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DES MOINES, Iowa — The last 18 months for frontline health care workers have been tiring and trying. The pandemic has exacerbated an existing problem, low nurse staffing levels. It’s happening nationwide and in hospitals and health care centers in Iowa. The Iowa Center for Nursing Workforce shows health systems in the state are reporting all-time high vacancies.

Libby Maher worked as a registered nurse at one of Des Moines’ three major hospitals for seven years. She quit in July.

“Leaving the bedside was probably the best decision I made for my career in a long time,” Maher says. “It was just overwhelming in the sense that you were doing everything you could do and people still died.” By then, our state was 16 months into the pandemic. Just like COVID-19 surges had come and gone, so did the support for health care worker she says. “Everyone was like ‘health care heroes,’ you know,” Maher smiles. “You felt support. You were backed by the hospital. It felt like a team. You were all in this together.”

The fanfare faded and burnout set in. Recent studies show 94 percent of health care workers are experiencing some kind of burnout right now. For months, the Winterset mother of two worked three 16-hour days straight, instead of her normal 12-hour shifts. She earned overtime pay and a one-time $700 bonus, but Maher says it just wasn’t enough and no end in sight.

“You are just mentally exhausted and it reflects in your whole body,” she said. The 34-year-old says she knows of at least eight other nurses who have already quit their jobs at the hospital and have gone elsewhere. A survey from the Iowa Board of Nursing and Iowa Center for Nursing Workforce released this spring reveals there are more than 1,500 job openings for registered nurses in the state. The majority of them are direct care positions at hospitals in urban areas. It points to the reasoning behind nurses leaving the bedside as pay, work-life balance and job competition. The survey also says that on average the time for a majority of Iowa hospitals to replace a nurse is longer than three months because hospitals have trouble finding qualified applicants.

A spokesperson from Broadlawns Medical Center says it has 280 registered nurses at its hospital. In the last year, the turnover at Broadlawns was 11 percent, which was below the statewide average of 14 percent, according to the hospital. UnityPoint Health calls the issue of nurse staffing levels a “sensitive but serious topic.” A spokesperson for the health care system says, “It’s a particularly challenging time to work in health care, and UnityPoint Health joins hundreds of hospitals and health systems across the country and the world addressing critical workforce staffing issues.” Statewide, UPH employs 6,500 nurses, citing a 1.5 percent monthly turnover rate in the last 12 months. MercyOne says it too is “finding it difficult to identify candidates with the number of available positions,” according to a hospital spokesperson. It adds, “While we continue to recruit for additional health care heroes to join our family, we remain committed to providing safe, compassionate care to those in need.”

A national projection from the Bureau of Labor Statistics National Healthcare Professions and RN Staffing report predicts by 2030 there will be a 510,000 shortfall of registered nurses in the United States, while the number of RN jobs are expected to grow by 200,000 per year through 2026. A recent study also shows 21 percent of nurses plan to transition to a non-patient care nursing role after the pandemic.

On the cardiology floor of the Des Moines hospital where Maher used to work, she says it was hard to care for patients the way she wanted too. She tells WHO 13 News, full staff meant one nurse to four patients. With fewer nurses she says the ratio is now one to eight and there is a struggle to maintain quality care. “You’re not in the room as long. You may miss something on their assessment that you might otherwise have picked up on if you had more time in there,” she explains. “It’s dangerous to be honest.”

The pandemic continues to push nurses to their limits. COVID-19 hospitalizations are up in Iowa, intensive cares beds are full and COVID-19 vaccine requirements for health care staff at hospitals are creating a divide. An emergency room nurse at a Des Moines hospital whom WHO 13 News tried speaking with claims they were silenced by the hospital when it came to speaking to the media about the hospital’s current conditions. Despite the hospital’s policy which allows nurses to speak with members of the media with prior approval and not on behalf of the health care center, the nurse alleges they were told they would be violating policy and could face disciplinary action, even termination. Broadlawns Medical Center, UnityPoint Health and MercyOne deny those allegations, telling WHO 13 News that media interviews have been allowed with staff members throughout the pandemic with their approval.

Des Moines hospital nurses are not in a union; some say that might help in situations like these. Maher worries for the future of health care as hospitals continue to work at capacity. “The problem is bigger than just how much we get paid. That’s not the problem, it’s just a small factor in the big picture,” she says. “You need more manpower.  How do you fix that? I have no idea but I know that it’s going to get worse again before it gets better.”

Broadlawns Medical Center, UnityPoint Health and MercyOne all say they have experienced turnover in the last 12 months. Broadlawns says it has about a dozen nursing positions open at the hospital right now but hired 70 RNs in the last year. MercyOne and Unity Point say they are always working on recruiting and retention strategies, especially during a pandemic.