It had been four years since Joan Davenport, a nurse and assistant professor in the University of Maryland School of Nursing, did regular clinical work. Normally she teaches full-time, but since the coronavirus pandemic began, she has taken shifts at the Baltimore Convention Center, testing the public for COVID-19 during breaks from classes and meetings.
Lately, she began to vaccinate people, and as classes ramp back up this year, she plans to continue volunteering through the state’s health care reserve corps. She said many people from the nursing school have done similar work.
“The fastest way I could get to work was in the convention center, where I’ve been doing testing, not patient care, but that helps the other critical care nurses who are caring for patients,” Davenport said. “There are not enough of them, specifically, and they are taking a beating.”
Health care workers have been in short supply for years, but the pandemic has exacerbated the deficit. Officials and observers say the biggest issue is the lack of nurses, especially as the nascent vaccination effort begins to expand beyond health care workers and nursing homes to seniors and others with health conditions and essential workers. The same nurses who care for COVID-19 patients and perform testing are being asked to staff the vaccination clinics at hospitals and health department sites.
Maryland nurses are already stretched, stressed and spent. Some are leaving their jobs and signing on with staffing agencies that pay better and are driving up the cost of providing care.
“We are relying on people working in their off hours, and when we ultimately extend the campaign to get people vaccinated we will not have enough people,” said Tiffany Tate, executive director of the Maryland Partnership for Prevention, a nonprofit that works with state and local health departments to manage vaccination clinics.
Normally the group focuses on flu shots, but it has expanded its mission to include COVID-19 vaccinations. She used to pay $60 an hour to staffing agencies for nurses, but now pays $80 and has heard of some charging $200.
An advertisement on the app of the Trusted Health nurse staffing agency recently offered $5,606 a week for “travel nurses” at Johns Hopkins Hospital. Such nurses are usually contractors who work without health benefits or paid time off, and sometimes must take on shifts and assignments outside of their realm of experience.
A Hopkins Medicine spokesman said the system’s rates fluctuate and keep pace with market rates “that are competitive to ensure we can recruit and retain our nurses.”
Raquel Guillory Coombs, spokeswoman for Maryland Attorney General Brian Frosh, said the office has fielded one call from a hospital system “concerned” about the rising costs for nurses. She said, however, nursing services are not covered under state price-gouging statute or any order by Gov. Larry Hogan.
Some of the largest health care staffing agencies in Maryland did not respond to requests for comment about demand or pay.
Vinielle Acha-Morfaw, who worked as a travel nurse in the Baltimore area last spring, said she received handsome compensation for her work in the emergency department at Sinai Hospital. But she had less control over her schedule and felt uneasy about taking time off.
The 26-year-old Silver Spring resident said the current travel rates pale in comparison to the true value of a nurse.
“We deserve a doctor’s salary — we run the ER,” said Acha-Morfaw, who has since switched to a full-time position at the Washington, D.C., VA Medical Center. “When the travel nurses leave, we’re being worked twice as hard.”
In December, Hogan ordered that any licensed health care providers with proper training could administer the COVID-19 vaccine, a move that should help, Tate said. The order covers such providers as doctors, nurses, pharmacists, physician assistants and paramedics.
The governor also called on nursing programs to encourage nursing students to volunteer. The state’s Board of Nursing issued guidance in March that said nursing graduates may practice without a license and current students could perform support tasks that free up nurses.
Dr. Theodore R. Delbridge, executive director of the Maryland Institute for Emergency Medical Services Systems, said about 1,125 nursing students have been added to the state’s staffing capacity since last spring, with another 150 in the process of joining the ranks. Every nursing school in the state has participated in the program, he said, and some have offered academic credits for those who opt in.
Some nursing schools, including those at Towson University and the University of Maryland, also allowed some nursing students to graduate early or begin their clinical experiences ahead of schedule, said Jane M. Kirschling, dean of Maryland’s nursing school
Kirschling said interest in Maryland’s School of Nursing in Baltimore has remained steady over the course of the pandemic, and enrollment in its program at Shady Grove in Montgomery County will increase, even as the demands on nurses grow.
But the number of nursing students and volunteers joining the state’s staffing capacity has not offset the mounting deficit.
“Some folks have stepped out of the workforce earlier than they would have without a pandemic. Hopefully that will slow,” Kirschling said. “When nurses get older, the workforce historically leaves because of the physical demands on the body. What you see now is health care providers who are closer to retirement and might’ve said, ‘I don’t want to take the risk anymore.’ ”
“I don’t think people realize how physical nursing is,” added Davenport, the nurse and assistant professor. “It’s pure fatigue that nurses are feeling. They are working longer shifts and extra shifts. I’m amazed and appalled and proud at the same time.”
To alleviate more of the pressure on nurses, Hogan pledged to send qualified vaccinators to health departments, a “herculean process” that has already begun, according to Charles Gischlar, a Maryland Department of Health spokesman. Officials are tapping retired and active medical professionals and the Maryland National Guard to staff vaccination clinics.
So far, 614 vaccinators were sent the week of Jan. 4 to eight local health departments through Maryland Responds Medical Reserve, a group of medical and public health volunteers. Four more counties are slated to get vaccinators in the next month and others still can request aid.
The state also will send vaccinators to two counties from MarylandMedNow, a staffing agency launched recently by the state. And two more will get help from the Maryland National Guard’s Mobile Vaccination Support Team, which administered 500 vaccines the week of Jan. 4 and planned to continue offering support to counties.
“Through the MarylandMedNow or Maryland Responds Medical Reserve Corps programs, all levels of nurses are able to assist with the state’s vaccination distribution — especially now that it is ramping up fast,” Gischlar said in an email.
“The tasks they would be able to perform will be contingent on their education/training level and the vaccination site manager,” he said. “These licensed health care workers will be able to significantly bolster our front line forces in the administration of the COVID-19 vaccines, especially as vaccine production ramps up and the state moves into subsequent phases of priority groups.”
Hospitals are coping by tapping their own networks and outsiders for backup.
Sharon Boston, a spokeswoman for LifeBridge Health, which operates Baltimore’s Sinai Hospital and others in the region, said the system is using retired nurses, physicians from practices, clinical managers and educators, nursing students and pharmacy students to round out staffing for its vaccine clinics.
It’s not yet clear where more reinforcements will come from, given the nursing shortages across the country.
The American Association of Colleges of Nursing reported the shortage that existed pre-pandemic was already significant with no end in sight. The group points to a U.S. Bureau of Labor Statistics’ projection that even though 300,000 people will join the ranks of nurses between 2019 and 2029, retirements and other exits will leave a deficit of about 176,000 in the workforce.
There are 85,756 registered nurses in the state, according to the latest figures from the Maryland Board of Nursing. There also are more than 24,200 licensed practical nurses and nursing specialists.
Jen Kates, director of global health and HIV policy at the Kaiser Family Foundation, said nurses are needed for so many things that “there aren’t enough hands” for an all-hands-on-deck global pandemic.
“And there are so many bottlenecks with vaccinations that the one not getting enough attention is ‘who is giving the vaccinations,’ ” she said. “In many places, there aren’t enough nurses.”
Like Maryland, Kates said, several states are calling up the National Guard, deputizing others such as dentists to offer shots and tapping more health care workers for support roles. Pharmacists, who have been playing a growing role in vaccinations generally, also will be expected to take up more slack from nurses.
The shortage of nurses is uneven across the states, and how quickly extra nurses and others can be brought on to run vaccination clinics also will be uneven, she said. States also have patchwork regulations about who is allowed to give a vaccine. Training will be another hurdle.
And, Kates said, preventing widespread burnout among the nurses could become a greater challenge.
“Everyone is stressed right now,” she said. “It’s a pandemic effect that’s hard to combat.”