Waves of American doctors and nurses leave their practices and head to Canada to avoid U.S. political climate

Often born and trained in the U.S., many nurses and doctors are leaving the U.S. for Canada.
(Graphic by Oona Zenda, KFF Health News)

At a time when Americans can least afford to lose medical professionals, many are leaving the U.S., citing the country's current political climate as their reason for leaving. In rural parts of the U.S., already facing a chronic shortage of medical care providers, the loss of any medical professionals makes accessing care more difficult.

"American nurses, doctors, and other health care workers moving to Canada, and specifically British Columbia, where more than 1,000 U.S.-trained nurses have been approved to work since April 2025," Brett Kelman of KFF Health News reports. 

Justin and Amy Miller from Wisconsin serve as one example. They are both nurses who were born in the U.S. and trained at American schools, but didn't want to stay in the U.S. because of policies and cuts by the Trump administration, Kelman explains. They moved their family of five to Canada, where they found new nursing jobs.

As the Trump administration systematically slashed "funding for public health, insurance, and medical research, many nurses have felt the draw of Canada’s progressive politics, friendly reputation, and universal health care system," Kelman reports.

For U.S.-trained nurses, Canada is rolling out the welcome wagon. "Ontario and British Columbia have streamlined the licensing process for American nurses since Trump returned to the White House," Kelman writes. British Columbia also launched a $5 million advertising campaign last year to recruit nurses from California, Oregon, and Washington state."

Doctors are leaving as well. "Michael, an emergency room doctor who was born, raised, and trained in the United States, packed up his family and got out," Kelman reports. KFF did not use his last name because he expressed concerns about reprisals if he returned to the U.S. 

Rural Canadians, who also struggle with accessing medical care, are also hoping to attract some American medical professionals. Doctors Manitoba, which "represents physicians in the rural province that struggles with one of Canada’s worst doctor shortages, launched a recruiting campaign after the election to capitalize on Trump and the rise of far-right politics in the U.S," Kelman writes. 

Rural hospitals tap into high schools to meet ongoing staffing challenges

Ballad Health is one of several rural-serving 
hospitals training high school students.

Ballad Health is a rural hospital system in Tennessee that, like many rural hospitals, spends millions of dollars a year paying traveling nurses to cover staffing shortages. To address its recruitment woes, Ballad is working with area high schools to train its next generation of medical care workers, reports Te-Ping Chen of The Wall Street Journal. 

Ballad's high school training academy includes students from "five northeast Tennessee school districts," Chen writes, "The first batch of 200 students will graduate in 2029, with their licensed practical nurse credentials and be eligible to work right away at Ballad, earning $23 an hour." 

Building and implementing a medical training academy for high school students is time-intensive and expensive, so Ballad Health partnered with Bloomberg Philanthropies, which "last year announced it was pumping $250 million into 10 programs in states including Tennessee, Texas and North Carolina to create a high school-to-healthcare pipeline," Chen explains. 

Ballad isn't alone in its staffing struggles, and as the baby boomer generation ages, demand for medical care staffing is expected to grow. Chen reports, "Human resources advisory firm Mercer projects a deficit of 100,000 healthcare workers by 2028."

Since 2006, Baystate Health system, which serves rural populations in western Massachusetts, has invested in a "high-school career program for jobs such as respiratory therapist and sterile processing technician," Chen adds. "Many participants have gone on to pursue additional training, and more than 900 have ended up working for Baystate in the past decade."

Oregon is using visiting nurses to help curb infant and new mother mortality rates; visits may have other benefits

Why babies do what they do is often a mystery.
(Photo by Chris Anderson, Unsplash)

Some of the most complicated human beings to deal with are the tiniest: babies. Often referred to as "bundles of joy" or "little miracles," babies can be cranky, impossible to calm and impervious to sleep.

With that backdrop, it's fair to say new parents have it tough, and many lack the resources they need to confidently care for a newborn, which can lead to stress, emergency department visits, and even neglect or abuse. To address these needs and provide a response to high infant and mother fatality rates, the state of Oregon implemented an evidence-based program called "Family Connects" that makes life with a newborn better for everyone, reports Cory Turner of NPR. "The program offers any family with a new baby up to three no-cost visits at home with a trained nurse."

After the birth of their first child, Matt and Amber Luman from rural Jefferson County, Oregon, chose to participate in Family Connects. Turner writes, "Matt and Amber seem genuinely relieved when [Nurse] Ibrahim arrives for her second home visit with them." After baby Esserley gets a thorough medical check, "comes the beating heart of any Family Connects visit: the chance for new parents to ask a registered nurse whatever they want. . . . Some share their confusion or frustration. Others are eager for advice or comfort in those early weeks of a baby’s life when new parents are most likely to feel exhausted and adrift."

Most new parents need all the help they
can get. (Photo by T. Heftiba, Unsplash)

The Oregon Health Authority based the state's program on a small, successful Family Connects model developed in Durham, N.C. "Research from its smaller rollout there found it was associated with a handful of significant benefits, including a big drop in the number of trips new parents were making to the emergency room," Turner reports. "A study of Family Connects in Durham found mothers in the program were 30% less likely to experience possible postpartum depression or anxiety."

Oregon policymakers used the Durham program model and expanded it to a statewide outreach. "Every nurse acts as a kind of human clearinghouse of local and regional support for caregivers," Turner explains. "If a family is struggling with housing or food insecurity or addiction, the nurse will connect them with local groups and agencies that can help. Mental health counseling, marriage counseling, child care while mom or dad finishes their degree online."

In Durham's smaller rollout, the program "suggested a real return on investment," Turner reports. "Rolling out Family Connects in Oregon has been a costly struggle." From the pandemic to the nursing shortage to trying to cover a state that can be widely rural, Oregon's program has been expensive. It remains to be seen if the "benefits of Family Connects will outweigh the costs."

Today is Rural Health Day -- a focus on the many people and organizations addressing unique healthcare needs

Today is the 13th annual National Rural Health Day, an opportunity to bring an increased awareness of rural health-related issues and to recognize "the incredible efforts of rural healthcare providers, communities, organizations, State Offices of Rural Health, and other stakeholders dedicated to addressing the unique healthcare needs of rural America," according to the Power of Rural website. 

Since 2011, Rural Health Day has been set aside as a special focus for the country to observe. In his Presidential Proclamation, President Joe Biden said, "America’s rural communities are indispensable to who we are as a nation, where over 60 million people who live in rural America fuel our economy and help forge our future.  On National Rural Health Day, we recommit to investing in rural communities and delivering affordable, quality health care so that generations of rural Americans can thrive."

The day's celebration includes the unveiling of the "2023 Community of Stars," a recognition program designed to honor extraordinary efforts by individuals and organizations who exemplify the "Power of Rural." A navigational map includes 39 stars chosen by their respective State Office of Rural Health that all have an inspirational story and ideas to share. 

The Power of Rural website is chockablock full of free resources and ideas to support rural health communities including promotional kits and ways to celebrate. 

Wednesday quick hits: Oreo scandal; dead solar panels; photos of the year; the nurse shortage; food inflation dips

Is there less creme filling?
(Wall Street Journal photo)

Sometimes less is more, but sometimes less is just less, especially if you're talking about less filling in your delightfully creamed Oreo. "Oreo fans think there's less filing, but the Snack maker says it hasn't tinkered with creme ratio," reports Jesse Newman of The Wall Street Journal. "But suspicious consumers are on high alert."

Inquiring minds want to know: Where do dead solar panels end up? "The majority end up in landfills," reports Izzy Ross of Grist. "But there are no federal requirements for recycling solar panels, and states have different regulations for what to do with them. Panels can also contain small amounts of heavy metals like lead, which makes getting rid of them more complicated. The vast majority of panels are thrown away in landfills — only about 10 percent are recycled."

Photo by Louie Palu, National Geographic

It's finally time for the National Geographic photos of the year. A diverse and beautiful world awaits. In the photo, left, Finnish and U.S. soldiers train for winter warfare by navigating an obstacle course while on skis. The exercise took place two months before Finland — which shares an 800-mile border with Russia — joined NATO. The training was arranged in response to the war in Ukraine.

Is there a nursing shortage? That depends. "In 2022, the American Hospital Association quoted an estimate that half a million nurses would leave the field by the end of that year, bringing the total shortage to 1.1 million," reports Brittany Trang of STAT. "At the same time, National Nurses United insists there isn't a nurse shortage at all. There are plenty enough nurses for the country, they say — merely a shortage of nurses who want to work under current conditions."

Bill Watterson comic via
Mental Floss

When life gets too heavy, lift yourself up with some comics like Calvin and Hobbes. The wacky duo gets up to all kinds of shenanigans. The cartoon strip's artist was also a bit of a card himself.

After two years of stubborn food inflation, Americans can expect a slow drop in at-home food costs. "According to economists with the Department of Agriculture, while food prices are expected to remain higher in 2024, the rampant inflation rates experienced in 2022 and 2023 are anticipated to return to more 'normal' levels in the upcoming fiscal year, reports Charlsie McKay, RFD-TV News, which covers rural America.

Photo by M. Zilses, Unsplash

As the the holiday season approaches, it's time to consider how to eat all the treats you love without looking like you ate all the things you love. "What if the best way to curb sugar cravings is just to eat as much as you want? That is the core of an idea gaining traction among dietitians," reports Alina Dizik of The Wall Street Journal. "Who say that letting ourselves graze unfettered on a cache of Halloween fun-size Snickers can reduce our sugar lust in the long run."

Nursing schools are turning away thousands of qualified applicants despite nursing shortage

Photo via OSF HealthCare

Amid a national nursing shortage, schools are rejecting tens of thousands of qualified applicants each year because they don't have the capacity to train them. The lack of nurses nationwide can disproportionately hurt rural areas as fewer nurses may choose to work in rural medical facilities when they have so many other options available.

"At a time when registered nurses are going on strike to protest staffing shortages, applicants who want to enter or advance in the profession are being turned away from nursing schools," reports Tami Luhby of CNN. "Nearly 78,200 qualified applications were not offered spots at nursing schools last year, according to the American Association of Colleges of Nursing, which represents schools with baccalaureate and advanced degree programs." 

Nursing shortages aren't limited to hospitals and clinics; they are also a problem for nursing schools. "The programs are contending with a lack of faculty, clinical placements for students and preceptors who supervise the students during their rotations at health care providers," Luhby explains. "Preceptors also have strict limits on how many students they can oversee, with the ratios often set by state nursing boards." Community colleges that offer associate nursing degrees are bumping up against the same limitations.

As baby boomers age, the need for more nurses will only grow. "There were nearly 3.2 million registered nurses on the job in 2022, according to the Bureau of Labor Statistics. Employment is projected to grow by a faster-than-average 6% between 2022 and 2032, translating into about 193,100 openings annually, on average, over that period, according to the bureau," Luhby reports. "Nursing schools have nearly 2,000 full-time faculty positions to fill, according to the nursing college association." 

Salaries for nurses with advanced degrees are a major obstacle to nursing school recruitment and retention. Luhby notes, "The national median salary for nursing school professors with master's degrees is just under $89,000, according to the Nursing College Association. However, the median salary for advanced practice registered nurses with graduate degrees is $120,000, according to the 2022 Nurse Salary Research Report issued by Nurse.com."

In response to the national problem, the Department of Health and Human Services announced that "it will pump an additional $26.5 million into the Nurse Faculty Loan Program, which provides low-interest loans to those studying to be nursing school faculty and the cancellation of up to 85% of loans for those who work as full-time faculty after graduation," Luhby reports. Some nursing schools have forged relationships with nearby health systems to pull their current nurses into advanced degree programs. At the same time, the hospital allows shift flexibility, so an employed nurse continues to work while training to become a teaching faculty member for the nursing college.

Proposal for more nursing-home staff seen as unattainable by many owners; resident advocates say it's not enough

Nursing homes may not be ready for 'tsunami' of baby boomers.
(Photo by G.A. Pflueger, Unsplash)

Nursing homes have struggled for decades to find a sustainable business model that provides optimal staffing numbers for resident care. Now federal officials have released "a proposed rule requiring the nation’s nursing homes to hire minimum numbers of front-line caregivers, a long-anticipated response to decades of complaints about neglect and abuse in an industry that critics say is unprepared for the tsunami of seniors heading its way from the baby boom," reports Christopher Rowland of The Washinton Post.

The Centers for Medicare and Medicaid Services proposed "minimum nurse staffing standards . . . per resident for registered nurses and . . . nurse aides," as well as a requirement to have a registered nurse at the nursing home around the clock. Many industry stakeholders consider the proposal futile. Rowland explains, "Without a supply of prospective workers, it will be impossible to meet the requirements of minimum staffing, the industry has argued. They also contend that Medicaid reimbursement rates need to be significantly increased if more workers are required in facilities." Nathan Schema, president and chief executive officer of the Evangelical Lutheran Good Samaritan Society, which operates a large chain of nonprofit nursing homes, told Rowland: "I just can’t understand how CMS is effectively trying to fix the roof while the house is on fire. It’s the beginning of the end for small-town nursing homes."

Rowland adds, "A fifth of nursing homes would have to hire registered nurses to meet the requirement, the government estimates." LeadingAge, the largest association for nonprofit nursing homes, told USA Today that the proposed regulation would be impossible for many nursing homes to meet. “There are simply no people to hire—especially nurses,” said Katie Smith Sloan, the group's president and CEO. “America’s under-funded, long-ignored long-term care sector is in a workforce crisis.” Sloan said nursing homes would have to “reduce admissions or even close” if the rule takes effect.

"While the industry reacted negatively to the proposed rule’s release, the guidelines also disappointed advocates for better treatment of residents in chronically short-staffed nursing homes, who contend the rule does not go far enough and enshrines substandard levels of care," Rowland reports. "Advocates for better quality care in nursing homes say the industry’s high staff turnover rates point to the true problem: insufficient pay and poor working conditions."

Rural areas are finding new ways to overcome shortages of doctors and nurses; stories from Maine and Montana

Dr. Kaycee Gardner in Miles City, Mont. (Photo by Amy Lynn Nelson)

Rural America is set to have one of the largest physician shortages by 2030, and nurses are likewise in short supply in rural areas.

Montana is already feeling the pinch and has been looking for ways to recruit and retain young physicians. "The greatest predictors for who will become a rural physician boils down to specialty and background," reports Emily Schabacker of the Billings Gazette. "Family medicine physicians are better positioned to serve rural populations than those who opt for more specialized training. And physicians raised in rural places are more likely to return to rural places to practice, making rural recruitment more important than ever."

One challenge facing Montana has been the lack of student interaction with medical professionals and very limited opportunities for high-school students to shadow doctors. Dr. KayCee Gardner, who practices in Miles City, Mont., "grew up 35 miles south of Broadus, where only a physician’s assistant and a nurse cared for the community," Shacbacker writes. "Not knowing any doctors growing up, Gardner never thought she’d end up in the medical field. No recruitment programs or career summer camps came to her corner of Montana."

To encourage their rural physician development, RiverStone Health created the RiverStone Health MedStart camp, which "aims to expose high schoolers from rural communities to careers in medicine," Schabacker reports. Camp organizer Nikole Bakko told her, "Every county in the state has been represented at one of the five participating health centers since the camp began in 2010. . . . Rural students aren’t being exposed to (careers in medicine). With MedStart we’re able to show them opportunities they don’t typically see."

The medical-provider shortage is not limited to physicians. "Rural hospitals have endured physician shortages for decades, but the staffing dearth that followed the pandemic has made staffing challenges even worse. As a result, critical access hospitals are relying more on traveling nurses," reports Schabaker. Rich Rasmussen, CEO of Montana Hospital Association, said the high cost of traveling nurses are and expense that has threatened to sink the state’s larger hospital systems.

In Maine, the most rural state in the country, is addressing its nursing shortage and the additional costs with a "Grow Your Own" model. Eastern Maine Community College in Bangor "partners with rural hospitals to provide nursing education close to home for students who would rather not come into the city," reports Nichole Dobo of The Hechinger Report, which covers education. "Now in its sixth year, the program is helping the community college increase enrollment in a job that’s in great demand. And it is reaching students who might otherwise struggle with transportation costs (especially during a period of epically high gas prices), family responsibilities or just a preference for staying close to home."

Maine is also reaching out to more non-traditional students. Emily Thompson, "then 47, had recently re-entered the workforce as a cashier after raising her child. A woman came into the store, worried about getting gas into her car because she had forgotten her wallet. As she helped the woman with the electronic payment app on her smartphone, she noticed her name tag: Pilar Burmeister, director of the nursing program" at the college, Dobo writes. "Now, she’s looking forward to May when she plans to graduate as an R.N. and leave her cashier days behind."

The program "partners with rural hospitals to provide nursing education close to home for students who would rather not come into the city," Dobo reports. "Now in its sixth year, the program is helping the community college increase enrollment in a job that’s in great demand. And it is reaching students who might otherwise struggle with transportation costs (especially during a period of epically high gas prices), family responsibilities or just a preference for staying close to home."

Pilar Burmeister, director of the program, told Dobo, “It’s a win-win for everybody. We get to increase our rolls. Hospitals win because they get nurses. Students win on saving time and money.”

Also, "This rural focus helps community colleges train more people who are likely to stick around in the rural hospital after they graduate," Dobo notes. Thompson told her, “It is going to be a bit of a new lease on life for me. I wasn’t making a bunch of money at the store. I liked working there. But this is a real career for me.”

Stories from three states show higher risk of pregnancy and childbirth in rural areas, as abortion laws pose complications

Pregnancy-related mortality per 100,000 live births
(Daily Yonder graph, adapted by The Rural Blog)

"Rural women are twice as likely to die from pregnancy complications than women in large metropolitan areas, federal data shows," Sarah Melotte reports for The Daily Yonder. The lack of pregnancy and childbirth care in rural hospitals, especially for high-risk cases, contributes to the problem. And rural women of color and their babies face even worse odds. Stories out of Montana, Nebraska and Texas illustrate the overall trend, made more worrisome fears that that eroding abortion rights will increase the number of high-risk pregnancies. Montana State University sociologist Maggie Thorsen told Melotte that the U.S. is already "the only industrialized country in the world that has a growing maternal mortality rate."

Fewer than half of the nation's rural counties had obstetric services in 2019, a Commonwealth Fund study found. Many hospitals have shuttered them (a trend the pandemic has accelerated), citing expense, lack of personnel, and declining rural birthrates. "Women unable to reach obstetrics units in time to give birth can end up delivering in an emergency room en route to the desired hospital. This can have deadly consequences for individuals with high-risk pregnancies," Melotte reports. "Common complications associated with these births include hemorrhaging, preterm birth, and preeclampsia."

A recent study of Montana maternity deserts illustrates the trend. Thorsen and others found that pregnant Montanans drove an average of 42 minutes from home to give birth, but that trips of several hours were not unusual. About 44% of the state's population lives in rural areas, more than twice the national average, Melotte reports. About half of its counties are maternity-care deserts, and 10% of the state's population—some 93,000 people—live in those deserts.

Native American women in Montana have even higher rates of complications or death in childbirth. Indigenous women (who tend to live in rural areas) are less likely to live within an hour's drive of high-level obstetric services than white women; not many Indian Health Services hospitals in the state provide such services, Thorsen told Melotte.

A story from Nebraska highlights other facets of the issue. Emergency help can be hard to access in rural areas. One rural woman who had preeclampsia called an ambulance, but it took so long to get there that she ended up giving birth in the ambulance, assisted by an EMT who had never delivered a baby, Addie Costello reports for the Flatwater Free Press. Local primary-care physicians can provide some obstetric services, but many are retiring and not enough doctors are replacing them.

Many rural hospitals can't afford to maintain obstetric units since rural births are more likely to be covered by Medicaid than by private insurance. Nebraska Medicaid reimburses at half the private rate, Costello reports. The story also emphasizes health disparities for women of color and their babies.

In Texas, which leads the nation in maternity-ward closures, a recent story presents one of the more extreme examples of a maternity desert: Big Bend Regional Medical Center is the only hospital in 12,000 square miles. It has an obstetric unit, but for more than a year that unit "has closed routinely, sometimes with little notice. Some months it’s been open only three days a week," Claire Suddath reports for Bloomberg. "Big Bend doesn’t really have a choice. In the past two years, almost all its labor and delivery nurses quit. The hospital has tried to replace them, but the national nursing shortage caused by the pandemic has made that impossible. When Big Bend is too short-staffed to deliver a baby safely, its labor and delivery unit has to close."

The staffing shortages also extend to Big Bend's ambulances; the county has two, but only enough EMTs to run one. And when the hospital can't deliver babies, the ambulance must drive a patient to the nearest hospital that can. That means the area's only ambulance is out of pocket for at least five hours.

Rural hospitals face danger as pandemic funding runs out; 1 in 5 are at significant risk of closure or service reduction

Federal pandemic aid drastically slowed the pace of rural hospital closures. (Bipartisan Policy Center graph)

Federal pandemic aid helped slow the pace of rural hospital closures, but that aid is drying up, and the hospitals are still dealing with pandemic-driven financial problems and staffing shortages, and one-fifth are at significant risk of closure or service reduction, the Bipartisan Policy Center reports.

A new BPC report offers insights on the state of rural health care through interviews with providers, national organizations, federal and state policy experts, and rural hospital leaders in Iowa, Minnesota, Montana, Nebraska, Nevada, North Dakota, South Dakota and Wyoming.

The report focuses mostly on strengthening health-care delivery through Medicare and Medicaid, since those programs play an outsized role in rural America. Here are some highlights from the report:

• About one-third of Americans are enrolled in Medicare.
• Nearly one-quarter of Americans under age 65 rely on Medicaid as their primary health insurer.
• Many rural stakeholders said that, once federal pandemic aid dries up, many rural hospitals will once again be at risk of closure unless additional action is taken to protect them.
• Hospitals experiencing persistent financial losses (negative total operating margins over three consecutive years) ranged from 6% in Nevada to a high of 38% in Wyoming.
• Out of 2,176 rural hospitals, 441 (one-fifth) face three or more concurrent signs of financial risk that put them in danger of service reduction or closure, and 909 (42%) face two or more signs of risk. The risk signs include negative total operating margin, negative operating margin on patient services alone, negative current net assets, and negative total net assets.

Based on its interviews, the Bipartisan Policy Center recommends several short-term policies to stabilize and strengthen access to rural hospitals and health clinics:

• Provide rural hospitals full relief from across-the-board Medicare spending reductions, known as sequestration, until two years after the federal public health emergency ends.
• Take rural facilities out of the ongoing 'extender' and 'needing to be renewed' budget cycle, including by permanently authorizing the Medicare Dependent Hospital program and making rural low-volume payment adjustments permanent.
• Update or rebase Sole Community Hospital and Medicare Dependent Hospital payment structures to ensure reimbursement is in line with current costs.

The report also has a raft of recommendations to improve workforce recruitment and retention, and improve access to specific services such as ambulance care, telehealth, behavioral health, and maternal care services. Read the report here.

Rural hospitals are still short of revenue to hire nurses as pandemic relief aid begins to run out

"Rural hospitals, already struggling with financial strains due to Covid-19, face an even more significant threat, experts said – the workforce shortage," Liz Carey reports for The Daily Yonder. "Hospitals say they are short on workers in all areas of the healthcare system, not just the clinical ones. According to the American Hospital Association, about 20 percent of all hospitals across the country expect worker shortages to reach dire levels."

In 2021, nearly 105,000 nurses in the U.S. left hospitals for one reason or another, including death and retirement; that was the largest drop in the nation's nursing workforce in history, according to Julia Harris, a senior policy analyst with the Bipartisan Policy Center. The pandemic "has really stressed the workforce in ways that we’re not going to recover from for decades," she told Carey.

"According to the U.S. Bureau of Labor Statistics, U.S. health-care organizations will need to fill nearly 200,000 nursing positions every year from now until 2030," Carey reports. "Some studies even project that the country will face a shortage of more than 29,000 nurse practitioners by 2025."

Harris noted that workforce is the number one expense for most cash-strapped rural hospitals, and that those expenses have been even higher during the pandemic because rural hospitals are obliged to use travel nurses, who are typically paid at least twice as much as staff nurses, Carey reports.

Federal pandemic aid has helped rural hospitals afford travel nurses, but with that money drying up, hospitals are increasingly on the hook for those expenses, Carey reports. And hospitals need the help, because they're still getting plenty of Covid-19 patients. Hospitals saw an average of 3,628 Covid-related hospitalizations as of May 28, 2022. On the same date in 2021, it was 3,060, according to the Centers for Disease Control and Prevention.

"The AHA is asking Congress for $1.51 billion to fund healthcare workforce development programs for the 2023 fiscal year’s budget, including $374 million for rural health programs," Carey reports. "The request represents an increase of $43 million over levels approved in 2022."

Health-care workforce shortages starting to affect patient safety

"Years of progress reducing medical errors and preventable hospital-acquired infections were reversed in medical centers and skilled nursing facilities during the pandemic," Tina Reed reports for Axios. "But ongoing health care workforce disruptions — including early retirements, nurses shifting to travel positions and increased workloads for those who remain — threaten hospitals' ability to get back on track."

Several recent studies have outlined the trend. A recent study of two hospitals (one urban, one suburban) found a link between increased reliance on traveling nurses and increased infection rates. Rural hospitals often use travel nurses too. Another recent study, this one from the New England Journal of Medicine, found that the pandemic erased years of improvements in patient safety at hospitals and skilled nursing facilities, Reed reports. Staffing shortages and workers' mental health were the two biggest concerns for patient safety in 2022, according to a recent report by healthcare safety organization Emergency Care Research Institute.

A big part of the problem is that many older nurses retired earlier in the pandemic, taking with them important institutional knowledge and experience. Though travel nurses can fill critical staffing gaps, the constant moves disrupt employee dynamics. "You trust each other. You know each other. You're able to call each other out. You have the confidence to say when you think something is wrong, which is critical to safety in medical care," Michael Ramsey, CEO of the Patient Safety Movement Foundation, told Reed.

More than half of Americans in a recent poll said they've directly felt the effects of health-care worker shortages. Some hospitals are trying to retain staff by increasing pay and benefits, as well as addressing workforce concerns like a lack of personal protective equipment, Reed reports.

Rural hospitals have accelerated maternity ward closures during pandemic, citing lack of personnel and money

Hospitals have been shuttering maternity wards for years, but the trend seems to have accelerated during the pandemic, especially in rural and Black or Hispanic communities. That will likely hurt health outcomes for rural pregnant women and their babies.

The U.S. "already sees far more deaths per capita among infants and pregnant women than comparably wealthy countries. And during the first year of the pandemic, the number of maternal deaths in the United States rose sharply," Dylan Scott reports for Vox. "Researchers from the University of Minnesota have found when a labor and delivery department closes, there tend to be more emergency deliveries and more preterm births, which are the leading cause of infant mortality."

Rural and minority communities are less likely to have access to all types of health care as it is, including obstetrics. "Before the recent closures, more than half of the rural counties in the United States already didn’t have a nearby hospital where babies could be delivered," Scott reports.

Hospitals cite various factors for closing maternity wards, including declining birthrates and staff shortages. And with fewer births, hospitals worry that staffers' obstetrics skills might get rusty, leading to worse health outcomes for patients, Scott reports.

Finances are also an issue. "Pandemic relief funding that has helped stabilize hospitals’ finances is also starting to run out," Scott reports. "Some hospitals argue that these closures are not financially motivated, but labor and delivery services are not a moneymaker for them. More than 40 percent of births in the United States are covered by Medicaid, and the program’s low reimbursement rates have been cited in the past to explain a hospital’s decision to close its OB department."

Closing a maternity ward can also hurt a community's relationship with the hospital. "There is a fundamental shift in a rural community when a hospital closes its OB unit," University of Minnesota professor and maternal mortality expert Katy Backes Kozhimannil told Scott. "It’s like a place where you can’t even be born. You can only die. The sense of that is really palpable."

Clamor to cap travel-nurse pay could keep rural nurses at local hospitals

Many registered nurses, feeling overwhelmed and underpaid during the pandemic, have jumped at the chance to double or triple their salaries as travel nurses. Cash-strapped rural hospitals are having a hard time retaining them. "In a nationwide survey late last year, 99% said they were experiencing staffing shortages," Melissa Phillip reports for the Houston Chronicle.

But some lobbyists and legislators are calling for an investigation in hopes of capping travel nurses' compensation; if successful, that could help stanch the flow of rural nurses to wealthier urban hospitals that can better afford to pay travel nurses' higher salaries.

"In the last few months, several groups, including the American Hospital Association, the American Health Care Association/National Center for Assisted Living and 200 members of Congress, have called for an investigation into claims that agencies that place travel nurses around the country have been 'price gouging' hospitals in need of staff," Chabeli Carrazana reports for The 19th. "The AHA has requested the Federal Trade Commission investigate the agencies, and late last month, a letter signed by a bipartisan group of legislators also asked the White House to investigate the claims."

Two representatives from largely rural districts—Democrat Peter Welch of Vermont and Republican Morgan Griffith of Virginia—"wrote that they have received reports saying staffing agencies have inflated prices by 'two, three or more times pre-pandemic rates' while taking 40 percent or more being charged to hospitals in profit," Carrazana reports. "At least eight private-equity firms have bought at least seven staffing agencies since early 2021, according to a report in STAT News."

"The White House did not comment on whether it was responding to the contents of the letter, and the Federal Trade Commission also declined to comment on whether an investigation was underway," Carrazana reports.

Pandemic roundup: why Covid can cause stillbirths; peer-to-peer mental health services for farmers; nearly 1 in 5 health-care workers have quit since the beginning of the pandemic

Here's a roundup of recent news stories about the pandemic and vaccination efforts:

It's already well established that stillbirths have increased in many areas with high Covid-19 rates. Now a new study suggests why: A coronavirus infection can invade and destroy the placenta, likely leading to stillbirths, the study says. Read more here.

Nearly a fifth of American health-care workers have quit since the beginning of the pandemic as they get increasingly burned out by the demands of overcrowded hospitals. A portrait of a Minnesota hospital shows what that stress looks like. Read more here.

Worker burnout is only one reason hospitals can't handle the new normal, says one analysis. Rural hospitals especially will continue to lose out: Urban hospitals with deeper pockets will keep poaching rural staff (example: traveling nurses), enabling lucrative elective surgeries. Smaller hospitals will continue to shoulder a disproportionate share of mild-to-moderate Covid-19 patients and will be more likely to have to pause elective surgeries and other non-Covid care. Read more here.

During the Delta variant surge last summer, rural counties with low vaccinations rates were hit the hardest, researchers found. Counties where the coronavirus vaccination rate was below 30% saw nearly double the case rate of counties where vaccination rates were over 50%. Read more here.

The pandemic has increased farmers' need for mental-health services, but many are reluctant to admit they need help. Programs that teach peer-to-peer counseling can be especially effective, but those and other programs may need more funding to remain sustainable. Read more here.

In January, more than 3,000 hospitalized patients became infected with the coronavirus during their stay, more than in any other month of the pandemic, new data show. Read more here.

The Food and Drug Administration delayed its review of Pfizer's coronavirus vaccine for children under 5 years old earlier this month. Sources familiar with the decision now say it's because a few children in the study got breakthrough infections of the Omicron variant after two doses of the vaccine. Since so few people get breakthrough infections, even a handful could be statistically significant. FDA officials and Pfizer agreed it would be better to wait for a larger sample size to assess the vaccine's effectiveness for that age group with both two doses and three doses. Results are expected in early April. Read more here.

Pandemic roundup: Interactive database lets you track local cases; dark days ahead for nurses and hospitals

Here's a roundup of recent news stories about the pandemic and vaccination efforts:

The pandemic highlights rural health-care disparities, writes the editorial board of The Daily Tar Heel, the student newspaper for the University of North Carolina at Chapel Hill. Read more here.

The New York Times has a new interactive database that allows you to track coronavirus cases in any state, county or metro area. Check it out here.

A recent Centers for Disease Control and Prevention study found that all vaccinated participants with severe Covid-19 had at least one other risk factor, including age, poor immune system, heart disease, and more. Read more here.

Hospitals and nursing homes are so short-staffed that some are asking infected nurses to come in to work. Some facilities are also asking nurses to use vacation and sick days to stay home if they test positive for coronavirus. That could put some infected nurses in an impossible position: risk financial ruin if they don't have enough paid time off, or go to work sick and endanger patients and coworkers. Experts warn that darker days are ahead for hospitals.

NBC News has a new interactive map tracking hospital stress. Check it out here.

Pandemic roundup: Nursing shortage means hospitals could be easily overwhelmed; vaccine mandate penalties delayed

Here's a roundup of recent news stories about the pandemic and vaccination efforts:

The Biden administration is delaying vaccine mandate penalties until 2022. Read more here.

The current nursing shortage means it won't take much to overwhelm hospitals this winter. Read more here.

Many nurses are leaving their jobs and tripling their salaries as travel nurses. Read more here.

The Trump administration gave a new agency $100 million to alleviate pandemic supply-chain problems in the health-care sector, but a government watchdog has found that the agency did not distribute any of the money. Read more here.

Medical professionals are often dismissive of patients with "long Covid," or symptoms that linger for months after the infection subsides. But even medical professionals themselves, who are used to being taken seriously, are having a hard time getting providers to believe they have long Covid. Read more here.

Pediatricians warn parents to watch out for long Covid symptoms in children. Read more here.

The American Psychiatric Association has added "prolonged grief disorder" to its diagnostic manual of mental disorders—an increasingly common ailment during the pandemic as many struggle with multiple losses. Read more here.

The Marine Corps is on track to have the lowest compliance rates with the coronavirus vaccine mandate. Read more here.

State lawmakers' anti-vaccine efforts may prove to be mostly symbolic, but could serve to rally Republican voters ahead of the midterm elections. Read more here.

In a New York Times op-ed, a rural Michigan doctor writes about how unvaccinated Covid-19 patients are filling the beds in the hospital where he works. Read more here.

Rural hospitals face widespread nursing shortages and lagging employee coronavirus-vaccination rates

"Vaccine hesitancy among rural health facilities remains rampant even as providers faced a major surge of Covid-19 due to the more transmissible Delta variant, a new study finds," Robert King reports for Fierce Healthcare. The study, released last week by the Chartis Group, "also found that nurse staffing shortages are contributing to suspensions in care in vulnerable communities." About 30 percent of respondents said the nursing shortage had caused their facility to suspend medical services, mainly surgeries, and another 22% said they were considering that.

Over 98% of the facilities surveyed reported staff shortages, mostly nurses. Burnout, retirement, and going for a better-paying job at another hospital are the main causes of the shortages, not mandates; in fact, about 75% of respondents said their facility doesn't have a mandate, King reports. The lack of mandates may have contributed to lower vaccination rates, the study noted.

However, vaccination rates are rising: "Chartis spoke with rural hospitals across the country from Sept. 21 to Oct. 15 and found that 44% of respondents said 50% to 69% of professionals in their facility were fully vaccinated," King reports. "That is an improvement on an earlier survey conducted in March and April of this year, where 37% of respondents said 50% to 69% of professionals were vaccinated."

The vaccination numbers will have to ramp up if the federal government's mandate takes effect. The rule would require all staffers to be vaccinated by Jan. 4 or risk losing federal reimbursement for Medicare and Medicaid patients. But 10 states have challenged the mandate in court, so its future is uncertain.

Portrait of Washington hospital illustrates rural health-care workers' deeply held resistance to coronavirus vaccination

Dayton, in Columbia County,
Washington (Wikipedia map)

President Biden's coronavirus vaccine mandate for health-care workers has not, by and large, resulted in widespread staff shortages from workers quitting instead of getting vaccinated. But vaccine mandates are far less popular in rural America, as illustrated by an in-depth look at a hospital in rural Washington state, Eli Saslow reports for The Washington Post.

Gov. Jay Inslee, a Democrat, issued one of the nation's first vaccine mandates for health-care workers in August. With days to go before the deadline, the issue was far from settled at Dayton General Hospital, according to CEO Shane McGuire. "Dozens of McGuire’s employees were still marked as unvaccinated. At least 15 were in the process of applying for religious or medical exemptions, a few had already quit in protest, and many more were facing termination unless they decided to vaccinate against the coronavirus in the next five days before the mandate went into effect," Saslow reports. "McGuire liked to refer to his small staff as a family, and many in fact were family, but it had been splitting in two since the beginning of the year, when exactly 50 percent of the hospital’s few hundred employees chose to be vaccinated and 50 percent refused."

The story recounts McGuire's struggle to educate staffers about vaccines and make it more palatable to skeptical staff while making staff feel that their concerns were heard. Saslow also profiles Katie Roughton, the hospital's director of nursing, who quit rather than get vaccinated. "Regardless of scientific facts or the vaccine data, she believed what she was hearing on her TV, her computer, the local grocery store, her own family dinner table: The vaccines were rushed and oversold, and worse yet, the state mandate signaled the government’s latest attempt to seize greater control," Saslow reports. "It was an infringement on individual rights. It was socialism. Her father-in-law had taken an experimental anthrax vaccine before deploying for the Gulf War, and he blamed the side effects for making him permanently disabled. Four of her family members were being forced to quit their jobs over vaccine mandates, and they were encouraging her to do the same."

Roughton snapped when one of the hospital's doctors called her to ask how she believed they could further control the spread of the virus, Saslow reports: "'Do you want my personal or professional opinion?' she asked, and before long she was prodding him about the breakthrough infection and the science of vaccines, and he was calling her 'stupid,' and they were screaming at each other — doctor against nurse, liberal against conservative, no longer partners in patient care but adversaries staking out opposite sides in an ideological battle that Roughton had been fighting since."

Community colleges can boost ranks of rural nurses, but programs are highly competitive; more teachers needed

The pandemic has thrown into sharp relief a long-standing problem: The country doesn't have enough registered nurses, especially in rural areas.

For example, a recent Southern Illinois University Medicine report found that rural Illinois is short as many as 19,100 nurses, Jakob Emerson reports for WICD in Springfield. The reasons cited in the report likely apply in other rural areas: Nurses go for better-paying urban jobs, especially since they likely have large student loans to pay off; medical education is concentrated in urban areas; and rural nurses tend to be older and aren't replaced as quickly as they're retiring. And some rural RNs are being lured away by lucrative traveling nurse jobs.

"Pre-pandemic reports from the Bureau of Labor Statistics show there were more than three million nurses in the nation in 2019, and an estimated 176,000 annual openings for registered nurses across the country," Morgan Matzen reports for the Sioux Falls Argus Leader. A RegisteredNursing.org data analysis found that nursing shortages in many states are expected to get even worse by 2030.

Another reason for the overall shortage: Nursing schools don't have enough instructors to train more, Yuki Noguchi reports for NPR. The pandemic has worsened this shortage, too: Nursing educators need advanced degrees but typically earn half what they would as a nurse working on the floor. The pandemic increased financial strains for many nursing instructors, forcing them to quit and find more lucrative work. In 2019, colleges and universities turned away some 80,000 qualified applicants because they were short of faculty or other resources.

Colleges in South Dakota and other states, are trying to address the problem by offering more classes, Matzen reports. Community colleges, especially in rural areas, can play a vital role in boosting nursing associate's degree programs, but community-college nursing programs are notoriously competitive, Devon Haynie reports for U.S. News & World Report. Look here to see if your local community college offers an associate degree in nursing.