Greeneville East

Greeneville Community Hospital East and hospitals across the nation are contending with a nursing shortage, providing an additional challenge with the pandemic.

The coronavirus pandemic is more challenging for Ballad Health and other hospital systems across the country due to a continuing nationwide nursing shortage.

During weekly briefings about the pandemic situation in the region, Ballad Health officials provide current hospital capacity statistics and have regularly commented about how a significant surge in cases would stretch available staffing and other resources, creating a challenging situation to care for both virus patients and individuals with other medical issues. That capacity has been over 90% for several weeks.

As part of its plan to care for COVID-19 patients, Ballad Health has shifted some nurses and other direct medical care personnel from its smaller facilities to one of the three major hospitals in the system.

Nurses and other personnel from Greeneville Community Hospital East have been transferred temporarily to Johnson City Medical Center to care for patients in its COVID-19 care unit.

For Greeneville East and the other hospitals, this results in less staff and thus rooms available for patients with medical issues other than the coronavirus. For the local facility, it is also coming at a time when hospital officials report a higher than normal patient volume for the summer as many people who are coming to the emergency room have waited to come, due to fears of catching the virus, until they are sick enough to require hospitalization.

Ballad Health continues to be proactive in taking measures to bring more nurses into the system and adjusting staffing levels to meet personnel needs in individual facilities.

While the coronavirus has caused some changes in efforts to promote the nursing profession to young people, plans are to resume those activities as the pandemic eases.


While the coronavirus has made the shortage more acute in many areas, it is not a new issue for hospitals across the nation.

Lisa Smithgall, chief nursing executive for Ballad Health, said hospitals have been facing a nursing shortage for the past several years, and it is expected to continue at least through 2026.

“A catalyst of the shortage is that a large percentage of nurses are retiring,” Smithgall said. “The largest portion of hospital nurses are baby boomers. Some are moving out of hospitals to other places to reduce their hours as they reach retirement age.”

When most of the nurses of the baby boomer generation entered the field, a majority of the available jobs were in hospitals with a few positions open in doctor offices, she explained, so that generation has made up a large percentage of the hospital staff for years.

“We are now competing for nurses with other areas of health care,” she said. “On top of that, we are competing with the number of professions that are out there for women.”

Through the years, the places where nursing positions are available have increased, Smithgall said.

In addition, nurses have traditionally been women, and the professions open to women are much greater than when the baby boom generation entered the workforce, she continued.

Men are a larger presence in the nursing workforce in hospitals, Smithgall said, but still only 11%-15% of that workforce, depending on the region of the country.


Ballad Health is taking some proactive steps to increase the number of nurses in the region. One is to work collaboratively with nursing schools at the colleges and technical schools in the area. The health system is working with East Tennessee State University, Northeast State Community College and community colleges in Southwest Virginia to provide clinicians to teach courses in their nursing programs, Smithgall said.

These schools are facing the same issues as hospitals as many of their instructors from the baby boom generation are retiring, and they face challenges in finding people to teach those courses, which Ballad Health can help provide, she said.

Ballad Health is also providing scholarships to help nursing students with their tuition and other costs to finish their programs, Smithgall continued. In return for the aid, the students commit to working a set amount of years for the health system once they finish their program and are licensed.

Realizing that students look at a career field in middle school, Ballad Health has started a program to introduce middle school students to the nursing profession, Smithgall said. A large event in the Tri-Cities was scheduled for this year, but it will most likely be postponed until 2021.

The health system also works with high schools and technical schools to introduce students to the medical field and nursing and let them know what options are available to enter the field.

Sometimes, students think they cannot afford college but want a profession, she said. This program shows how they can enter the field by gaining licensure as a certified nursing assistant in high school, enter the workplace and seek further education for higher positions from there.

For employees of the health system, Ballad Health also provides financial assistance for them to enter a nursing program or to seek a higher level of licensure.


While promoting the profession to a new generation, Ballad Health is also working to address current nursing needs in several ways.

The health system has a floating pool of nursing staff who are sent to facilities with staffing needs, Smithgall explained. These staff members are offered a little higher pay than staff designated to a certain facility, she said, but they do not know where they are working until they receive their daily assignments.

As in the COVID-19 pandemic, Ballad Health has temporarily shifted some personnel due to needs that have arisen in the past, but those staff are sent to a facility as close to their own as possible, Smithgall said. Those in the floating pool can be sent anywhere in Ballad Health’s 21-county service area.

Registered nurses are also offered special compensation to take on extra shifts above their regular time, she said.

The system also uses contract nurses to help provide additional caregivers. Popularly known as “traveling nurses,” these professionals work under contract for a temporary time to provide care in the hospitals.

Executive orders in regard to licensure issued by Tennessee Gov. Bill Lee’s during the pandemic have allowed Ballad Health some other helpful tools to address nurse staffing.

Some states grant a nurse’s license that allows the individual to work in that state as well as others. Tennessee, Virginia and North Carolina have that type of license.

However, there are some states that grant a license that allows a nurse to practice in just that state but not any other, Smithgall explained. Lee’s executive order allows people with licenses from those states to practice in Tennessee.

Another executive order addresses an issue that arose as testing centers for the State Board of Nursing licensure exam closed due to the coronavirus.

With those closures, nurses who had just graduated or finished their programs were not able to take their licensure exams, Smithgall said. As the testing centers have reopened, there are some delays in scheduling due to the number now who need to take exams.

Through the executive order, hospitals can employ nurses who have successfully completed their course of study at the academic standard that makes them eligible for the licensing exam, but have not been able to take the test.

The nurses’ continuing employment is based on whether they obtain licensure once taking the test, but the order allows them to work until that time, providing needed staff, Smithgall said.

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