Interview: Nursing Leader on Causes, Effects of Dire Shortage

The Covid-19 pandemic has had a huge impact on the entire world. The pandemic is mainly over (we hope), but during the time of mass quarantines and other upheaval, the medical field was under a lot of scrutiny. The mistrust between medical professionals and the population was a new situation that had not happened for decades, if ever. People were rejecting vaccines even though the world's top doctors were working in unison to prevent more death.

But even before Covid, there was already a nursing shortage in the US. According to Healthline, it started in 2012 and is only supposed to get worse. Healthline and others project that by 2030, more than one million nurses will be needed. 

To get a view from the inside, I talked to Laura Needham, who has been a nurse for 18 years. She first worked as a labor and delivery nurse in Montgomery, then transferred to UAB and eventually its cardiovascular intensive care unit. Then she started working for Children’s of Alabama in 2012. In 2014, she became the director of nursing for cardiovascular services. And in 2021, she was promoted to her current position of Division Director, Inpatient Nursing Services. 

The Acta Diurna:

How has the job of being a nurse changed over the years?

Needham: “Our knowledge of disease processes and treatment options [has] improved. This has allowed our patients to have more treatment plan options ... and there's been improvement in professional relationships between physicians and nurses, [but a] societal shift to being more on edge and litigious as it relates to healthcare workers.”  

How has that mistrust, especially during and since the Covid-19 pandemic, affected you and your colleagues' abilities to do your jobs? 

"We are more worried about how our actions might hurt us ... 99.9% of healthcare workers try their best to help people. [Now, medical staff] worry a mistake will result in a lawsuit, losing our license, or even jail time. [Before Covid] people visited the hospital and were able to watch us work. They saw the connections made with the patients the dedication we had, the long hours worked, the effort we put into saving their loved ones and the tears we shed with them."

But during COVID, visits stopped, and she and her colleagues "lost a lot of trust almost overnight, creating a work environment that is less than ideal.”  

Why was there a nursing shortage prior to COVID?”

"The baby-boomer generation began retiring around 2012. This group made up the largest part of the workforce, so it had a major impact ... people are living longer so they have more congenital conditions. [People] are also living more unhealthy lifestyles."

Would an increase in pay fix the nursing shortage?

"That is a slippery slope. Nurses make up a large portion of the staff at hospitals. That doesn’t prevent hospitals from paying nurses well ... but now you have the responsibility of continuing to pay those higher rates that compound each year with merit raises and/or marker adjustments, not to mention overtime ... Probably a mixture of both work environment and pay would yield the best results."

This directly affects Alabama and even Altamont. For most people in Alabama, if they have a serious illness or injury that requires advanced treatment, they have to go to UAB. If not, they must go out of state. This especially applies to children. There is only one other children’s hospital in Alabama, and it's in Mobile, and it's smaller. If a student at Altamont required life-saving surgery, her or she would go to Children’s of Alabama. But if there are not enough nurses, that patient might end up in Atlanta or Nashville or somewhere else far from home. Transport and time can increase the chances of complications, and distance makes hard situations harder for everyone.