simultaneously hire about 7,000 travel nurses. By 2021 they were searching an average of 28,000.

Prices for these nurses have skyrocketed in part due to a huge infusion of federal COVID-19 aid funds most states are using to hire travel nurses for hospitals. To the south of the Gulf, Mississippi has spent around $90 million and Louisiana nearly $250 million.

Because hospitals and governments are able to pay high prices for a nursing contract, traveling nurses can choose the best deal.

Hoover says many of his employees left chasing those jobs, so he had no choice but to hire traveling nurses. While the hospital typically pays full-time nurses about $25 an hour, he has to pay a traveling nurse about five times that — more than $5,000 a week instead of the $1,000 he’s used to.

Even before the pandemic, keeping the doors of King’s Daughters open wasn’t easy. Hospitals in Mississippi receive less federal funding than other states because state leaders voted against expanding Medicaid last year. Small hospitals like King’s Daughters often serve large numbers of uninsured patients and rely on government help to offset the cost of care.

Some hospitals have such small operating margins that there is little room for error. Adding the high costs of traveling nurses, extra staff retention bonuses and overtime pay is “simply unsustainable,” it said Robyn Begleywith the American Hospital Association.

“Some hospitals are struggling year after year to break even and are really in trouble,” Begley said.

Cars pass an intersection in downtown Brookhaven, Mississippi
The small town of Brookhaven, Mississippi has a population of only about 12,500. King’s Daughters Medical Center is one of its largest employers, January 23, 2022.

Meanwhile, Hoover said he wasn’t concerned about the hospital’s near-term closure. There has been enough government aid to keep it afloat, although he knows the long-term future is uncertain, especially if there is a further surge in COVID-19 cases.

For now, he’s particularly concerned about the facility’s ability to continue to help people like the Nations who are in dire need of a hospital bed when another isn’t available.

“This is what the new healthcare will look like for the next three months, the next six months and the next year. If this pandemic goes away tomorrow, you’re still going to have trouble transferring patients,” Hoover said. “Healthcare is changing. We have to figure out how to adapt to that.”

Health workers now have the power

At King’s Daughters, the small cash raise has been enough to keep some staff, like nurse Derek McKenzie, happy.

McKenzie has been in the hospital for nine years and understands why it’s tempting to quit to become a traveling nurse. But he believes the move also has downsides.

“I’m not saying they don’t pay me well. All I’m saying is that right now, even in Jackson, I’m not going to make what a traveling nurse makes,” he said. “But it’s never a guaranteed full-time job.”

For McKenzie, King’s Daughters is like family. He would like to be paid more, but he knows that this small hospital’s finances are tight. His family lives here too, so there’s no point in uprooting his life.

“I’ve been here since I finished nursing school. I mean, that was my home base,” he said. “Everyone I know has been here … I have no desire to relearn new facilities, new doctors and all that.”

King’s Daughters Intensive Care Manager Jaymie Heard said he was grateful for the staff staying here, but it’s clear the mindset of many staff has already changed.

“People used to look for jobs to make a career,” she says. “Now they see that they can thrive in their careers and make more money. [The idea of] In my opinion, staying in one place for a long time is a thing of the past.

“People don’t care about longevity or retirement anymore. They go to the highest bidder.”

Jaymie Heard, chief of the intensive care unit at King's Daughters Medical Center in Brookhaven, Mississippi, sits at his desk in his office.
Jaymie Heard, director of intensive care at King’s Daughters Medical Center, says it’s difficult to hire staff to fill vacancies in his nursing department, January 23, 2022.

Barry Assinsays a human resources industry analyst, the reality of the healthcare industry today is that workers call the shots — not employers — and the decision to stay or leave a hospital depends on what they want in life.

“I think the end result of this will be a necessary upward revision to how much nurses are being paid,” Asin said. “The fronts have turned.”

This story was produced by the Gulf States Newsroom, a collaboration between Mississippi Public Broadcasting, WBHM in Alabama and WWNO and WRKF in Louisiana and NPR.

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