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Finding Solutions to Vermont's Psychiatric Nursing Shortage


by Ed Sutherland

Photo courtesy of Fletcher-Allen Health Care
Photo courtesy of Fletcher-Allen Health Care

Three years after Tropical Storm Irene closed Waterbury’s Vermont State Hospital for good, a new $28 million replacement, the Vermont Psychiatric Care Hospital, has opened in Berlin. But are the troubles which beset the Waterbury psychiatric institution—including a lack of nurses—also visiting the new hospital? While there have been no allegations of wrongdoing at the Berlin institution, some experts are raising the question of whether it is suffering from a lack of qualified care-givers.

The new hospital opened in July. The 25-bed facility brought the number of psychiatric beds available statewide to 52, just under the 54 at the Vermont State Hospital. However, not all of the Berlin beds can be used because of a shortage of specialized nurses.

To provide seven staff per shift for one-on-one care, the hospital needs to hire four more nurses, according to testimony at a September hearing of the Legislature’s Joint Oversight Committee on Mental Health. Right now, traveling nurses are plugging the gap.

At the September hearing, committee members grilled mental health administrators on the nursing shortage question. The committee heard that psychiatric nursing is a special calling, where stress and age play special roles.

“One of the highest-risk environments you can be in is being a psych nurse,” Dr. Jay Batra, medical director for the Department of Mental Health, told the legislators.

Susan Farrell, chair of the 2012 Vermont Blue Ribbon Commission on Nursing, told The Bridge that the shortage of psychiatric nurses comes just as Vermont is attempting to rebuild support for mental care.

“It has been my experience that nurses who work in speciality areas, especially psych, are in greater shortage and typically have been. This has been the case in Vermont for a few years,” Farrell wrote in an email.

“There is currently a low nurse vacancy rate in all the Vermont hospitals,” University of Vermont assistant nursing professor Mary Val Palumbo told The Bridge. At its height, in 2001, the nursing shortage amounted to a 15 percent vacancy. However, while the sheer number of nurses has increased, some areas of the profession still contend with significant deficits. “Speciality areas like psych nursing have problems with recruitment,” she said.

Other specialties facing a staffing crunch include operating-room and intensive-care nursing.

A 2013 Vermont State Board of Nursing survey found that just 14 percent of working nurses were involved in psychiatric care. The board asked those psychiatric nurses who were not working why they had left the profession. An identical proportion, 14 percent, pointed to stress as their reason for leaving the profession. The survey also found the majority of working nurses had just one to five years’ experience.

Both Farrell and Palumbo would like to see better-educated nurses entering health care and academia. The number of practicing diploma nurses—those who lack even an associate’s degree—fell to 9 percent in 2013, down from 23 percent in 2003, but the number of nurses possessing a bachelor’s-level degree rose by just 1 percent during the same decade. “The psychiatric hospital presents a unique challenge in that nurses at the psychiatric hospital need special skills to work with some of our most complex, challenging patients. So we have to make sure the training is available and the pay is adequate,” State Senator Anthony Pollina (P-D—Washington) told The Bridge.

When it comes to pay, the Department of Mental Health received an earful at the September hearing.

“We know care would be better if we didn’t have this rotating staff,” said State Senator Claire Ayer (D—Addison). The traveling nurses in Berlin receive $54 an hour, while the state offers permanent nurses a pay-and-benefits package worth $45 an hour.

Pollina, a member of the joint committee, has heard his share of disconcerting stories.

“In terms of shortages … many nurses—concerned with patient safety—have reported working on hospital units that are understaffed and where nurses are overworked. We’ve had many conversations about the need to set safe staffing levels and cut back on long, overtime shifts for nurses,” he said.

Along with the educational issues driving nurses away from specialization, the possibility of experienced nurses leaving the field is a real threat, experts note. Half of Vermont’s 5,000 working nurses are 50 or older, according to UVM’s Palumbo. There are more nurses over 60 than under 30. In other words, the institutional memory of Vermont nursing is at risk.

The somewhat better economic conditions have made delayed retirements more practical, but “in the next 10 years, there is going to be quite a change in the demographics of the nursing work force,” Palumbo told Brainwaves, a UVM publication. “The nursing shortage vanished during the recession years. Now, we’re just seeing some signs that the older nurses are thinking about retirement.”

Unless the issues of experience, pay and aging are addressed, Pollina told The Bridge, “we could find that, offered the choice, nurses may decide to work at a regular hospital rather than the psychiatric hospital, causing a continued shortage there.”