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By Heidi Perez-Moreno
UNC Media Hub

RALEIGH – In short breaks throughout her work shift, Donna Cranford will find time to sort through stacks of patient files towering over her nursing station cubicle.
The stacks grow as the day goes on at the Preston Medical Associates’ busy nursing station. She makes mental notes of the million and one tasks she needs to do. The light on the office phone won’t stop blinking red with unanswered voicemails and calls.
It is difficult to attend to menial paperwork when you have dozens of patients to see.
“There’s always something that can happen in the clinic that’s going to deviate you from that,” Cranford said.
On most days, Cranford will power through the day’s work so that she can get home to her husband and son. But some days are harder than others.
Waking up and realizing she has to go to work will trigger anxiety and nerves. Putting on her scrubs takes more mental stamina. Sometimes the bags under her eyes haven’t yet deflated from the day before.
“Truthfully, there are many days that are hard,” Cranford said. “But I love what I do. It’s important to me to be here for the patients and for my teammates because, when one of us is down, it only causes additional stress for those of us working at the department.”
On a typical day, Preston Medical Associates will see as many as 125 patients, leaving the load to be split among the three licensed practitioners at the clinic.
Cranford sits at one of the station’s four desks – directly across from the only other nurse working the Friday shift. A third nurse originally scheduled to work has taken a personal day. Since the pandemic began, two open nursing practitioner positions have remained unfilled.
“It doesn’t necessarily impact the amount of patients we are seeing, but it does put a lot of extra responsibility in and work on the two nurses that are remaining,” said Schquithia Peacock, who co-owns Preston Medical Associates. “They’re often there after the five o’clock hour, which is when we typically stop.”
Preston Medical isn’t alone in facing this shortage.
Across North Carolina, nurses at major hospital systems, private practices and clinics are struggling to hire nurses. In Wake County, there are roughly 800 vacancies for nursing positions at WakeMed Hospitals, hospital spokesperson Debra Z. Laughery said.
A September survey by the N.C. Nurses Association found that, among more than 450 respondents, the majority reported feeling additional stress and burnout due to the pandemic and nursing shortage. Around 58 percent of respondents reported experiencing shortages in their workplace.
“Has it had an impact? Absolutely. It limits our ability to be able to take care of patients,” said Dennis Taylor, who formerly served as president of the N.C. Nurses Association.
How did this shortage happen?
At the start of the COVID-19 pandemic, it felt as though nurses were adapting to the demand of working additional hours and handling viral caseloads among patients.
Taylor, who is a trauma ICU nurse at Atrium Health Wake Forest Baptist, said nurses were learning to adapt, including hopscotching to different departments based on staffing needs.
“They were very good at adapting to changing their roles and potentially working in areas that they might not necessarily have been educated in,” Taylor said. “Basically, just pitching in and doing whatever needed to be done to take care of the patients that needed to be taken care of.”
The distribution of the vaccine, which began in December, provided a glimmer of hope. By spring, COVID-19 case counts were decreasing. But, months later, hospitalization and ICU capacity rates were rising again following a surge of Delta variant cases. Nurses faced a second COVID-19 wave, having barely recovered from the first.
“People are tired,” said Meka Douthit, director of nursing at Cone Health in Greensboro and president of the state Nurses Association. “We’ve been in this war – it’s like a war-zone – for almost two years now.”
The UNC Health system reported more than 1,000 registered nurse openings in August. Nursing turnover had increased from 17.8 percent in 2019 to 19.5 percent in 2020, according to a national survey from Nursing Solutions Inc.
But staffing shortages among nurses isn’t only linked to the COVID-19 pandemic. It only made the issue ever so clear.
One of the biggest contributors to the shortage is a decline in nurse educators able to train and recruit incoming nurses to the field. Only 3 percent of nurses in North Carolina are also educators out of about 125,000 practitioners working across the state, according to research from the N.C. Board of Nursing.
It’s not that there’s a lack of interest in the field. Getting into nursing school is increasingly competitive, and many schools turn prospective practitioners away. Salaries for nurse educators are also, on average, lower than what they could be making at a hospital or private practice.
“Nursing is having a really difficult time right now recognizing nurse educators as a profession within itself,” Taylor said.
COVID-19 burnout is a contributor as well. Douthit said it’s become even more commonplace for nurses to work overtime and get calls on their day off – either from their team or another department – asking them to work a shift.
“I’ve seen nurses who have been in the profession for a long time, longer than my 25 years, saying that we’re OK — but we’re not OK,” Douthit said. “You almost see them at the point of mental break.”
It’s hard to work when COVID-19 has disrupted your life. Since it began, Cranford must go home and confront the virus again after having it be a running theme at the office.
At home, her 5-year-old grandson asks: “Why do we have to wear masks? Why can’t I play with my friends outside? Why can’t I sit next to my friend at school?”
She tries to retain the normal aspects of her life. Eating dinner with her family after work. Or reading a bedtime story to her grandson before bed.
“Sometimes I’m so tired,” Cranford said. “But those are some of the things that I think are important to keep his life normal with the craziness out here in the world.”
When an uncle died of COVID-19, it became harder for her to go into work.
Through all this, Cranford puts on her scrubs and reports for work. Sometimes, she takes a breather in the office alone. Other times, she has to let herself shed a few tears to process the grief and stress.
“There are some days that I get angry and I’m like ‘I don’t want to do this anymore,’” Cranford said. “There are some days that are hard and that are emotional and you just naturally don’t want to do that. But I’ve been a nurse for 30 years and I can’t imagine doing anything else.”
Months before the pandemic started, one nurse at Preston Medical Associates quit.
Finding someone didn’t seem like a hard task at first — like fishing out of a pond. Maria Salsone, office manager at the clinic, searched through nurse employment, social networks and job postings hoping to find someone to take her place.
“I’ve gotten three people through agencies,” Salsone said. “They all left.”
Then COVID-19 hit. Weeks into it, another nurse left after becoming pregnant. Once she had the child, she came back, but shortly left once more after realizing she needed to take care of the newborn.
Although the office was only down two nurses, that’s nearly half of the clinic’s staff. With hundreds of patients typically docked for a day’s work, two extra sets of hands on deck play a key role in ensuring the office runs smoothly.
Finding people to occupy those two spots was harder than it looked. In the last year, there have been roughly 50 applications. Many either didn’t have the right training or qualifications.
Others went through an interview process and made it to a training that lasted weeks, but either weren’t able to handle the workload or didn’t have enough training at a private clinic.
It’s led to those around the office lending a helping hand wherever they can and taking on tasks that aren’t necessarily on their job descriptions. If they’re a nurse short, Salsone or someone else in the office will sometimes walk a patient to their room and take their vitals.
The office gets increasingly more stressed when one nurse goes on vacation and is even more understaffed. Salsone tries to recommend to the nurses that they don’t take vacations at the same time unless absolutely needed.
Under those circumstances, nurses will take on additional patients and have more paperwork to sort through.
“We want them to have breaks, but it’s always a struggle trying to keep up,” Salsone said.