Forgotten on the Frontlines

For two years, Jessica Dahlman, a nurse at Logan Health in Kalispell, has arrived to work at 5:30 a.m. to start her 12-hour shift on the surgery center floor knowing there won’t be enough staff to accommodate the hospital’s patient load.

Since the pandemic began in 2020, Dahlman has watched hospital capacity fluctuate with numbers often nearing capacity while she’s simultaneously said goodbye to a steady stream of coworkers who have retired early, left to pursue lucrative contracts as temporary travel nurses or changed careers entirely, all because they are burned out.

“We are all suffering from some form of PTSD,” Dahlman said.

Dahlman, who is also a union delegate, has been a nurse for the past 13 years, spending about half of her career at Logan Health, working on hospital floors ranging from the intensive care unit (ICU) to her present position in same-day surgery, where her stress levels have ebbed and flowed with the pandemic’s COVID surges while patients regularly insist the virus is a sham.

“We have this moral fatigue,” Dahlman said. “We have ethical dilemmas because we don’t feel protected and we don’t feel like we’re giving our patients what they need.”

According to the U.S. Bureau of Labor and Statistics (BLS), the industry has lost nearly a half-million healthcare workers nationwide since February 2020, with one in five departing since the pandemic began.

At Logan Health, Chief of Human Resources Deb Wilson says the hospital is experiencing the same recruitment and retention issues as other industries, where employees are also leaving to retire early or have changed careers.

To fill those staffing gaps among nurses, hospital administrators are utilizing travel nurses, which Wilson says accounts for about 15% of the staff spread out among Logan Health’s five branches in Kalispell, Whitefish, Shelby, Cut Bank and Conrad and their three long-term care facilities.

Wilson says that while the hospital has historically used travel nurses as a tool to prevent staffing shortages, they are seeing more since the pandemic began, while the hospital is simultaneously seeing nurses leave Logan to travel nurse elsewhere.

According to the BLS, travel nurses earn $51 an hour on average while staff nurses earn $38 an hour.

Cindy Hinzman is one of many nurses who left Logan to travel nurse last year in order to earn better pay, and after what she characterized as a tense relationship with administrators.

“My husband and I talked about it, and we decided that I’d do some travel nursing and I could help pay down some debt and visit family while doing it,” Hinzman said.

While Logan Health didn’t know what percentage of its nursing staff is under contract by travel nurses at its Kalispell branch specifically, ICU nurse Sarah Shanklin-Johnson says her floor likely has more than 60% travel nurses.

Shanklin-Johnson has worked as a nurse for 11 years, spending most of her career at Logan Health in Kalispell. And while she said she’s glad travel nurses are available to help, the constant turnover takes its toll.

“Things have dramatically shifted,” Shanklin-Johnson said. “We went from being a unit that was staffed with a lot of senior nurses that had a wealth of knowledge to a lot of core staff leaving to travel when the pandemic started. There’s been a huge transition with a majority being travelers. It’s odd to show up to work and not recognize anybody and it’s sometimes alarming. You don’t know their skill level.”

Despite the constant flow of travel nurses, both Dahlman and Shanklin-Johnson say the hospital is understaffed and their workloads fluctuate with each COVID wave. Normally the winter season is slow, but the recent Omicron surge has them taking on more patients.

On average, Logan Health’s capacity has hovered around 90%, Wilson said, with peaks of over 100% last October and November.

Aside from the long hours and extra shifts, Dahlman says nurses are also suffering from emotional stress because they are unable to provide the level of care they want to for their patients.

“We are all coming at this moral dissonance because at this point we’re all short staffed and we’re not able to provide the care that we want to provide these patients,” Dahlman said. “One of the big things that hurts all of us is patients that are not able to have their family members available while they’re sick and dying. There would be people crying in the waiting rooms because they couldn’t come in. We’re holding up iPads for people that are dying alone.”

Shanklin-Johnson says she has to prioritize her time to focus on life-saving priorities and she, too, wants to provide more for patients.

“We push ourselves to the max,” she said. “We’re not taking breaks or eating or drinking for 12 hours and at the end of the day we feel like we’re not doing enough. That just hurts your heart at the end of the day. That’s somebody’s mom or dad or brother or sister.”

As of last week, Logan Health had 600 job openings in all departments, according to hospital spokesperson Mellody Sharpton, and officials are working to recruit and retain employees with competitive wages and benefits packages.

“We want to offer flexibility to keep older workers in place for folks who are thinking about retirement,” Wilson said. “When people come to Logan and take employment here, we don’t think of anything they do as a job but more as a career.”

But hospital officials are preparing for more shortages in March after the U.S. Supreme Court’s decision to allow vaccine mandates for healthcare workers takes effect. The hospital is now working to educate employees about their options.

“We’re doing extensive planning,” Wilson said. “We have to follow the law, but we also have to support our employees. We are crossing that bridge when we get to it. There’s opportunity for religious and medical exemptions.”

Meanwhile, nurses at Logan Health are continuing to work long hours while picking up extra shifts. Shanklin-Johnson says she’s not sure how much longer she can keep up with the demand. She has considered changing careers but doesn’t know what else she would do.

“I went into this job because it’s a passion of mine to care for other people and I just don’t know what other role I could play that would be fulfilling in that aspect,” she said.

Some patients’ attitudes are also making matters worse. Dahlman says people in the hospital are constantly discrediting healthcare workers, telling them that COVID isn’t real. Others just have a short fuse.

Dahlman remembers when nurses were viewed as heroes at the start of the pandemic, and while she does receive gratitude from a segment of her patients, the trust and respect in healthcare workers has slowly diminished over the last two years.

“I think we just feel forgotten,” Dahlman said.