Main content
COVID-19: Impact on the nursing workforce
Media Contact
Rosemary Pitrone

Emory Healthcare's Chief Nurse Executive Sharon Pappas joins epidemiologist Jodie Guest to discuss the impact of the pandemic on the nursing workforce. Pappas describes Emory Healthcare's approach to addressing nursing shortages and strategies to ensure that all patients receive the care they need.

Over the past two years, health care systems across the country have experienced increasing nursing shortages. The pandemic worsened already elevated levels of stress and burnout among nurses, causing many to leave the profession, retire or choose travel nursing positions with higher pay rates. To fill these vacancies, health care leaders are tasked with improving work environments to better support these essential workers and the patients who rely on their care.

To learn more about Emory Healthcare’s approach to addressing nursing shortages, Jodie Guest, PhD, professor and vice chair of the department of epidemiology at Emory’s Rollins School of Public Health, spoke with Sharon Pappas, PhD, RN chief nurse executive at Emory Healthcare. Pappas, who is responsible for nursing practice across Emory’s hospitals, ambulatory care and post-acute agencies, describes Emory’s strategies to support nurses and ensure that all patients receive the care they need.

Their conversation is part of an online video series hosted by Guest, who also leads the Emory COVID-19 Outbreak Response Team, answering questions related to the COVID-19 pandemic.

Q: What was the state of nursing staffing at Emory Healthcare prior to the pandemic?

A: Emory Healthcare had a strong foundation in nursing staffing prior to the pandemic, Pappas says, demonstrated in part by the fact that four Emory facilities have achieved Magnet® designation by the American Nurses Credentialing Center’s (ANCC) Magnet Recognition Program®.

“One of the things that drew me to Emory Healthcare was the fact that both our board, as well as our senior leaders, had an expectation that all of our organizations would achieve Magnet recognition,” Pappas says.

Magnet recognition is the gold standard for nursing excellence. As of May 2021, only 8.9% of hospitals in the U.S. are Magnet designated. Four Emory Healthcare facilities have achieved this recognition: Emory Johns Creek Hospital, Emory University Hospital, Emory Saint Joseph’s Hospital and Emory University Orthopaedics & Spine Hospital.

“Magnet was derived from a research study back in the 80s which determined that there are certain things that, when they exist in a hospital, it becomes a place where nurses want to practice,” Pappas explains. “These are things like the type of leadership; it’s how decisions are made; it’s about professionalism, autonomy, being able to measure the results of nursing work and improve it.”

“You can see how important a good nursing work environment is to Emory Healthcare,” she continues. “Every one of our hospitals and clinics are aware of the Magnet structure and requirements — and the importance of a good nursing work environment for retention — so I think we start there as a foundation that existed way prior to the pandemic.”

Before the pandemic, the turnover rate for clinical nurses at Emory Healthcare was 12.5% — low, compared to the national average of 16 to 17% at that time. Like hospitals across the country, Emory Healthcare has experienced an increase in turnover during the pandemic, and the rate is now closer to 18%.

“But that pre-pandemic state of Magnet hospitals, of low turnover, of strong nurse engagement — which is part of the credentials of being a Magnet hospital, and also of really good patient outcomes because of nurse engagement — were all present prior to the pandemic,” Pappas says. “And we will return there, it'll just take a little time.”

Q: What does the nursing workforce at Emory Healthcare look like now?

A: “We do have more vacancies than we had prior to the pandemic, and we're in the process of replacing those,” Pappas says. “Emory has addressed some important things that we heard from our workforce about their benefits and their compensation, and we continue to address changing compensation market changes which is playing a big role now in bringing nurses back into Emory Healthcare.”

There is a particular focus on increasing the number of nurse residents at Emory Healthcare. This year, they aim to hire 700 nurse residents.

“And we’re pacing there,” Pappas says. “It's so important that we have ways not just to attract these residents, but also to be able to give them an experience of learning that is one that prepares them very well for the different roles that are here at Emory Healthcare that they will fill.”

“We have mechanisms [so] that nurses can continue to learn and grow while they're at Emory,” she continues. “Just like physicians, board certification is an important element of nursing excellence, so when you think about some of the programs we have for nurses to come in and become certified in their specialty — like critical care nursing, medical surgical nursing, perioperative nursing, oncology nursing and many others — all of these are available to nurses by getting their practice experience and then also sitting for an exam that credentials them to work in that specialty, and then we pay you more for you to have that specialty, as well.”

“All of these things, to me, begin to line up with our Emory Healthcare true north of being a place where people come to learn and grow,” Pappas adds. “What you learn at Emory is like not many others, because of the patient complexity that we have here and the fact many times when patients come here, we’re their last stop because they haven't been able to solve their problems. So, it's wonderful to be able to see those patients recover, which is one of the very important parts of nurses being called to work toward their purpose. I think that's what really contributes to their own well-being.”

Q: What is the nurse residency program at Emory Healthcare like?

A: The Emory Healthcare nurse residency program is accredited by the Commission on Collegiate Nursing Education (CCNE), the same organization that accredits the Nell Hodgson Woodruff School of Nursing.

“That credentialed residency means that when you enter our nurse residency, you know what to expect,” Pappas says. “You know that there will be ways to not only support your knowledge growth, but also support you learning how to take care of patients, learning how to work on teams, learning how to be part of multi-professional teams and really get focused on patient outcomes. So, it's broader than just what many people refer to as orientation.”

The Emory Healthcare nurse residency is a one-year program that empowers newly licensed nurses to successfully transition into clinical practice. “As you take on more and more responsibilities in direct patient care, we're supporting you in making sure that you're adapting to that okay with monthly groups that actually talk about how you stay happy, healthy and doing what you love,” Pappas says.

“We also have a second residency that many people don't know a lot about,” she adds. “It's our critical care residency for advanced practice nurses — for them to be able to come in and become an advanced practice provider. Both nurses and PAs can enter this residency. It is a year of proctored and mentored practice in our critical care areas that is also nationally credentialed and is sought after by many nurses who want that type of onboarding experience.”

Q: How does the Nell Hodgson Woodruff School of Nursing play a role in staffing?

A: “I want to give a shout-out to the School of Nursing at Emory,” Guest says. “The U.S. News & World Report just came out with national rankings, and again we see that the nursing program at Emory is ranked number two in the country — which is really exciting and certainly is an incredible pipeline to work with our incredible Emory Healthcare system.” 

Pappas agrees. “Emory Healthcare is actually the largest employer of Emory School of Nursing graduates, and we want to keep that status because we know how great the Emory School of Nursing students are,” she says.

“We have programs that allow them to actually begin their work with us before they even graduate,” Pappas continues. “That is an opportunity that many people just can't pass up, and we're always glad to have that strong partnership and to work directly with the school, both in development of curriculum and clinical experiences, as well as celebrating the success of many of the students that finish there.” 

“Our School of Nursing does a wonderful job recruiting faculty, and so through our partnership, we're able to say things like, ‘Wow, can you increase enrollment? Because you have faculty,’” she adds. “They’ve been very responsive, developing programs like InEmory where the whole cohort of students does all of their clinical experience in Emory facilities, so that by the time they're completed, they are practice-ready and have a lot of knowledge about our system — like how to become a nurse who practices in a Magnet organization.”

“That's an important differentiator for us, and we want to make sure that we include that in their pre-licensure education,” she says. “So, the partnership with the School of Nursing has just been an incredible opportunity to refine some of these things that we know are important to nurses and to patients.”

Q: How does Emory Healthcare continue to provide patient care amid nursing shortages?

A: “That is our number one objective: to make sure that our patients get the care they need,” Pappas says. “Where we have had extreme shortages, we have actually partnered with a contractor — and we only partner with a very small number, because we want to make sure the quality of these nurses is high — and we supplement our own employed nurses with nurses from an agency. We monitor that very closely to make sure that their onboarding is preparing them to deliver on the high bar of care that is expected at Emory.”

“I really do hold a high accountability as the chief nurse that we are always able to provide an adequate surveillance system, because nurses are the people who are there 24/7, overseeing patient care,” she continues. “I think that having enough nurses to make sure there's adequate eyes on patients, and also to make sure when those eyes see things that they're concerned about, they know how to intervene and actually impact the care in a way that the patients have a better outcome.”

Q: What has it been like to work in nursing in a hospital setting during the pandemic?

A: “This pandemic has been really stressful, and it's been really stressful for everyone,” Guest says. “It has been a different kind of stressful for people who work in public health and people who work in the health care system.”

“The impact of these two years of pandemic has really been rough,” Pappas says. “I heard a nurse make a comment one day that has really stuck with me, and one that has been kind of my motivator to work a little faster and do all I can to correct this. She said to me, ‘I just feel like I’m failing at something every day.’” 

“When you think about the fact that — here come a large number of patients like we had never cared for before, and we were changing our approach to those patients on a regular basis to make sure that we were using the right treatments, we were using the right mechanisms to prevent spread of the deadly virus and [we] were really having to make a lot of changes quickly,” Pappas says. “It really kind of rattles you as a clinician when you think about, ‘I’ve always done it this way, now I’m doing it this way, and tomorrow I may do it a different way.’” 

Emory Healthcare leaders have recognized the importance of providing nurses with opportunities to talk about their experiences during the pandemic. Pappas points to the establishment of the Woodruff Health Sciences Center's Office of Well-Being (EmWELL) as a holistic and collaborative effort to promote wellness and professional fulfillment among employees throughout Emory’s health sciences.

“I feel very proud that our leaders here at Emory Healthcare have created an Office of Well-Being that is really going to help us to develop our knowledge and our capabilities around clinician well-being, so that as we recover from the stages of the pandemic and as we begin to recreate our new nursing workforce and nursing work environment, we have the best of science around well-being at our fingertips in order to be able to support our people,” she says. “That's really at the core of our strategic initiatives. It's at the core of what we do to be able to improve lives and provide hope.”

Q: What might be the continued impacts on health care post-pandemic? 

A: The pandemic caused many people to skip routine appointments or delay seeking care, impacting patients’ overall health. Pappas says Emory Healthcare is prepared to care for these patients as they return to clinics and hospitals in person. 

“I really am strongly committed to ‘open for business,’” Pappas says, adding that there is a system-wide project currently underway to augment Emory’s care model.

“It's an interprofessional team that is taking many different aspects of our direct care and saying, ‘How can we augment our care while we're still in the process of hiring replacements for people who maybe need a break, or people who have shifted to another practice setting for a while — out of the very complex hospital role.”

Emory Healthcare already uses technology to augment care teams through the Emory eICU, a technology hub that provides an added layer of care for individuals in the intensive care unit (ICU). Patients receive constant monitoring by qualified remote physicians and nurses who are alerted to every aspect of the patient’s condition when other physicians are not able to be at the bedside. Pappas says that they are now piloting a version of the eICU for acute care settings.

“If we have an acute care unit that maybe has an increased number of nurse residents on the night shift or on the day shift, we want to be able to have them backed up with an experienced nurse on the other end of a monitor and a telephone, so that they're actually able to see the patient through cameras and technology to actually support the nurse right there at the bedside,” Pappas explains. “So, we're piloting that at one of our hospitals and look forward to seeing what we learn from that.” 

“We're also looking at other people who are providing care at the unit level,” she continues. “Take, for example, a clinical pharmacist. Is it always a requirement that a nurse or a physician perform a medication history, and how could we engage a clinical pharmacist or clinical pharmacy tech in order to collect a patient's medication history that would augment the physician or the nursing clinician that's on the unit?”

These are just a few examples of the many ways in which the pandemic has pushed health care systems to innovate new models of care.

“I don't think some of the workforce shortages would have occurred prior to the pandemic, and now what we're seeing is forcing us not only to think outside the box, but to think without a box,” Pappas adds. “We have actually been innovators because of necessity, and so I think that's been a real positive, and I don't look for us to go back. I think this is a new model, and a new workforce, and a new time.”

Recent News