Amid nursing shortage, hospital CEO says vaccination warrants may deter staff: NPR

NPR’s Michel Martin speaks with Dr Randy Tobler, CEO of Scotland County Hospital in Memphis, Missouri, about the Covid cases and staff shortages at his facility.


We’re going to start today by talking about some things that affect our health here in the United States and around the world. In a few minutes, we’ll talk about the pros and cons of the Biden administration’s plan to help immunize the world against COVID, but we’ll start with an issue closer to home. We are talking about a national nursing shortage. Hospital officials say they are reaching critical point as hospital intensive care units fill up again due to latest COVID variant, even as they lose staff due to burnout and more lucrative temporary positions out of state. To talk about it, we decided to call someone we checked in with throughout the pandemic. He’s the CEO of Scotland County Hospital in Memphis, Missouri, Dr Randy Tobler. He’s in a more rural part of the state, and he’s back with us now. Dr Tobler, welcome back. Thank you very much for joining us once again.

RANDY TOBLER: With pleasure. Great to reconnect, Michel.

MARTIN: Likewise. So how is it going ? I mean, what have been the last couple of months since we haven’t discussed?

TOBLER: Right now we’re going up to breathe after coming down, maybe for the third time, in August and early September. Finally, things are moderating, but as of August, Missouri’s zero point was down in Springfield, in the southwest of the state, for the delta surge. And it gradually moved northeast, where we are, and really hit us harder than the winter wave. And that, combined with the progressive nursing shortage that has just worsened as the pandemic continues, was truly a perfect storm to bring us to our knees.

MARTIN: And why? If nurses are leaving, what have they said about the reasons, or have they told you why?

TOBLER: It’s a lot of people jumping for money. I’ve heard signing bonuses of $ 10, $ 15, $ 20,000, quarterback differentials that are just out of our league. We have tried to combat this by increasing our scale for nurses, but even that is the loyalty to the hospital and the community and that sense of neighborhood that keeps some nurses. But we’ve lost five in the 18 months of the pandemic so far.

MARTIN: In the first wave of this crisis, another problem was that – and that was before the vaccines – hospital workers were getting sick. Was this a problem?

TOBLER: Yes. If you have someone who either because of a personal encounter with COVID or because of a family member and they have to take care of them or quarantine, which has happened, then we are a broken down nurse. And when you already have vacancies in your nursing staff, where do you get people from? It has been more and more difficult, and I am so grateful to the staff who keep answering the bell to keep going up the hill whenever we ask them to. I am so proud of them.

MARTIN: Well, now there are vaccines available. President Biden released a series of mandates this month, including one covering some 17 million healthcare workers in facilities that receive federal funding. Some directors have said they feared staff might resign because of it. I understand that you do not have a vaccination mandate in your hospital at the moment. Is it correct?

TOBLER: That’s right. And in fact, ironically, two days before the president’s speech when he announced this upcoming tenure, we had actually been mailing nurses across the region and even across the state saying, hey, come see us because we have no warrant.

MARTIN: So you were hoping it would be a draw. You were hoping that the fact that you didn’t have a vaccination warrant would be a draw for you.


MARTIN: But aren’t you – you’re not afraid that your staff will get sick or the patients will be exposed? Wasn’t that a problem?

TOBLER: It’s a concern, but everyone wears N-95 masks, whether or not they are vaccinated, when providing patient care. And, again, we have to balance the risk of staff getting sick and maybe leaving us temporarily or not having staff at all because we make it a warrant and they jump out of the ship – because it’s is the other thing. The fatigue and exhaustion in nursing when dealing with these incredibly sick patients and having to watch patients die without their families nearby – the emotional, physical and professional toll of nursing is simply enormous.

MARTIN: Whoa. Do you think – are you confident or at least hoping that there will be no more breakouts in your part of Missouri?

TOBLER: I’m hopeful. I am not confident because we are just not seeing the vaccination rate accelerating as I would like. In our four-county area that we serve, the maximum, the best rate of fully immunized people is around 35%. There is just a lot of resistance to vaccines. Usually where I’ve seen people get vaccinated, unfortunately, is when – it’s not six degrees of separation – usually one or two degrees of separation from someone who – who gets seriously ill or dies, unfortunately. This is often when people pull the trigger and get the vaccine that has been resistant before.

MARTIN: You know, Dr Tobler, I know it’s hard to see people suffer like this and work so hard. If you don’t mind me asking it this way, like, what’s the worst about it? What hurts the most?

TOBLER: What hurts the most is the people you work with and care for – you delivered their babies. You operated on them for screaming out loud. And in this particular case, due to the gravitational pull of the viral social media videos and some people, unfortunately with my credentials spreading fake information, they believe that on someone I thought was we had a great relationship, a relationship of trust, loving relationship. It hurts. It hurts doctors, nurses, anyone who tries to encourage people to do the right thing and get vaccinated.

MARTIN: Well, Dr. Tobler, we sure appreciate you talking to us every now and then, and we certainly wish you the best as you continue to, you know, fight through this thing. It was Dr Randy Tobler, CEO of Scotland County Hospital in Memphis, Missouri. Dr. Tobler, we thank you very much for your time.

TOBLER: Always my pleasure. Thanks Michel.

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