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Revolving door: Why are nurses leaving their jobs and then coming right back?


There's a strange thing happening in nursing homes across the country. Staff members, fed up with low pay and long hours, are leaving but then coming right back. Indiana Public Broadcasting's Justin Hicks explains.

JUSTIN HICKS, BYLINE: Roughly a quarter of all nursing homes say they have a shortage of nurses. Zina Lowery (ph), a licensed practical nurse in Indiana, says that's because even before COVID, it was a nearly impossible job.

ZINA LOWERY: They aren't being compensated properly. They are being asked to pick up extra shifts, to pick up double shifts. And that's a lot. Everyone needs to treat their nurses better.

HICKS: Add COVID challenges to that, and it's easy to see why nurses are leaving nursing homes in droves. Many, like Lowery, who are sticking around, are going to staffing agencies. They offer flexible, short-term contracts and, lately, pay a lot more for the exact same work. Lowery says right now, she can make roughly $20 an hour more than when she was a nursing home staff member. In areas with really critical shortages, nurses can make even more.

LOWERY: We're gaining that power back. We're understanding our worth and knowing our power. And we're negotiating that.

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HICKS: But some nursing home officials are crying foul. They say the rising rates they're having to pay staffing agencies amounts to price gouging. Here's Bernie McGuinness, CEO of Majestic Care, a company with long-term care facilities across the Midwest.

BERNIE MCGUINNESS: To be blunt, I feel taken advantage of. Not even close to a fair market value am I being asked to pay. And that price just - it's unsustainable.

HICKS: McGuinness says he wants to pay his nurses better and compete with staffing agencies. But he relies on reimbursements from Medicare and Medicaid, which haven't kept up. So he's at a disadvantage.

MCGUINNESS: We've seen our costs go up, you know, 10, 11% each year during this pandemic in a labor standpoint - in some markets, even more. Reimbursement does not go up 10 and 11% a year.

HICKS: So McGuinness wants lawmakers to step in and do something to control the rising costs. Chris Madden heads a staffing agency, Networks Connect. He acknowledges nursing homes are upset but says it's more about supply and demand.

CHRIS MADDEN: The villain is COVID (laughter). The villain is COVID here. And it's just the silent villain that you can't talk to, you can't reason with. And we are just all - nobody knows what to do.

HICKS: Madden says staffing agencies have to compete against each other for fewer nurses demanding bigger paychecks.

MADDEN: Can you blame them? I mean, can you blame them? They're just saying, if this is what the market's paying, then I want to get paid that, too. They're not holding their care. They're just saying, I want to be compensated for it.

HICKS: John Bowblis researches economics and geriatric care at Miami University in Ohio. He says federal CARES Act money going to nursing homes has helped some weather recent spikes in labor costs. But that's not sustainable.

JOHN BOWBLIS: If this continues on this way, you will see a large number of nursing homes that may have to declare bankruptcy. Or the other option is politically that you have to increase reimbursement. And a lot of states don't want to do that.

HICKS: Instead, what some states are doing is considering putting wage caps on how much staffing agencies can pay workers. So far, Minnesota and Massachusetts are doing exactly that. And economists worry that capping salaries could backfire and drive away even more nurses. For NPR News, I'm Justin Hicks.

(SOUNDBITE OF KASPER LINDMARK'S "GRACE") Transcript provided by NPR, Copyright NPR.

Justin Hicks