Hospital employment is rebounding from record-high vacancy and turnover, though rates remain higher than pre-coronavirus pandemic levels, according to a new survey of 128 of the state’s hospitals.
The report from the Missouri Hospital Association found around 14% of all staff positions at hospitals were vacant in 2023, a rate that’s lower than it was at the height of the pandemic but still higher than in 2019.
“The trend is going in the right direction,” said Hospital Association spokesman Dave Dillon. “But it's hard to know exactly where we're headed and how much we can move towards numbers that we saw pre-pandemic.”
According to the report, close to 16% of positions for registered nurses — who make up the largest group of hospital workers — were vacant. The national average is 10%, according to a survey from NSI Nursing Solutions, a national recruiting firm.
Licensed professional nurses, who provide more basic care for patients than registered nurses, by far made up the category with the highest vacancy rate. More than 1 in 5 LPN positions remained unfilled.
Vacancy and turnover rates varied by region. There was a higher level of churn among RNs in rural parts of the state, while turnover among food and environmental services workers in the St. Louis area was higher than the statewide average.
The numbers are an improvement from two years ago, when many nurses left hospitals to join lucrative travel staffing agencies, Dillon said. Hospitals demand for temporary staffing has decreased since wards were filled with people sick with the coronavirus.
The pandemic’s long tail still is affecting staffing, according to some health workers in the St. Louis area.
In early 2020, “We were heroes, and everybody wanted to buy us lunch,” said Jill Ehrlich, an RN from Wildwood who worked at SSM Health St. Clair Hospital for more than 30 years, including 12 as a charge nurse. “Then all of a sudden, we weren’t heroes anymore.”
A bout of long COVID left her unable to work for a half-year, Ehrlich said. When she returned to work, the job had changed. The hospital was asking staff to treat more people with fewer resources.
“My staff was running crazy and rarely getting lunches and getting breaks,” she said. “Nobody is supposed to work like that. They went to nursing school for a reason, they care about their patients and their families. And the reward just wasn't coming back.”
Ehrlich said the staffing issues create a “spiraling effect” for hospital workers. People quit because they’re overwhelmed, so other workers have to fill in the gaps. That makes the jobs even more stressful, and still more quit.
She now works at an infusion clinic and said the decision to leave hospital work was difficult.
“I thought I would retire there,” she said.
The high demand for nurses and other health workers means employees are able to move around to find a place that fits them best, which could contribute to high turnover rates.
Ellen Lindner, an RN from Foristell who graduated from nursing school in 2019, started work at St. Louis Children’s Hospital just as the pandemic was beginning.
While children weren’t hospitalized for the coronavirus nearly as much as adults, she said she worked with many kids who were suffering from pandemic-related behavioral issues.
“It was traumatic in itself,” she said. “I decided I needed to find something else to ease my anxiety and stress, especially as it was my first nursing job.”
Lindner now works at SSM Health St. Joseph’s, but in a post-surgery unit that she said is much less stressful. Most of the people she worked with at Children’s also left, she said.
“The good thing about nursing is you can always find something else if you’re not happy,” Lindner said. “I’ve always been the kind of person that if I get a job, I like to stay. But nursing is kind of like, you have to bop around to make moves for yourself.”
That demand means hospitals need to work harder at attracting workers, said Dillon of the Hospital Association.
“Hospitals have to be the employer of choice in the community,” he said. “The hospitals that are going to be successful at this realize that the world has changed. Doing exactly what we were doing in 2019 simply doesn't match what they want to be doing in their future.”
