Florida hospitals rebound from severe nursing shortage during pandemic

After being stretched to the breaking point during the pandemic, the nursing shortage crisis may be over for now in Florida.

Across the state, the vacancy rate for registered nurses has fallen in the past year from 22% to 13%, according to a survey of more than 200 hospitals conducted by the Florida Hospital Association. The turnover rate for nurses has also plummeted from 32% in 2022 to 20%, and hospitals are reporting many nurses have returned to their old jobs.

The numbers are a relief for hospital executives after the COVID-19 public health emergency severely exacerbated the pre-pandemic nursing shortage.

As COVID-19 cases arrived in the state, nurses quit or retired early rather than risk bringing home the virus to loved ones. Others quit to take up lucrative positions as contract nurses, whose average hourly rates soared from $74 to $155, roughly $6,000 per week.

As the omicron and delta variants began filling emergency departments and intensive care units with sick patients, hospitals had no choice but to hire more contract nurses and were competing with other states for the same workers.

As a result, spending on contract workers at Florida hospitals rose from about $436 million in 2019 to $2.6 billion last year, while overall workforce costs rose to $6.2 billion, according to the association. That included a 60% increase in overtime costs.

Hospitals have since reduced their dependency on contract nurses and are getting costs under control, said Mary Mayhew, executive director of the association.

“The bottom line, hospitals could not possibly compete with the travel wages that were being paid,” she said. “At some point, you got to do what is sustainable and what is supported based upon the cost of the care and the reimbursement you’re getting for that.”

Mayhew credits hospitals with resolving the crisis but also acknowledges that the end of the public health emergency and subsequent fall in contract nursing rates have helped. The average contract nurse hourly rate has fallen to about $30, according to ZipRecruiter.com.

In the face of the staffing crisis, hospitals were forced to increase pay for nurses and also bump up signing and retention bonuses, hoping to make permanent positions more attractive, Mayhew said.

Increasing the training of new nurses was also a priority for hospitals and the association, which lobbies on their behalf. In 2022, Florida lawmakers allocated an extra $125 million for nurse education programs, student loan reimbursement and scholarships. Earlier this year, another $79 million was awarded to high-performing nursing education programs. And the number of partnerships between nursing schools and hospitals has expanded, Mayhew said.

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There has also been a push to make working conditions more attractive. That includes using technology to relieve the administrative burden on nurses so there is more time to care for and interact with patients. Robots that can deliver meals to patients and voice-activated software that can interpret a nurse’s interaction with a patient and convert it into documentation of patient care are among the technologies being trialed in Florida hospitals, she said.

“I saw just a level of concern among the hospital executives about the workforce that I had not seen before,” said Mayhew. “Hospitals have been really working to both recruit new nurses and retain the staff that they have and they’re seeing really incredible results from that.”

At its worst, in August 2022, virtually 1 in 4 nursing positions at the 15 Tampa Bay region hospitals then run by BayCare were vacant.

Like others, the nonprofit was forced to fill many of those vacancies with contract nurses. But BayCare was also able to make use of a nursing pool it maintains, which gives it more flexibility in meeting short-term demand without having to reach out to nursing agencies.

“If we had not had that pool, we would have faced much more challenging times,” said Lisa Johnson, BayCare’s chief nursing officer.

Even after BayCare opened a 16th hospital in Wesley Chapel, its vacancy rate has since fallen to 12%, and the nonprofit has seen about 1,300 employees who left during the pandemic return this year. About 14% of employees in orientation are returning workers, Johnson said.

“No one could have planned or expected what we went through with the pandemic,” she said. “What helped us the most as we went through the storm was that our foundation was solid.”

Despite the turnaround, Florida still faces a long-term nursing shortage as the state’s older population expands. The U.S. Census Bureau estimates that 32.5% of Florida’s population will be 60 and older by the year 2030, up from about 21% currently.

Florida is expected to add almost 51,000 registered nurses and 4,000 licenses practical nurses by 2035, according to an IHS Markit study commissioned by the association and the Safety Net Hospital Alliance of Florida.

But the challenge for Florida will be to keep pace with growing demand for nurses that is expected to rise by as much as 40%. By 2035, Florida could face an “unprecedented” shortfall of 59,000 nurses, the study found.

“We’re a state that (has) seen such an increase in our population, many of whom are over the age of 65 and their health care needs are generally higher than a younger population,” Mayhew said. “We want to make sure that we’re not just bailing out the boat, but we’re charting a course.”