Short on staff: Nursing crisis strains U.S. hospitals

Registered nurse Kara Salonga, pictured at nursing station at the West Virginia University Hospitals in Morgantown, West Virginia, U.S., September 6, 2017. Picture taken September 6, 2017. REUTERS/Mike Wood

By Jilian Mincer

MORGANTOWN, West Virginia (Reuters) – A shortage of nurses at U.S. hospitals hit West Virginia’s Charleston Area Medical Center at the worst possible time.

The non-profit healthcare system is one of the state’s largest employers and sits in the heart of economically depressed coal country. It faces a $40 million deficit this year as it struggles with fewer privately insured patients, cuts in government reimbursement and higher labor costs to attract a shrinking pool of nurses.

To keep its operations intact, Charleston Medical is spending this year $12 million on visiting or “travel” nurses, twice as much as three years ago. It had no need for travel nurses a decade ago.

“I’ve been a nurse 40 years, and the shortage is the worst I’ve ever seen it,” said Ron Moore, who retired in October from his position as vice president and chief nursing officer for the center. Charleston Area Medical’s incentives include tuition reimbursement for nursing students who commit to work at the hospital for two years.

“It’s better to pay a traveler than to shut a bed,” he said.

Hospitals nationwide face tough choices when it comes to filling nursing jobs. They are paying billions of dollars collectively to recruit and retain nurses rather than risk patient safety or closing down departments, according to Reuters interviews with more than 20 hospitals, including some of the largest U.S. chains.

In addition to higher salaries, retention and signing bonuses, they now offer perks such as student loan repayment, free housing and career mentoring, and rely more on foreign or temporary nurses to fill the gaps.

The cost nationwide for travel nurses alone nearly doubled over three years to $4.8 billion in 2017, according to Staffing Industry Analysts, a global advisor on workforce issues.

The burden falls disproportionately on hospitals serving rural communities, many of them already straining under heavy debt like the Charleston Area Medical Center.

These hospitals must offer more money and benefits to compete with facilities in larger metropolitan areas, many of them linked to well-funded universities, interviews with hospital officials and health experts show.

Along West Virginia’s border with Pennsylvania, university-affiliated J.W. Ruby Memorial Hospital in Morgantown is spending $10.4 million in 2017 compared with $3.6 million a year earlier to hire and retain nurses.

But these costs are part of the facility’s expansion this year, including adding more than 100 beds as it grows programs and takes over healthcare services from smaller rural providers that have scaled back or closed.

J.W. Ruby, the flagship hospital for WVU Medicine, offers higher pay for certain shifts, tuition reimbursement, $10,000 signing bonuses and free housing for staff who live at least 60 miles away.

Next year, the hospital is considering paying college tuition for the family members of long-time nurses to keep them in West Virginia.

“We’ll do whatever we need to do,” said Doug Mitchell, vice president and chief nursing officer of WVU Medicine-WVU Hospitals.


Nursing shortages have occurred in the past, but the current crisis is far worse. The Bureau of Labor Statistics estimates there will be more than a million registered nurse openings by 2024, twice the rate seen in previous shortages.

A major driver is the aging of the baby boomer generation, with a greater number of patients seeking care, including many more complex cases, and a new wave of retirements among trained nurses.

Industry experts, from hospital associations to Wall Street analysts, say the crisis is harder to address than in the past. A faculty shortage and too few nursing school slots has contributed to the problem.

Hospitals seek to meet a goal calling for 80 percent of nursing staff to have a four-year degree by 2020, up from 50 percent in 2010. They also face more competition with clinics and insurance companies that may offer more flexible hours.

Healthcare experts warn that the shortfall presents risks to patients and providers. Research published in August in the International Journal of Nursing Studies found that having inadequate numbers of registered nurses on staff made it more likely that a patient would die after common surgeries.

UAB Hospital in Birmingham, Alabama, has invested millions to attract nurses, but still has 300 jobs to fill. At times, nursing vacancy rates in some of its departments has hit 20 percent or higher.

“We’ve rarely canceled a surgery or closed a bed because of lack of staffing,” said Terri Poe, chief of nursing at the hospital, the state’s largest, which serves many low income and uninsured residents.

Last year, the medical center covered nearly $200 million in unreimbursed medical costs for patients. It spent $4.5 million for visiting nurses during fiscal 2016, including $3 million for post-surgery services, compared with $858,000 in 2012.

Healthcare labor costs typically account for at least half of a facility’s expenses. They jumped by 7.6 percent nationally last year, after climbing at a rate closer to 5 percent annually in recent years, said Beth Wexler, vice president non-profit healthcare at Moody’s. The spending has proven a boon for medical staffing companies like AMN Healthcare and Aya Healthcare.

Missouri’s nursing shortage reached a record high in 2017, with almost 16 percent – or 5,700 – of positions vacant, up from 8 percent last year. Thirty-four percent of Missouri registered nurses are 55 or older.

“Our biggest challenge is getting the pipeline of experienced nurses,” said Peter Callan, director of talent acquisition and development at the University of Missouri Health Care in Columbia, which is expanding. “There are fewer and fewer as people retire.”

Last year, the academic medical center hired talent scouts to identify candidates, Callan said. It spends $750,000 a year on extras to attract and keep nurses, including annual $2,000 bonuses to registered nurses who remain in hard-to-fill units and up to five years of student loan repayment assistance. It offers employee referral bonuses and a chance to win a trip to Hawaii.

Smaller hospitals find it much harder to compete in this climate. More than 40 percent of rural hospitals had negative operating margins in 2015, according to The Chartis Center for Rural Health.

In rural Missouri, 25-bed Ste. Genevieve County Memorial Hospital had to offer signing bonuses, tuition reimbursement and pay differentials when staffing is “critically low” in units such as obstetrics.

They haven’t closed beds, but have hired less experienced nurses, raised salaries and turned away at least one patient who would have been in its long term care program.

“We’ve had to try whatever it takes to get nurses here,” said Rita Brumfield, head of nursing at the hospital. “It’s a struggle every day to get qualified staff.”

To see the entire graphic on the U.S. nursing shortage, click

(Editing by Michele Gershberg and Edward Tobin)

Injured Venezuela protesters face another woe: finding medicine

Volunteers get ready for help injured demonstrators in Caracas, Venezuela April 22, 2017. REUTERS/Marco Bello

By Alexandra Ulmer

CARACAS (Reuters) – Demonstrators injured in Venezuela’s often violent street protests are facing additional hardship: how to get treatment in a crisis-hit country where basics like antibiotics and painkillers are running short.

Venezuela’s state prosecutor says 437 people were hurt in nearly a month of protests against leftist President Nicolas Maduro, whom the opposition accuses of morphing into a dictator and wrecking the oil-rich country’s economy.

Close-range rubber bullets, flying rocks, tear gas canisters and tear gas have caused the majority of wounds and health problems, according to over a dozen doctors and rights groups.

Most of those injured appear to be opposition protesters, but Maduro supporters, security forces and bystanders are also seeking treatment, these people said.

Families are hauling injured relatives to multiple health centers, scouring pharmacies for medicine, raising funds to buy pricier drugs on the black market, and posting messages on social media begging for medical donations.

But with around 85 percent of medical supplies unavailable, according to a leading pharmaceutical group, many Venezuelans are still unable to get optimal treatment – or any at all.

Luis Monsalve, 15, was hit in the face by a tear gas canister amid a major protest last week. Since then, his family and friends have been scrambling to collect supplies for surgery to allow him to see with his right eye again.

“If we had everything, they could have operated on Saturday,” said his father Jose Monsalve, 67.

Others tell similar stories.

Administrative assistant Raquel Mignoli, 44, caught a nasty stomach bug after jumping into Caracas’ sewage-filled Guaire river to avoid a volley of tear gas but was unable to find medicine despite visiting five pharmacies.

Teacher Yrma Bello, 57, lost consciousness and suffered facial bruising after being slammed to the ground by a water cannon in the jungle and savannah state of Bolivar. The local hospital did not have painkillers or anti-inflammatories, so her friends started a campaign on WhatsApp for donations.

The injuries are heaping more stress on Venezuela’s saturated hospitals and dwindling ranks of doctors, some of whom are volunteering to treat people at protests.

The shortages are also a cruel irony for some injured demonstrators, who were actually out protesting those chronic shortages that have cancer patients going untreated and millions of Venezuelans skipping meals.

Maduro’s government says protesters are to blame for the violence that has engulfed crime-ridden Venezuela. He says that beneath a semblance of peace, Washington-backed opposition leaders are actually riling demonstrators up in the hopes of staging a coup.

Authorities have arrested nearly 1,300 people this month. Some two dozen people have also been killed, many of them from gunshots.

Venezuela’s Information Ministry, Health Ministry and Social Security institute did not immediately respond to requests for comment.


To combat shortages, Venezuelans abroad – the vast majority of whom left because of economic problems and crime – are donating medicines in cities from Miami to Madrid.

In the opposition hotbed of Tachira state, volunteer doctors work at demonstrations in civilian clothing and use pseudonyms to avoid being arrested or targeted by pro-government groups who see them as supporting Maduro’s foes.

“We still don’t have (gas) masks but in the midst of tear gas we’ve treated patients wounded by rubber bullets or asphyxiating,” said a doctor known as ‘gypsy.’

In Caracas, around 120 medicine students, doctors, and volunteers have revived a primary care response team first created during 2014’s bout of anti-government protests.

While they wear white helmets with a green cross, none wear flak jackets and some resort to wearing goggles to protect themselves from tear gas. Their equipment has nearly all been donated or bought by the volunteers themselves, and they’ve had to create makeshift neck braces from shoes, belts, and hats.

Still, when the determined group walks through a protest in single file, demonstrators stop their shouts of “No more dictatorship!” and instead clap and cheer them on with yells of “Thank you!” and “Heroes!”

Amid a widespread feeling of abandonment in a country where the economy is thought to have contracted 19 percent last year and many basic services only function intermittently, the volunteer doctors are seen as a ray of hope.

“We’re ready to tend to 200 people, but at some point there will be 400,” said volunteer and medicine student Stephanie Plaza, 22, on the sidelines of a recent march under the sizzling tropical sun.

“There are more injuries than in 2014, because there are more people protesting,” she said, adding the injuries have been more serious, too.

The group, which describes itself as apolitical, also treats security officials. Still, it has come under fire from some government supporters who compare them to Syria’s White Helmets rescue workers.

“Amid the opposition’s desperation to create this idea of a humanitarian crisis in Venezuela… it has organized a group of doctors to hide its paramilitary actions in the streets,” said a tagline on pro-government TV show ‘Zurda Konducta.’

The medical group refuted the accusations.

(Additional reporting by Anggy Polanco in San Cristobal and Maria Ramirez in Puerto Ordaz; Writing by Alexandra Ulmer; Editing by Girish Gupta and Andrew Hay)

As drug supplies run short, Egyptians turn to herbal remedies

Herbal medicine worker taking spices to make medicine

By Mohamed Zaki and Mohamed Abd El-Ghany

In the Cairo working class neighborhood of Basateen, dozens can be seen lining up outside a decades-old herbal spice shop with pyramid-shaped stacks of jars on display, filled with everything from honey and ginger to camel’s hay.

Apothecaries say there is a roughly 70-80 percent increase in sales after a series of harsh economic reforms hit medicine supply in pharmacies across the country and increased the cost of some generic and even life-saving drugs.

Store owner Samy al-Attar – whose last name is Arabic for apothecary – says a knowledgeable apothecary can find substitutes for drugs treating almost all non-terminal illnesses.

Just like pharmacies, the walls inside al-Attar’s store are lined with drawers and containers. But rather than pharmaceutical drugs, they hold herbs, each said to have its own unique healing property.

Customers impatiently crowd outside the shop window, where employees can be seen dashing around the tiny interior, choosing from a variety of textures and colors, filling clear plastic bags with orders.

Al-Attar’s role is like many pharmacists. Customers explain their symptoms and he produces a concoction of spices and herbs along with a method of administration.

Egypt’s health ministry is in the middle of negotiations with pharmaceutical companies over a 15 percent increase in prices of locally-produced drugs, and a 20 percent increase in the prices of imported ones.

Local spices and herbs, meanwhile, cost between 5 and 10 Egyptian pounds ($0.27-0.54) per kilogram.

($1 = 18.5000 Egyptian pounds)

(Writing by Seham Eloraby; Editing by Ahmed Aboulenein and Mark Potter)

Half of Aleppo residents want to flee, no food, fuel, no aid

A medic holds a dead child after airstrikes in the rebel held Karam Houmid neighbourhood in Aleppo

By Tom Miles

GENEVA (Reuters) – Half of the estimated 275,000 Syrians besieged in eastern Aleppo want to leave, the United Nations said on Wednesday, as food supplies are running thin and people are driven to burning plastic for fuel.

Food prices are rising and supplies are running out. Mothers were reportedly tying ropes around their stomachs or drinking large amounts of water to reduce the feeling of hunger and prioritize food for their children, the U.N. said.

“An assessment conducted in eastern Aleppo city concluded that 50 percent of the inhabitants expressed willingness to leave if they can,” the U.N. Office for Coordination of Humanitarian Affairs said in an update on the Aleppo situation.

It did not say how many of the other 50 percent were determined to stay.

The United States and other Western countries say Moscow and Damascus are guilty of war crimes in deliberately targeting civilians, hospitals and aid deliveries for more than 250,000 people trapped under siege in Aleppo. The Syrian and Russian governments say they target only militants.

Aid workers in eastern Aleppo have distributed food rations for 13,945 children under 6 years old, but a lack of cooking gas makes it difficult to cook what little food remains.


“Reports of civilians rummaging through the rubble of destroyed buildings to salvage any flammable material that can be used for cooking are common,” the report said.

“Poor-quality fuel, which is made from burning plastic, is available in limited amounts.”

A liter of diesel fuel costs about 1,300 Syrian pounds or about $2.25, while a liter of petrol costs 7,000 Syrian pounds or about $13.70.

Psychological health is also suffering, the report said.

“Moreover, arguments among spouses have reportedly increased as many women are blaming their husbands for choosing to stay while it was possible to leave the city.”

Civilians are walking up to 2 km to fetch water, which is available from boreholes, and the water situation across the city is “of grave concern”, the report said.

“Local authorities in charge of the Sulaiman Al-Halabi water station shut off the electrical power to the station to prevent extensive damage should hostilities impact the water station directly,” it said.

(editing by Ralph Boulton)

California power grid passes first heat wave test amid gas shortage

Lost Angeles skyline

(Reuters) – California’s power grid passed its first test of the summer with no rolling blackouts on Monday, when customers cranked up their air conditioners as temperatures soared into the triple-digits for the second consecutive day in some southern parts of the state.

The California Independent System Operator, which manages the state’s power grid, issued a so-called flex alert on Sunday, urging homes and businesses to conserve energy on Monday afternoon.

As consumers heeded that call and temperatures on Monday came in a little cooler than expected, the ISO cut its peak power demand projection for the day to 43,728 megawatts from 45,316 MW.

Monday’s alert was the first big test of power generators’ ability to meet heightened energy demands in the greater Los Angeles area without natural gas supplies normally furnished by the now-crippled Aliso Canyon. The storage field, California’s largest, has been effectively idled since a major well rupture there last autumn.

So far, the ISO has not issued another flex alert for Tuesday but said on its website it would be “helpful” if customers conserve energy.

With cooler temperatures expected for the rest of the week, the ISO forecast demand would peak at 42,581 MW on Tuesday and just 39,036 on Wednesday.

AccuWeather meteorologists forecast the mercury would reach 87 degrees Fahrenheit (31 Celsius) in Los Angeles on Tuesday before falling to a near-normal 82 degrees on Wednesday. They had exceeded 100 degrees on Monday.

With Aliso Canyon shut down, state regulators have warned that the Los Angeles area faces up to 14 days of gas shortages severe enough to trigger blackouts this summer.

Aliso Canyon, owned by Sempra Energy’s Southern California Gas Co unit, normally supplies the region’s 17 gas-fired power plants, hospitals, refineries and other key parts of the state’s economy.

(Reporting by Scott DiSavino; Editing by Lisa Von Ahn)

Nepal Suffering from Supply Shortage; Tensions Rise between Nepal and India

Nepal is low on gasoline and medical supplies due to an unofficial economic blockade imposed by the neighboring country where they get most of their supplies, India.

Many Nepalese believe that the blockade is a way of retaliating against the Nepalese government after they approved a new constitution that New Delhi believed to be discriminatory to an Indian community living in Nepal’s border districts., the Madhesi.

Violent protests by the Mahesis that killed at least 45 people have taken place for months while Nepalese lawmakers debated the constitution. The violence escalated after the constitution was made official.

Shortly after, Indian trucks stopped crossing the border. Only about 100 or so have crossed the border since Wednesday, but more than 1,000 are sitting at the border with medicine, gasoline, produce, and cooking fuel. Currently, fuel is being rationed in Nepal, and is no longer being sold for the use of private vehicles for the next three days.

“Why is India imposing a blockade against us? Don’t we have the right to draft our constitution?” asked Nirmala Rai, a school teacher who participated in a demonstration near the Indian Embassy in Kathmandu on Monday.

India has stated that there is no blockade against Nepal. They blame protesters for blocking the roads and scaring their truck drivers.

Officials on both sides announced that they are working on the situation and that supplies will resume soon, but neither side had a time estimate for when the trucks will cross the border again.