Oct. 19—Clatsop Behavioral Healthcare has moved to a four-day work week. The mental health agency has also raised wages, provided retention rewards and started offering signing bonuses up to $1,000. They even plan on renting a house to give new hires a temporary place to live.

The incentives have not been enough to fill open positions during a health care labor shortage impacting facilities throughout Clatsop County.

"I think anybody who's been in either the service industry, or the 'helping other people out' industry faced enormous, enormous pressures over the past year and a half," said Amy Baker, the executive director of Clatsop Behavioral Healthcare, the county's mental health and substance abuse treatment provider. "And I think we're seeing the cumulative effect of that."

Health care leaders say limited housing and staff burnout from the coronavirus pandemic have heightened a staffing challenge decades in the making.

Combined, there are nearly 200 open health care positions in the region as of this week.

Over half of the positions are in nursing and nursing support, with the rest being physicians, administration, custodial staff and other roles.

'A statewide phenomena'

Clatsop Behavioral Healthcare has 11 jobs posted.

"One that is specific to my industry, and this is probably true to other industries too, but the rate of pay has really not kept up with cost of living," Baker said. "So the issue around not having enough staff is a statewide phenomena."

Baker said she used feedback from her employees to implement the four-day work week, hoping to promote work-life balance in the personally taxing work of caregiving. Employees work nine-hour days.

"We have a lot of really compassionate people who work here, and it's hard to absorb that suffering and not take it home with you," she said.

Several health care providers said the lack of affordable housing options narrows the applicant pool. They said people have turned down jobs after searching for a place to live and coming up with nothing reasonable.

"We are definitely seeing staffing shortages," said Nancee Long, the director of communications for Columbia Memorial Hospital. "A lot of it is related to the inability to find housing locally — that has been an issue. But I think a lot of it is also due to the fact that nationwide, people are potentially leaving medicine, due to COVID issues and burnout issues. This is a difficult position. It's a difficult job."

Judy Geiger, the vice president of patient care services at Columbia Memorial, said at a news conference this month with local health care leaders that the Astoria hospital is working on recruitment plans. As of this week, they have 119 jobs posted on their website.

"We are, just like the rest of the country, seeing a larger vacancy rate in health care jobs that is higher than we've seen in the past many years," Geiger said. "People are reevaluating their lives, I believe because of the pandemic, and choosing to leave health care settings in larger numbers than they normally would."

Over 90% of nurses at Oregon Health & Science University Hospital, the state's largest, reported mental exhaustion, according to data provided by the Oregon Nurses Association this month. Sixty percent said they are considering leaving the profession.

The state's vaccination mandate for health care workers did not significantly contribute to the staff shortage at Columbia Memorial, Long said. Out of over 700 employees, Columbia Memorial lost nine who either refused to be vaccinated or had their exemption requests denied.

Yakima Valley Farm Workers Clinic, which has locations in Astoria and Clatskanie, said it only lost one worker to the state mandate.

Tina Foss, the vice president of operations for the region, said their six job postings are unrelated to the pandemic, and their team has expanded since last year. In the past four months, she said they have had eight staff leave and 10 join.

"We have experienced a small number of turnover earlier in the year at the height of COVID, but for us that has settled down," Foss said.

She said they have added internal support for staff, such as meals and employee recognition, and that the supportive community in Astoria has had a positive impact on retention.

Fresenius Kidney Care's Astoria location has seven jobs posted.

In a written statement, Casey Stowell, the regional vice president of Fresenius Medical Care, the parent company, said, "We are offering competitive salary and benefits with the opportunity to make an impact in the lives of our patients living with kidney failure."

Local health care leaders agree the labor shortage was the result of yearslong issues coming to a head.

"Nationally, there's been struggles to hire into the health care field — and it was even before the pandemic hit — and then once the pandemic hit it really exacerbated that situation," Jason Plamondon, the chief nursing officer at Providence Seaside Hospital, said at a news conference this month.

He said the hospital is trying to be creative about hiring bonuses and other incentives. Their website lists a nursing position in maternity care with an $8,000 signing bonus.

"There's all sorts of opportunities, so I think (it's about) just trying to sell ourselves really as an ideal place to come and work, and so far we've been doing OK," Plamondon said.

Providence Seaside has over 450 employees and had 50 jobs posted as of last week.

Margo Lalich, the county's interim public health director, said that recruitment has been an issue for the past few decades, originating in nursing schools.

"Part of the reason there was a nursing shortage, and it has sustained itself, is because we have a nursing faculty shortage across the country. There are so many vacancies," Lalich said at the news conference. "And so there just isn't the faculty to educate the students and then there aren't the clinical spots."

'A better balance'

The Oregon Nurses Association recommends higher salaries for nursing faculty and the creation of more scholarships and loan forgiveness for nursing students, especially students of color, bilingual students and people from rural areas where the need is greater.

Despite the pandemic inspiring more people to apply for nursing school, retaining new graduates will still be a challenge, said Kevin Mealy, the communications director for the union.

"For older nurses, there used to be a better balance between the amount of patients you would send home healthy, and the amount of patients who wouldn't leave the hospital, but that ledger has grown very unbalanced so there's a lot more complicated challenging patients who you may not be able to help," Mealy said. "And I think that causes an enormous weight for people, especially who joined the profession in order to help treat people and care for them and help them get better."

Eighty-five percent of nurses at OHSU said they are unable to use their vacation time or take a mental health day, according to union data. On top of shifts over 12 hours long, Mealy said, the conditions are unsustainable.

"Because we've been in this almost two-year cycle, there has been no letdown," Mealy said. "So we're asking people to run at sprint speed for a marathon. And that isn't possible."

In Clatsop County, the health care labor shortage is in part a result of national issues years in the making that the pandemic intensified. With openings in every local facility, competition is steep.

For those working, Mealy said competitive wages and benefits packages matter, in addition to supporting the mental health needs of staff by expanding services. Those are the kinds of work environments applicants look to find, too.

"Employers are eager to put up the 'heroes work here' signs, and nurses have answered the call." Mealy said. "But there does need to be a point where we acknowledge that this can't be a permanent state. We can't live in this 'Groundhog Day' of going over and above, every day."