FARGO — As the COVID-19 pandemic drags into the winter months, health care facilities across North Dakota are feeling the effects of staffing constraints and a barren job market for nurses.

Hospital systems statewide including Sanford Health, the Jamestown Regional Medical Center and Minot’s Trinity Health have activated their surge plans, which include measures such as limiting visitations and elective surgeries as well as in some instances sending patients either to local nursing homes or out-of-state locations such as Billings, Mont., and Aberdeen, S.D.

With community spread, close contact and household contact to blame for more than eight of every 10 COVID-19 cases in the state, nurses statewide have either taken ill or needed to be isolated due to a potential virus exposure. The resulting strain on staffing became so dire that North Dakota Gov. Doug Burgum announced Monday, Nov. 9, that asymptomatic COVID-19-positive health care workers could continue working in virus units at hospitals and nursing homes. North Dakota — which has led the nation in new cases per 100,000 residents for much of the last two months — is believed to be the only state to implement such a policy, Forum News Service research found.

Two days later, the North Dakota Nurses’ Association spoke out against Burgum’s announcement, while hospitals including Sanford said they do not plan to allow COVID-19 positive workers into the workplace.

Recruiting void

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Adam Broers is Bethany Retirement Living’s Senior Executive of Human Resources and Safety. He said that filling nursing positions in a rural setting is a difficult enough task without a pandemic.

"Nursing recruitment is a challenge no matter what, but particularly during the pandemic, I would say it has worsened," Broers said. "Where it has probably worsened is that there aren’t a lot of available applicants."

Jack Kennelly, vice president of strategy for Sisters of Mary of the Presentation, shared a similar sentiment. "The pool for health care professionals in the rural context is, by its nature, a small one," Kennelly said in a statement.

The difficulty sourcing applicants has prompted numerous health care providers throughout the state to adopt lofty sign-on bonuses for new nursing hires. SMP’s Ave Maria Village in Jamestown is offering a whopping $20,000 sign-on bonus and a $5,000 finder's fee for anyone who directs a registered nurse or licensed practical nurse to the facility and they are subsequently hired.

Ave Maria Village, located at 501 19th St. NE in Jamestown, N.D., is offering a $20,000 sign-on bonus for new RN or LPN hires as well as a $5,000 finder's fee for the community. John M. Steiner / The Jamestown Sun
Ave Maria Village, located at 501 19th St. NE in Jamestown, N.D., is offering a $20,000 sign-on bonus for new RN or LPN hires as well as a $5,000 finder's fee for the community. John M. Steiner / The Jamestown Sun

While the sign-on bonus predates the pandemic, Kennelly said it is a "response to the marketplace in general."

Broers said that the $5,000 sign-on bonus Bethany is currently offering also predates the virus and that the sign-on bonus is offered periodically to attract applicants. Even in non-pandemic years, Bethany will offer the bonus three or four times, he added.

Also putting a dent in Bethany's hiring has been a lack of applicants from out of the region. "Oftentimes it seems like we may get applicants from outside the area and we just aren’t seeing that," Broers said. The East Coast, particularly the Philadelphia area, has been a common source for nurses, but because many are reluctant to travel or relocate, those hires are down in 2020 as compared to the previous two or three years, he continued.

Kim Kupfer, CNA, Bethany on University
David Samson / The Forum
Kim Kupfer, CNA, Bethany on University David Samson / The Forum

To respond to staffing needs, Bethany has also begun to use med-aides, who Broers said are responsible for distributing medications and have been a "huge assistance" for nurses.

Sign-on bonuses have been found across the state. In Williston, CHI St. Alexius Health offered a $7,500 sign-on bonus for a recent RN navigator opening. The North Dakota State Hospital in Jamestown is also promoting a $5,000 sign-on bonus for an open RN position. The Wellington, an assisted living facility in Minot, is also advertising a sign-on bonus for an RN job, though the amount wasn’t specified.

Staffing strain

As evidenced by Burgum’s move to permit COVID-19-positive health care workers to work while infected, the state is desperately attempting to keep its at-capacity hospitals staffed.

Sanford Vice President and Medical Officer Dr. Doug Griffin explained as much at a recent city of Fargo COVID-19 briefing. Griffin said that Sanford has seen its highest number of patients since the pandemic began, with well over 500 patients in Fargo and more than 100 being treated for the virus.

The surge has prompted Sanford to hire more traveling employees than ever and even ask retired employees to return to work if they’re willing, Griffin said.

Sanford currently employs 120 travel nurses on contract for up to 13 weeks. Forty of those have extended their contracts, while 10 more started Nov. 16. Fifty more will start later in November.

Essentia’s Chief Medical Officer Dr. Rich Vetter said their "critical need" at this stage of the pandemic is staffing. "We have a number of clinical care staff who are out due to high-risk COVID-19 exposures," he said. "The vast majority of those exposures have occurred within our community and outside of activities related to patient care."

Burgum announced Thursday evening, Nov. 19, that roughly 60 Air Force nurses will be deployed across the state to provide relief for the state's more than 20,000 nurses. The Air Force nurses will be deployed Saturday, Nov. 21, and support at least six hospitals in North Dakota four largest cities: Trinity Hospital in Minot, CHI St. Alexius Health and Sanford Medical Center in Bismarck, Essentia and Sanford in Fargo and Grand Forks's Altru Health system.

The deployment is in response to the state's request for assistance from the Federal Emergency Management Agency. "With hospitals projecting a surge in COVID-19 patients in the coming weeks, we're deeply grateful to the Department of Defense and FEMA for granting our request for additional resources to help save lives and alleviate the immense pressure on North Dakota's hospitals and long-term care facilities," Burgum said in a news release announcing the deployment.

In the state's nursing homes, where nurses interact with a higher-risk demographic on a daily basis, staff are spread thin as a result of the state’s rampant community spread.

"With staff who test positive for the virus and the resulting sick time, which is extended beyond the symptomatic stage due to quarantine requirements, there is a type of shrinkage of the pool that makes for an even more challenging environment for the employment of nurses across the entire health care industry during this pandemic," Kennelly said.

Bethany Retirement Living and many other nursing homes are offering hefty sign-on bonuses to registered nurses and licensed practical nurses. Forum file photo
Bethany Retirement Living and many other nursing homes are offering hefty sign-on bonuses to registered nurses and licensed practical nurses. Forum file photo

Broers, who described Bethany’s nursing openings as "pretty constant," explained that the number of unfilled open positions hasn’t been Bethany’s biggest problem this year. "The biggest thing for us hasn't been the number of openings," he said. "It's that we of course always try to do the right thing and then you have people out for close contacts on positives."

Bethany employees who test positive are required to leave work for 10 days from symptom onset, per the North Dakota Department of Health’s recommendation. Broers reported that health care personnel, who receive weekly tests and are outfitted with full personal protective equipment, feel "pretty safe." Still, the resulting COVID-19-related absences have made day-to-day scheduling a daunting task, he remarked.

Fortunately, Broers said, Bethany has received little pushback from staff on its COVID-19 mitigation strategies.

"It's part of their role," he said. "It's part of why they go to school for that and become educated because that's what they want to do."