During the worst of the COVID-19 pandemic, as emergency departments filled and patients on gurneys lined hospital hallways waiting for care, much of our focus was on hospital beds still available to treat more sick.
But vacant beds is only part of the equation.
Available beds, imaging equipment, and lifesaving drugs don’t mean as much if the hospital doesn’t have the nurses to care for patients.
Hospitals across the country are reporting problems employing enough nurses and rural hospitals are struggling the most.
Health care facilities must become innovative in attracting the best nurses, offering hefty signing bonuses, tuition reimbursements, and flexible work hours, said Marci Olinger, chief nursing officer at Bravera Health Seven Rivers in Crystal Rivers.
Olinger said she has to also offer new nurses a better work environment.
“They want to work where they can give safe care,” Olinger told the Chronicle.
Nurses want to work in a hospital where, when they get overwhelmed or confronted with a patient problem they don’t know how to solve, their supervising nurses or director of nursing will “pitch in to help” rather than tell them to “do the best they can.”
“They want to know their manager cares about them,” she said.
Olinger said Bravera Health Seven Rivers offers all that and more, but hiring the desired number of nurses, and the best ones, is not easy.
Olinger’s efforts are against a backdrop of nurses leaving the business in ever greater numbers.
The pandemic did not cause the exodus of nurses, but rather the data shows it sped up what was already on the horizon.
That’s especially true for rural hospitals.
In a November 2021 survey of 130 rural hospitals, 96 percent responded that they were having trouble filling nursing positions.
Nearly a third said that their shortage of nurses resulted in the suspension of some services and another 22 percent said they were considering some service suspensions, according to the Chartis Group, a health care consulting company.
Nearly half the hospitals reported they had turned away patients because of the nursing shortage.
Olinger said that Bravera Health Seven Rivers has not had to eliminate services and makes up any shortages with traveling nurses, but they demand higher salaries.
Olinger said the Bravera Health system network, which oversees three hospitals, along with a freestanding ER facility in Citrus Hills, and other health care facilities and offices, allows Seven Rivers the kind of flexibility it needs attract the best nurses.
HCA Florida Citrus Hospital in Inverness declined to participate in this story.
Meanwhile Olinger has her work cut out for her.
As of May 2022, hospitals nationwide employed 76,000 fewer workers than in March 2020, according to data collected by the Federal Reserve Bank of St. Louis.
When it came to health care and social assistance workers, 551,000 quit their jobs or took work elsewhere during April 2022, according to the U.S. Bureau of Labor Statistics.
That was the highest number for the month of April since the record keeping began in 2000.
There are many reasons for the exodus.
One survey in 2020 reported that about 75 percent of nurses reported being overwhelmed and suffering from burnout. Another 2021 survey by Morning Consult reported that nearly one in five nurses surveyed said they were considering leaving the health care profession.
Meanwhile, the nurses still at their posts are aging.
The average age of registered nurses was 50 years, according to a 2018 publication by the U.S. Department of Health and Human Services.
The Bureau of Labor Statistics predicted that the United States would need about 200,000 new registered nurses annually to replace those who were retiring.
Given that the report was before the pandemic and the higher-than-expected quit rates for nurses, the country will need more new nurses than that.
Rural hospitals often have it harder.
Metropolitan areas have an average of 30 more registered nurses per 10,000 residents than do rural hospitals, according to the U.S. Department of Health and Human Services.
Olinger, 54, told the Chronicle when she first became a nurse, the work environment was different.
“When I first became a nurse, we were pretty much told what to do by the director or (supervising) nurse,” Olinger said.
Nurses rarely were allowed to participate in policy decision making, she said.
That’s now changed.
Olinger said that when there’s a problem, supervisors and administrators involve floor nurses, who often have the best perspective as to how to fix the problem.
Rank-and-file nurses are also included in hiring new nurses.
Olinger said that results in nurses being invested in the hire and want that new nurse to succeed and remain at their job.
“We want them to stay with us for an extended period of time, it’s a lot cheaper in the long run,” Olinger said.
And when hospitals don’t have enough nurses, they turn to traveling nurses. These are nurses who typically work for an agency and travel to where nurses are most needed.
But they are not cheap.
The average hourly salary of a registered nurse in Florida is $36.60. That’s 13 percent below the national average, according to Indeed, an online employment website.
Agencies representing traveling nurses usually demand $40 – $50 an hour more.
Olinger told the Chronicle she has about 290 nurses, of which about 30 are traveling nurses.
She wants a total of 350 nurses and to phase out the need for traveling nurses as much as she can.
But many new nurses would rather work in larger cities which offer more social life.
It’s up to hospital staff like Olinger to get them to come here.
Olinger said that she’s got a good shot at getting a nurse to sign on with Bravera if they visit Seven Rivers.
“If I can just get them through the door,” she said. “It’s a great organization to work for.”
One of the nurses Olinger convinced to work at Seven Rivers was Heather Seeko, 28.
With the shortage, Seeko could have worked almost anywhere.
But Olinger got Seeko to come through the door.
That’s when Seeko did her nursing school clinical requirements at Bravera Health Seven Rivers.
So why did Seeko stay?
“I stayed here because of the staff and the opportunities the hospital offers,” she told the Chronicle.
“They’ve been very accommodating,” she said about her scheduling. Seeko has a 4-year-old daughter.
“You feel like you’re in a family,” Seeko said. “Everybody knows everybody. It’s just so rewarding.”
Seeko said the hospital staff made her feel welcome and welcome to ask questions when she needed help.”
Aprille Matos, 50, is a registered nurse and used to work for an acute dialysis company.
Now she works as an intensive care unit nurse, having known Seven Rivers’ director of critical care when she once worked at HCA Florida Citrus Hospital.
“I work here because of the people. I worked in ICU a lot (while with the dialysis company) and got to know many of the nurses, she said.
“You learn so much every day,” she said. “You see someone on a ventilator and then you watch them walk out without a ventilator.”
Matos stayed working even during the worst of the pandemic.
“There are definitely sad moments (doing nursing work). Sometimes you come home crying,” she said. “But the good outweighs the bad.”
The heat is on for Citrus County.
A widespread heatwave covering most of the eastern United States, from the Ohio Valley to the Southeast, stretched into Central Florida, hitting locals with heat index values in the triple digits, according to meteorologist Ross Giarratana, of the National Weather Service in Ruskin.
“A really strong ... ridge of high pressure has set up across portions of the Mid-South,” Giarratana said Wednesday, June 15, “and it’s pretty much keeping much of the eastern U.S. in well-above-average temperatures ...record-breaking in some cases.”
Peak heat index values for the Citrus County area are expected to last into Thursday, Giarratana said, before they “somewhat cool off” by Friday and then into the weekend.
“But we’re only talking about the difference of let’s say 108 heat index for today to perhaps 106 by Saturday, 105,” the meteorologist noted. “It’s still going to be warm nonetheless, and we still encourage people to use heat precautions – spend time in air conditioning, and stay hydrated.”
Heat index values are a combination of air temperature and humidity.
“So as the humidity goes up, and the air temperature goes up,” Giarratana said, “the body’s ability to sweat and cool itself off starts to diminish.”
National Weather Service (NWS) officials issued heat advisories Wednesday morning across several states, spanning as far south as Levy and Marion counties to warn of heat index values at 108 degrees or higher for the day.
“The reason for the heat advisory in Levy County is there’s just more of the county that is going to experience, we think, the heat index value of 108 or higher,” Giarratana said, “but we don’t think it’s going to be widespread enough in Citrus to have the actual heat advisory in place.”
However, that doesn’t mean Citrus County shouldn’t take heed of stifling heat.
“We don’t want people to think the conditions could not be just as dangerous in Citrus County as it could be in a county that has a heat advisory,” Giarratana said. “It’s more than enough to cause some heat-related illness so we want people to be mindful of that.”
Giarratana said the NWS will continue to review its forecast to determine if a heat advisory should be issued Thursday for Citrus County.
“We’re looking at a peak heat index values getting up into the 108 range in a good portion of Citrus County, both today and tomorrow,” he said, “... and isolated spots that could be a little hotter than that, but we we don’t necessarily have those 108-or-higher temperatures as widespread.”
Anyone outdoors – especially during the hotter times between 10 a.m. and 4 p.m. – should drink plenty of fluids, take frequent breaks, seek shade, and take shelter with air conditioning.
Also, don’t leave children or pets unattended in vehicles.
“Those vehicles can heat up so quickly,” Giarratana said, “and it can be a matter of minutes for children or pets to become severely sick or, perhaps, even worse.”
Reprieves from the heat are still possible with the regular summer thunderstorms.
“We’re in that time of the year where sea-breeze activity is very common,” Giarratana said. “We won’t see storms every single day in the same locations by any means, but there’s probably always going to be some sort of potential, in most cases, that we’ll have isolated-to-scattered thunderstorms, and it just depends on the day.”
Developer Oscar Sol told 40 Meadowcrest residents during a question-and-answer session Wednesday he is willing to make concessions and modify his proposed 225-unit affordable apartment complex that would front that community on State Road 44.
Sol, founder and principal of Green Mills Group, assured them the rental facility would not increase crime, lower property values, add hundreds more cars to the subdivision streets and destroy the aesthetics.
But residents were not buying what he was selling. Their view was summed up by Kim Knudsen, who’s lived in Meadowcrest for five years.
“Why do you want to come here?,” she said. “How would you like it put in your front yard?”
Knundsen was greeted with applause.
Sol said he is open to reducing the density of the project, perhaps capping the units at 100.
“I would consider reducing it further,” Sol said. “But we need to have a constructive dialogue.”
Ardath Prendergast, the Citrus County Chamber of Commerce’s vice president of operations, offered the lone thumbs-up for the development. It would, she said, fill a desperate need for this kind of housing.
“We know change is coming to Citrus County,” said Prendergast, who lives in Meadowcrest.
While preferring Sol find an alternate site, Prendergast said she would not have problems with the community, especially after visiting Green Mills’ other two affordable, income-restricted locations in Forest Ridge and Inverness. They’re first-rate, she said.
Sol addressed the residents’ main complaints and offered these compromises:
There would be only one entrance off State Road 44 to prevent traffic on private roads.
He can tweak the site plan and concentrate the three-story section toward the commercial part of the property
The tall oak and pine trees surrounding the site would serve as a natural buffer and shield the complex from view
Property values did not decrease at Green Mills’ two other locations in the county (Forest Ridge and Inverness) and that should not happen here.
The aesthetics of the area will not change. “We don’t build ugly buildings,” Sol said. “We’re going to make it look nice.”
Regarding unruly tenants: “People are so desperate for attainable housing, the last thing they want to do is get evicted or be a bad neighbor.”
The apartment complex will have its own clubhouse and pool and there should not be tenants trespassing at the Meadowcrest amenities.
During Wednesday’s gathering held at Coastal Region Library, Sol presented the income limits for the rental complex: A one-person household cannot exceed more than $34,720. A two-person household’s income is capped at $39,680.
One-bedroom rents will range from $348 to $930. Two-bedroom units are $418 to $1,116.
Sol said someone will eventually build on that property and right now, a large department store could build there. What would you rather have, he asked, a Target or affordable apartments?
As one, they responded: Target.
The battleground now shifts to the planning and development commission (PDC) which meets at 9 a.m. Thursday, June 16, in room 166 of the Lecanto Government Building at 3600 W. Sovereign Path.
That board will consider Green Mills’ request to modify the community’s Development of Regional Impact (DRI) master plan. That would be the first step allowing a multi-family apartment complex on 14 acres now zoned commercial-business and office park.
Sol will make his case for a zoning change and residents have vowed to show up in force to oppose it.
County Administrator Randy Oliver on Tuesday presented his board with four options to jumpstart affordable housing in Citrus County.
The board agreed in consensus on only one of those options: to consider density bonuses for developers considering affordable housing.
The state allows local governments to adopt new zoning regulations that incorporate density bonus programs and strategies to increase affordable housing in their jurisdictions.
Housing is considered “affordable” when it is less than 30 percent of a family’s gross income. Anything over 30 percent is considered a cost-burdened household.
“I don’t want to do anything that competes against the private sector in the free marketplace,” County Commission Chairman Ron Kitchen.
If someone “comes forward with some ‘super program or new idea,’ we will listen,” Kitchen said.
Kitchen’s colleagues agreed.
Commissioner Jeff Kinnard said private entities are “getting this figured out with government cooperation” and mentioned Inverness as a model for bringing in affordable housing.
The Inverness City Council this month voted unanimously for a comprehensive plan amendment to land use change that would start the process leading to the proposed 100-unit affordable apartment complex off Forest Drive.
The council vote ushers in the change from the property’s current comp plan designation of low density residential to high density. Later this month the council is expected to approve the developer’s zoning change request.
Commissioners at Tuesday’s meeting said they would not support the following options to spur affordable housing:
Setting space aside for affordable/workforce housing in residential subdivisions and multifamily developments.
Developing a housing authority and issue a Multifamily Mortgage Revenue Bond program (MMRB) and other programs through a housing authority.
Dedicating general funds to offset costs associated with the development of multifamily housing.
Barbara Wheeler, executive director for the Mid Florida Homeless Coalition, presented county commissioners with dire statistics: rents are up 43.8 percent in two years; 163 people 55 and older on fixed incomes are homeless; the average rent in Inverness alone is $850 a month.
Wheeler urged the board for help.
“We can’t find housing for these folks,” she said. “We don’t have solutions.”