Aubree Jackson wanted to be an inpatient nurse ever since she took care of a mother who suffered a traumatic brain injury. But after one day at a Twin Cities hospital, in the middle of the pandemic, she started looking elsewhere for work.
Training had been hands-off during the pandemic and hadn't prepared her for the overwhelming caseloads, severely ill patients and feeling of guilt if she asked for help. In the middle of chaos, Jackson felt alone. It took a move to a laser hair removal clinic before the 26-year-old could breathe easy.
"I get a break" at my new job, she said. "That is super nice. I don't have to hold in my pee anymore."
The loss of nurses such as Jackson was a key talking point on picket lines earlier this month when 15,000 Twin Cities and Duluth hospital nurses went on strike. The Minnesota Nurses Association said hospitals need to improve pay and working conditions to retain existing nurses but also to address a worsening shortage by enticing former nurses back.
"There are plenty of licensed nurses … to fill the vacant positions in Minnesota hospitals," said Kelly Anaas, an intensive care nurse at Abbott Northwestern Hospital in Minneapolis and a union organizer. "But they are not going to come back until conditions improve."
Negotiations between the union and operators of 15 hospitals resumed this week, but with no agreements reached.
The stresses of COVID-19 exacerbated shortages at hospitals and their abilities to meet patient demand. Nursing vacancies doubled from 2,450 in 2019 to 5,587 in 2021, leaving 8% of jobs unfilled, according to the Minnesota Department of Employment and Economic Development.
The share of nurses working outside their licensed profession also rose from 9% to 12%, according to the Minnesota Department of Health. The increase means an additional 3,500 nurses are no longer caring for patients.
Paisley Svensson said her cardiac unit at North Memorial Health in Robbinsdale has become chronically understaffed, putting a strain on nurses who are caring for too many patients at once. A Health Department survey found that 10% of nurses are planning to leave the profession soon over burnout, up from 4% before the pandemic.
"There have been more shifts than I can count where I walk away feeling sad, feeling defeated," she said. "How many shifts like that does it take until you have to question yourself: What am I doing here?"
The shortage started before the pandemic, with baby boomer nurses retiring and reaching the age at which they needed health care themselves. Among the 12% of license-holders not working in nursing, 43% are retired, 19% are at-home caretakers and 11% are working outside their profession, the Health Department found.
M Health Fairview is aggressively recruiting veteran nurses to fill 100 high-need positions, offering $50,000 signing bonuses to work full-time in post-operative or intensive care and $30,000 to work in emergency rooms. But when it comes to nurses who left hospitals, it's less about money and more about lifestyle changes and family schedules, said Mary Nease, chief people officer for the Minneapolis-based health system.
"Nurses today, they're demanding different things," she said.
Fairview regularly reaches out to former nurses, but the strategy won't fill 800 vacancies, she added. The provider has leaned on its affiliation with the University of Minnesota School of Nursing, hiring 80% of summer interns to become nurses next spring.
Allina Health created an alumni campaign by which staff reach out to former nurses to gauge their interest in returning. Some raked in cash doing travel nursing but are ready for more stability, while others raised families but have time to work again, said Sara Criger, Allina's senior vice president of acute care operations. The Minneapolis-based system has 745 openings, about 13% of its nursing staff.
"People think you can't go back if you leave," Criger said. "That's not true. … We'd love to have you back."
Hospitals have filled gaps with temporary nurses from staffing agencies, often paying double or more wages. But Criger said greater reliance on temporary help exacerbates the problem, enticing staff nurses to leave for the riches of contract work.
Criger said she dislikes signing bonuses, because other hospitals are forced to match them and then everyone is paying more for the exact same pool of nurses. The risk of a salary arms race is why Twin Cities hospitals negotiate at the same time with their union nurses and avoid uneven wage scales.
Three-year deals are months overdue for 15,000 nurses at 15 hospitals in the Twin Cities and Duluth area, including four Allina and four Fairview hospitals. The nurses have sought pay increases of about 30% over three years, while the hospitals have offered just over 10%. MNA leaders said the high wage demands are partly a strategy to force concessions from hospitals that improve staffing and working conditions.
Amy Forkner retired early at age 55 in December, citing the stress of being a surgical nurse in what she says is an increasingly busy and disorganized St. John's Hospital in Maplewood. She renewed her license in July but doubts a return to hospital care.
"I had to block their number," she said of her old hospital. "They kept calling me to pick up shifts."
Losing veterans hurts, but hospital leaders said it is frustrating to lose new nurses in whom they have often invested weeks and thousands of dollars' worth of training. Many hospitals offer retention bonuses just to make sure nurses in key areas stick around a couple of years.
A young nurse such as Jackson could have been in hospital care for decades. She planned to spend a year on a medical-surgical floor and then move to the emergency room. Instead, she quit after a month — shortly after a COVID-19 illness that left her unable to climb stairs at home in Otsego, Minn.
Her clinic job lacks the adrenaline rush, but it pays more and offers stable hours and time to get to know patients compared to the hospital, she said.
"It was just the constant anxiety," she said. "There was too much to do (and) just not enough staff. That was another thing, there was never enough staff."
Hospitals have a better shot at getting Rachel Hanneman back. The 32-year-old nurse from Savage left HCMC in Minneapolis because the hospital couldn't assign her strictly to weekends — a schedule she needed as a single mother to minimize child care costs. A staffing agency found her the schedule she needed at a Mankato hospital that was desperate for weekend help.
Hanneman said she keeps an eye on staff positions and isn't ready to leave bedside care.
"I'm not there yet," she said. "I'm not done, but I don't like how close they pushed me to it."