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Ballad Health ICU nurse Emily Egan works with a patient in the COVID-19 unit at Holston Valley Medical Center in 2020. Ballad officials say a shortage of health care workers that already existed has been worsened by the pandemic.

Even as the wave of COVID-19 cases in the region due to the delta variant of the virus begins to subside, Ballad Health facilities are still struggling with staffing shortages.

It’s an issue Ballad was struggling with even before the COVID-19 pandemic.

According to Ballad Health, the United States was facing a looming nursing shortage, with a projected 1.2 million new registered nurses needed in the country by 2030.

This shortage was already beginning to become evident before the COVID-19 pandemic shined a spotlight on the issue.

Ballad says the shortage pre-pandemic was caused by a large portion of the U.S. population being over the age of 65 due to aging Baby Boomers, people born between 1946 and 1964.

The growing number of senior citizens require more health care services. Seniors are also living longer as health care improves and becomes more accessible, requiring medical services for longer periods of time during their longer life.

The large population of aging Baby Boomers has also led to a significant portion of the nursing workforce being at or near retirement age, according to Ballad. As these older nurses retire, hospital systems are finding it difficult to replace them.

Ballad also says that career options for nurses have changed over the years. In the past, working in hospital inpatient units was the only main career path for registered nurses. That is no longer the case. Nurses can now seek opportunities in physician offices, private companies, schools and other organizations. These jobs tend to be less stressful than hospital environments, and they often do not require night, weekend or holiday hours. Ballad says that makes those jobs more appealing for nurses with families.


With hospitals already facing these challenges, the COVID-19 pandemic exacerbated the shortage and accelerated the need for more nurses.

Two years ago, before the pandemic, Ballad Health had approximately 350 licensed nursing positions vacant.

One year ago, in the midst of the pandemic, the system had around 475 licensed nursing job openings.

As of this month, for its current patient volume, Ballad Health has a deficit of about 600 licensed nurses.

According to Ballad, the COVID-19 pandemic has led to frontline clinicians being constantly barraged with surges of COVID-19 patients. The instability and stress led many employees to become burned out and leave their nursing positions.

Ballad says that during the winter COVID-19 surge from December 2020 to February 2021, its nursing staff was shorthanded but fairly stable. Most hospital needs were being covered. However, as 2021 went on and the delta variant drove a surge of COVID-19 hospitalizations beginning in July, Ballad began to lose nurses who did not want to work at bedsides anymore. At one point during the delta surge, Ballad saw four or five nurse resignations per week.

Trying to keep nurses on staff, Ballad has paid out $11.4 million in COVID-19-related pay incentives. Ballad has also invested about $18.1 million in pay adjustments for its health care workers.

Ballad has also committed more than $100 million over 10 years to increase nursing wages for frontline nursing positions.

“This investment was one of many steps we took to address the national nursing shortage, with the U.S. federal government projecting, even prior to the COVID-19 pandemic, a shortfall of 800,000 nurses in 2020. This particular wage increase applied to a variety of nursing positions, including acute care registered nurses (RNs), licensed practical nurses (LPN), certified nursing assistants (CNAs) whose primary responsibility is direct inpatient care, scrub techs, longterm care LPNs and CNAs, clinic LPNs and certified medical assistants, behavioral health techs and telemetry techs,” Ballad said in a statement.

Still Ballad is looking to do more to bring more nurses into its hospitals.

“We’ve also focused a great deal of effort in recruiting new team members to Ballad Health, hosting drive-thru job fairs that allow candidates to learn about jobs, apply, be interviewed and receive job offers – all from their vehicles,” Ballad’s statement says.


As staffing shortages have persisted throughout the course of the pandemic, Ballad has also been forced to pay for expensive contract nurses also known as “travel nurses.”

Ballad says that prior to the pandemic, the system had fewer than 75 temporary contract nurses filling holes in its usual roster of 3,500 acute care nurses.

In August 2020, the number of contract nurses working in Ballad’s system had more than doubled to 150 contract nurses.

By August 2021, the number of contract nurses had reached 450.

According to Ballad, contract nurses typically work 13-week stretches and previously made double or triple the amount of money permanent staff nurses make.

Now the math has changed.

As hospitals across the country compete for contract nurses to fill their many open jobs, Ballad has found itself having to pay up to seven times as much as it normally would for contract nurses.

“With nurses burning out, staying home to care for family or quitting to become contract nurses themselves, Ballad Health has no choice but to pay the additional wages,” Ballad said in a statement.

Ballad has also required assistance from the National Guard during the most recent surge of COVID-19.

In August, 20 National Guard members arrived at Johnson City Medical Center to assist medical staff, and in September an additional nine Guard members arrived to help the staff at Holston Valley Medical Center in Kingsport.

These National Guard members served in a variety of roles, evenly split between administrative and frontline care.

MANDATES AND STAFFINGPossible COVID-19 vaccine mandates through the Occupational Safety and Health Administration and the Centers for Medicare and Medicaid Services have Ballad concerned.

“While vaccine mandates could solve some of the problems created by the COVID-19 surge, it could create more of a problem with staffing scarcity,” Ballad said in a statement.

About 63% of Ballad’s employees are vaccinated, and Ballad leaders say they continue to encourage their employees to get the COVID-19 vaccine.

However, Ballad is worried that a vaccine mandate could cost them personnel among the 37% of their employees who are unvaccinated.

“We do not want to make a bad problem worse by losing what might be between 5-10% of our staff. It would supplant our ability to care for patients,” Ballad said. Ballad based its estimated employee loss on an analysis of other health systems and East Tennessee’s vaccination health profiles.

“Ballad Health’s concern with mandating COVID-19 vaccines for remaining team members is a practical one. We have to ensure we have staff to take care of the patients in our facilities. Our primary concern is to ensure we have the staff to care for everyone who needs us,” Ballad said. “Every corner of the country is different. We’re in a rural area where, if we lose even a little bit of our staff because of the mandate, it puts us in an extremely precarious position.”

Ballad says that rural hospitals are facing a tougher challenge when it comes to staffing and recruiting new staff.

According to Ballad, a June report by the federal Health Resources and Services Administration (HRSA) found rural regions make up 60% of areas facing shortages of health professionals. Ballad also says that rural areas have larger aging workforces and populations with smaller salaries and more intense workloads.


Ballad is not sure how long the shortage of nurses will last, but is trying to grow the pipeline of young available nurses.

“We’ve been very proud to work with our local higher education institutions to bolster the number of clinical faculty available, as well as the availability of health care institutions for students to complete their clinical rotations,” Ballad said.

Ballad Health currently has both full-time and part-time job openings at every one of its inpatient facilities, outpatient services, and physician groups.

There will be a drive-thru hiring event at Greeneville Community Hospital from noon to 4 p.m. on Tuesday. Ballad will specifically seek to fill positions in nursing, nursing support and various technician roles, but applications will be accepted for all positions.

Job openings include long-term care licensed nurse practitioners, respiratory therapists, registered nurses, medical lab technicians, nursing assistants, certified nursing assistants, phlebotomists, patient service representatives, physician practice licensed nurse practitioners, radiologic technicians and engineering technicians

Ballad encourages anyone who might be interested in working at a Ballad facility to visit

As Ballad Health continues to grapple with staffing shortages, its leaders want to make sure that area residents are not going to emergency rooms unnecessarily. According to Ballad, seeking the appropriate level of care for preventative and low-acuity health issues or injuries, such as going to a primary care doctor or an urgent care center, can help alleviate the strain on the health care system.

Otherwise, Ballad officials say, East Tennesseans can do two things to take the pressure off the hospital system: get vaccinated and to be kind.

“One of the best things people can do is get their COVID-19 vaccine. The vaccine is highly effective at preventing hospitalizations, which would relieve a great deal of pressure on our hospitals and team members,” Ballad said in its statement. “Above all, please remember to treat health care workers — and everyone around you — with grace and patience as we work through an unprecedentedly difficult time.”

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