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Story Publication logo November 14, 2023

How a Houston Hospital Reversed the Trend of Nurses Leaving the Profession

a nurse places a medical device on a patient's finger

The pandemic left the nursing profession in a state of crisis. How are hospitals, health systems and...

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Multiple Authors
Video courtesy of PBS NewsHour.

There are more than five million nurses in the U.S. and a survey shows nearly a third of them are thinking of quitting. That would be a devastating blow for patients and hospitals. William Brangham reports on efforts to turn the tide for our series, Critical Care: The Future of Nursing, in collaboration with the Global Health Reporting Center and with support from the Pulitzer Center.

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Read the Full Transcript

Geoff Bennett: There are more than five million nurses in this country, and a recent survey found that nearly a third are seriously thinking of quitting, which would be a devastating blow for patients and hospitals.

Tonight, William Brangham starts the series about efforts to turn the tide called Critical Care: The Future of Nursing. It's a collaboration with the Global Health Reporting Center, including support from the Pulitzer Center.

Ashley Arbilo, Nurse, Houston Methodist Hospital: Would you like a coffee, Alfredo?

William Brangham: Ashley Arbilo is fueling up before the start of her shift at Houston Methodist Hospital. She's one of more than 8,000 nurses in this hospital network.

But as busy as it is now, she says it's nothing like it was during the height of the pandemic.

Ashley Arbilo: People were getting burnt out. Nurses were falling from COVID after treating patients with COVID. I saw staff being burdened from kind of the workload, and the assignments were just insane with how many patients were coming in.

William Brangham: Did that change your mind about wanting to stay in this field?

Ashley Arbilo: It did.

William Brangham: Caroline Mascarenhas, a former nurse here, was a hospital V.P. when the pandemic threw her into crisis mode.

Caroline Mascarenhas, Houston Methodist Cypress Hospital: It was a very trying time. It took an emotional toll, it took a spiritual toll, and it took a physical toll as well.

William Brangham: But even as the need grew, the supply of willing workers shrank.

Ashley Arbilo: A lot of my friends left for travel assignments.

William Brangham: Because the pay was so much better?

Ashley Arbilo: Yes, during the pandemic.

William Brangham: Two years in, nurses were quitting at more than seven times the rate they were before COVID-19.

Across the U.S., more than 100,000 nurses quit the profession during the pandemic. Many others left for new jobs, which put hospitals in a tough position. Pregnant and overworked, Ashley Arbilo was on the verge of doing the same.

Ashley Arbilo: And I was thinking about leaving. I had talked to one of my former managers and directors, and they were like, please don't leave the system. We may have something for you.

Very good. You will see me pop up on your television.

William Brangham: And this is where she landed, Houston Methodist's new virtual nursing unit, where Arbilo offers up direct patient care from afar to patients in eight different hospitals.

Ashley Arbilo: Good morning. Can you hear and see me?

William Brangham: She takes medical histories, asks and answers questions and helps with intake and discharge, all remotely.

Ashley Arbilo: Very good. So, in just a second, I will populate that paperwork here on my screen, so you can follow along with me. And if you have any questions or concerns, just let me know, OK?

And, sometimes, they do ask, like, are you really a nurse? And I'm like, yes, I have my badge on. I'm really a nurse.

William Brangham: What, you — meaning they wondering whether you're a real human being or whether you're actually a nurse?

Ashley Arbilo: Yes. Yes. (Laughter)

Ashley Arbilo: I have gotten questions like, are you real? I'm like, yes, I'm real. (Laughter)

Ashley Arbilo: I'm real. I'm not A.I.-generated.

William Brangham: I have a pulse.

Ashley Arbilo: I do have a pulse. I have a badge on. I'm a registered nurse with tons of experience. I'm here to help you and answer any questions.

Dr. Sarah Pletcher, Houston Methodist Hospital: It's really the engine room and the control room that represents our whole virtual health system.

William Brangham: Dr. Sarah Pletcher oversees this daily operation.

Dr. Sarah Pletcher: So you see staff here that are doing more than monitoring. They're also providing direct, engaged care.

William Brangham: Philosophically, is this about improving patient care? Is this about handling lesser staff?

Dr. Sarah Pletcher: I mean, the rationale is, we want to provide better care and do it sustainably and, wherever possible, we can give time back to the bedside team, so they have more time to look after the patients that need them on a shift.

Looks like you have got a patient on main eight ready for discharge.

William Brangham: According to the hospital's analysis, each time Arbilo walks a patient through intake or discharge, it gives 25 to 30 minutes of time back to the bedside nurse.

So, the idea was that these are the things that the bedside nurses would most like to not have to do and felt like they were interrupting their direct care of a patient, so let's do those virtually.

Dr. Sarah Pletcher: That's right.

William Brangham: The launch of a virtual nurse corps was just one part of Houston Methodist's plan to hold on to and to rebuild its staff.

The hospital stopped hiring temporary or travel nurses. At one point, there had been more than 200 working here. For nurses who remained, they offered flexible schedules, more choice of assignments, and higher pay.

Caroline Mascarenhas: I would say the second quarter of last year is when we started seeing the reverting back to normalization. And this past year, we really normalized.

William Brangham: Today, staff turnover is right back to where it was before the pandemic.

But that experience is not universal. The state of Texas projects that, over the next decade, it will take an additional 57,000 registered nurses to meet patient needs. And while Texas is in a worse position than most, this is a nationwide shortage, with a projected shortfall of nearly half-a-million nurses in the next two years.

Diane Santa Maria, Cizik School of Nursing, UTHealth Houston: We have been in crisis mode for years.

William Brangham: The woman whose face is on that bus, Diane Santa Maria, has been dean of the Cizik School of Nursing at UTHealth in Houston since 2018.

Diane Santa Maria: Even before the pandemic hit, the average age of a nurse was about 55. So they were already sort of hitting that range where we were going to see multiple people retiring over the next couple of years.

William Brangham: The exodus of older, experienced nurses creates higher demand for new ones. But, nationwide, the number of nursing students has also been falling since early in the pandemic.

It was down more than 15 percent last year, hitting a 10-year low. To help those who are enrolled, the Cizik school has added tutoring programs to help students graduate, and it's doubled scholarships to entice others in.

Diane Santa Maria: We have still have a long way to go until we reach our goal of making undergraduate education free. But it's a step in the right direction.

William Brangham: The state has taken its own steps too, from loan forgiveness to funding research projects done by young nurses. At the same time, there's a shortage of nursing faculty, which forced schools here to turn away more than 10,000 qualified applicants last year. This, too, is a nationwide trend.

Diane Santa Maria: In order to be nurse faculty, you still have to be a nurse, and then you have to go and get additional doctoral training, which is about 1 percent of nurses. So it's a very small pool of people.

William Brangham: There's no short-term fix, especially when the overall shortage is driving up salaries for nurses with advanced degrees, who make more at the bedside than in the classroom.

Those who do teach say the next generation of nurses can already see its own value.

Elda Ramirez, Cizik School of Nursing, UTHealth Houston: These kids, they're the future, and they're just going to do it their way. The old ways don't work for them.

William Brangham: Elda Ramirez is not just a professor here, but an emergency room nurse in two county hospitals.

Elda Ramirez: I'm happy because finally there's this new generation of people that are going to go, I'm not going to tolerate that. They're going to say, no, you're not going to pay me that much money. No, I'm not going to tolerate those hours. No, I'm not going to only work night shift.

They're saying, no, if you need me that bad, let's talk. That's what we need.

William Brangham: In the meantime, we can expect to see more hospitals like Houston Methodist trying to do more with less.

Dr. Sarah Pletcher: So you see here that she's able to provide this care for 16 patients at one time.

Ashley Arbilo: And then it looks like you already have an active MyChart account.

William Brangham: If that technology helps nurses stay in the profession, all the better.

It sounds like this shift means you got to stay in a career that you loved, but was taxing for your life.

Ashley Arbilo: I have told a lot of my colleagues, like, this is probably the best sort of job I could even dream up for a nurse. I'm still using my knowledge and skills, while also kind of balancing my home life and making sure, like, I'm mentally present and OK.

William Brangham: A balance that has been hard to find since a virus threw our health care world off-kilter.

For the "PBS NewsHour," I'm William Brangham in Houston, Texas.


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