Pulse Check Wisconsin-Insights from a Milwaukee, ER Doc

Episode 4- Special Episode-Nursing Shortage/Gov. Tony Evers

• Chris Ford

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Welcome to Pulse Check, Wisconsin. Good morning, good afternoon, good evening, whatever it may be for you. This is Chris Ford again for Pulse Check Wisconsin. For those who are just now picking up the podcast or are new to the podcast, I'm an emergency medicine doctor here in the city of Milwaukee. And I practice kind of all throughout the state of Wisconsin as well. And I want to thank you for joining us here today. First things first, I want to do a little bit of housekeeping. I want to thank everyone for listening up through this now fourth episode here. You know, I, I can't thank you enough for listening. I can't thank you enough for your feedback. I've gotten a lot of good feedback over the course of the first couple episodes. And you know, I want to thank you for, for making us, you know, now One of the fastest growing healthcare podcasts in the state of Wisconsin. We have had some very great guests on with us who have covered a wide breadth of information about substance abuse treatment therapies about the pandemic, kind of the inter- governmental workings of medicine and touching on those social determinants of health as well. Which we set out as our goal for this podcast initially. And so we're going to continue on with that same course. Today is a special episode. And so we're going to break up some of the episodes into some of these special edition episodes as well where we are going to kind of focus in on a specific topic. So today there won't be a case as we typically will do. But what we'll do is we are going to touch on one of the issues that's affecting our state here in Wisconsin, as well as throughout the country. And that is the nursing shortage that we are experiencing have experienced over the last couple of years and estimated to. Increase in its severity over the next several years. And so, you know, just to kind of give you some background about that, what we want to do is we want to, of course, retain the absolute most nurses that we can here in the state of Wisconsin over the last several years what we've seen in the emergency departments kind of pre COVID as well as post COVID we've seen boarding in the emergency department and what boarding is is essentially when you have a patient who is in the emergency department after the patient has been admitted or placed into observational status at the facility, but has not transferred to an inpatient observational unit. And so that patient essentially is held in the emergency department. Many emergency departments throughout the country, as I said before. Have experienced this kind of critical overcrowding and heavy emergency resource demand over the last several years. During the pandemic, we saw a large number of our nursing staff dwindle you know, either secondary to burnout or secondary to being lost to travel contracts to other states here in the state of Wisconsin, we were really hit hard. I know my hospital the hospitals that I worked at were hit hard as well as my colleagues throughout the state as well. So no one was safe from this epidemic of loss of nurses. And so To be honest, you know, there, there's multi factorial reasons as to why we're experiencing this shortage. I know a lot of friends of mine, a lot of colleagues of mine who who have nursing backgrounds will, will kind of attest to this and tell you that, you know, some of it has to do with some of the ratios that they have that they experience. And what I mean by ratios meaning how many patients there are they're being forced to carry during a shift secondary to those shortages. And again, that's not something that is unique to the state of Wisconsin. I have colleagues of mine who've worked down, you know, in Florida or, Pennsylvania, Ohio, Texas in which, their ratios for. One nurse for, you know, four patients, which is the norm has been extended to, one nurse for every eight patients or 10 and in those situations. You, you get that overcrowding which is something that, that creeps up and, and because of that we have more and more patients that stack up in the emergency departments and patients that aren't able to go to the floors because again, the floors too, are being strapped with a number of providers, a number of nurses that are there as well. And so, it's something that. I wanted to focus on because it's something that is going to affect your day to day and I wanted to give you a little bit of background into you know, why your wait times in the emergency department may be so high and talk about some of the things that we are doing in order to alleviate that. We're all working at the ground level on as well as the policy level to try to alleviate some of the stresses that are placed on the emergency department and the hospitals due to shortages and due to boarding. One of the measures that we're seeing here in the state of Wisconsin is a task force which has been developed. It's a healthcare task force in order to address the nursing shortage. We're estimated to have a deficit in the upcoming years of about 20, 000 nurses here in the state of Wisconsin. And so our governor here in the state of Wisconsin initiated an executive order in January of 2024 in which he placed our Lieutenant Governor Sarah Rodriguez in charge of spearheading this task force in order to promote A retention of nursing in the state of Wisconsin, as well as to facilitate a pathway into the nursing field to remedy this issue as best we can. The task force as we'll discuss a little bit more has folks from all over the allied healthcare profession. We have, you know, chief executives, we have doctors, we have nursing staff A host of people that are coming from all over in order to help retain our vital nursing staff here in the in the state of Wisconsin. And so with that being said what we will do is we will introduce our guest. You don't need to hear it from me. I want you to hear it from the source directly. And so Our next guest is a former educator here in the state of Wisconsin a Wisconsin lifer and in looking at the bio that I have in front of me, it looks like he is a bobblehead enthusiast, which I did not get a chance to ask him about, but I'll promise, you know, when we have him on in the future, hopefully we can ask him about that specifically a little bit more. So. With that being said, I won't waste any more time. I'd like to introduce you to the 46th governor of the state of Wisconsin, Governor Tony Evers.

Chris :

All right. Well, Again, thank you, Governor Evers for being here with us. It's a bit off topic, but as we were talking about before, I want to thank you personally for your role in securing fair maps in the state of Wisconsin for the first time in over a decade.

Gov Tony Evers:

Yeah, the, the people, well, people, the people of Wisconsin will have a better way to interact with, with government and, uh, and making decisions. And so that's what it's all about, frankly.

Chris :

So,

Gov Tony Evers:

thank you.

Chris :

Absolutely. Absolutely. Well, you know, just I know you got a tight time frame here. So we'll go ahead and get to the to the chase here in the beginning of the intro. What we did was we talked about. Some of the nursing shortage in the state of Wisconsin, and I just wanted to read off some of the statistics here. But according to the recent data that we have, it's estimated to be a shortage of about 20, 000 nurses by 2040 here in the state of Wisconsin. And as we've seen, you know, with our recent nursing shortage, it would be devastating for an strained already essential workforce. In order to combat this, it looks like as of January, you signed an executive order to create a task force on the healthcare workforce. Uh, so I just wanted to just reach out and see, if you can expound on what the role of this task force would be and how that would garner more nurses here in the state of Wisconsin.

Gov Tony Evers:

Yeah. And, and we have both, uh, uh, DHS secretary, Kirsten Johnson is part of that. And, and Amy, uh, uh, Pechacek from the department of workforce development. They're serving as co chairs of that. And we anticipate that this This group will be able to meet with folks because it's, it's a good work working group. They have, we have nurses on it. We have EMS folks on it, community health folks, you name it. So it's a good, good purpose. But I can also tell you, but Bringing this out and starting this workforce, uh, task force is really, really important healthcare task force because I've seen, I've seen results already. Uh, I, I visited, I think probably five or six. Uh, areas of the state where, um, the technical colleges and the UW system, uh, are working together. I, I, I'll use lacrosse as an example. They've completely really ramped it up. They have a good, uh, the tech, the technical college, they're working with UWL too. And they're, they're having, they're starting, they're, They were starting new classes of nurses, um, like every six months instead of once a year. So they're like doubling the numbers already. So I think, you know, is this going to solve everything in a quick way? Uh, you know, we, we've got, we're an aging population and there's going to be nurses. That are aging out too. So having this good start is important, but we have the right people together already and on the task force, they're doing good work. I was talking to the Lieutenant Governor this morning about that. But I also think that just having this discussion has caused. The technical colleges and the universities working together, uh, in a really interesting way, like UW Stevens Point and North Central Technical College, they have, they put together a four year program. Uh, the first years at the university, two years of, um, at the technical college, and they're ready to go out and work right then if they want to, but then they can, they can, you know, go into the workforce, which many are going to be doing that right away and then coming back for that last year. So there's. All sorts of really good, thoughtful things that are happening across the state. So I think we're headed in the right direction, but we have a long way to go.

Chris :

Yeah, I agree. And you know, just speaking as a healthcare professional, especially during the pandemic, it was devastating. The amount of nursing shortage that we had, we lost a lot of nurses across, uh, state lines as well. With the travel nursing. And so I agree with you. I think it kind of, you know, goes hand in hand with some of our boarding crisis issues that we have throughout the country, not just in the state of Wisconsin, but also felt here as well.

Gov Tony Evers:

Yeah, absolutely. And you bring up a good point there. We have DACA folks here in the state of Wisconsin that could really help us. You know, they're already our physicians or nurses or other, other trained professionals in the healthcare world. Absolutely. That because of their DACA status, it's, it's not happening. We we're working to find, you know, we try to get some legislation through, uh, last, last session. It didn't work. We're trying to see if there's other ways to get them licensed, but we're going to do everything we can. I mean, this is, this is a, uh, you know, you think about how it's. Relatively stable. The health care industry has been over the years and, you know, now we have a situation in Eau Claire where we're, you know, I have two hospitals going belly up, uh, uh, and closing their doors quickly. And so there, you know, there's a lot of people that are now finding other jobs, obviously, but the system, the systems themselves are struggling and, uh, and. And one of the biggest struggles obviously is having the appropriate number of people there.

Chris :

Yeah, and one of the things that you mentioned too was Lieutenant Governor Sarah Rodriguez will be leading this task force and for those who aren't familiar with her background, she has a background in public health and health care administration as well as a nursing background at the ground level. Um, you know, I think that having her helming the ship is going to go a long way looking at this issue from a multitude of different perspectives and again, hoping to garner. Uh, some results in, in going forward.

Gov Tony Evers:

Yeah, absolutely. She's obviously her background is perfect for this, uh, this task. And no, I, I, I feel positive, but it's just, you know, 20, 000 is 20, 000. That's a lot of folks. And, uh, and so, you know, having the start that we've had is good, but we're going to have to find ways to, uh, and we also have to find ways to bring back the drive or traveling nurses that you mentioned, uh, that, You know, clearly. Uh, finances played a role role in that. Uh, and, uh, and so hopefully, uh, when we can find the resources to make sure that people are paid a good wage here so that they don't become traveling nurses to Texas, we want them

Chris :

to,

Gov Tony Evers:

we want them to work here,

Chris :

right. Have there been any legislative barriers to addressing this, shortage in, in recent, recent months? Yeah,

Gov Tony Evers:

well, the last budget was not particularly helpful and, you know, I'll use the DACA, uh, as an example, uh, legislature has difficulties understanding how important those young people are to, uh, our, our, our economy and, but, uh, we, we got zero help on that. And so, you know, I think. I think people understand the differences, but, uh, sometimes it's hard, sometimes it takes two, two or three efforts to convince them of it. So we'll keep trying. I mean, we have, we have, we have the money, uh, there's, there's, we have a good surplus in the state of Wisconsin. So hopefully we can get the legislature behind us on this. The Republicans, the Republicans in general. And to be frank with you, uh, the FairMaps will help us.

Chris :

Yeah. And, you know, in upcoming episodes, I'm going to highlight, uh, some of how representation in the FairMaps and how that actually feeds into not only your day to day, but into your health care is one of the reasons why I get involved with trying to promote FairMaps as well. But, you know, a lot of folks understand how those things go together. And again, it kind of. emphasizes the importance of, your passage of fair maps and how that will hopefully down the road affect the folks in the state of Wisconsin.

Gov Tony Evers:

Absolutely. If you have competitive races and people have to lay it out to people, uh, that, that are voting for them and healthcare will be obviously one of those issues. So yes. That will, that will be on the agenda, uh, for, for people all across the state. If they want better healthcare, we, we need to make sure that the people that are sent to Madison are ready to, uh, ready to do that good work.

Chris :

1 of the things that you mentioned, too, was the nurse apprenticeship initiative that was developed in partnership with University of Wisconsin, Green Bay, and the goal was to train over 10, 000 certified direct care professionals, through that program. And as you said, there was a couple of, community, uh, available programs as well. What are the goals for that other than kind of increasing the amount of nursing students and will, there be any kind of reciprocity between any of the health care companies in the, in the state of Wisconsin,

Gov Tony Evers:

yeah, we have to get them involved. In fact, right after we're done here, I'm going over and talk to the folks at the, Hospital Association and, uh, and, you know, encourage them to work together on this issue, obviously, uh, taking a, uh, a nurse from one, one system to another and, and, and, uh, paying them more and, you know, that movement doesn't help, frankly, we, we, we need a, we need a statewide approach to this. And so I'll be encouraging them as leaders in the healthcare industry to, uh, kind of get behind this also.

Chris :

Absolutely. Well, governor, I know you have to run to another interview and I want to thank you again personally for taking the time out here today. I think it'll go a long way and helping folks understand the shortage that we're up against. Any, any advice for folks who want to get into these programs or advice for anyone who wants to help out with the shortage in general.

Gov Tony Evers:

Yeah, I would, I would, I would make sure that if anybody's interested in that, that they follow the work of that. Of that task force. And, you know, contacting directly the, uh, Lieutenant Governor or, or the Department of Health Services. You know, I think that work and the work that will come out of that, if people have questions and want to be involved, that'd be the place to go.

Chris :

Awesome. Well, thank you, Governor Evers, I appreciate your time and thank you so much as always.

Gov Tony Evers:

All right. Thanks a lot, Dr. Ford and keep up the good work.

Chris :

Thank you.

Gov Tony Evers:

Yeah. Bye bye.

I wanted to share a story that is present on the ACEP website. So ACEP is one of our national governing bodies in emergency medicine. It stands for the American colleges of emergency physicians who have been very vocal. And have been steadfast advocates in addressing some of the nursing shortage issues that we're experiencing as a country at a federal level as well as a state level and has also been instrumental in Creating a soundboard for health care professionals and emergency physicians to speak on some of the issues that they're having in their emergency department throughout the pandemic. And currently it should be known that. As of the beginning of this year, you know, roughly around 90 percent of emergency departments throughout the country are experiencing some form of boarding. And a lot of it has to do with some of the nursing shortages as well. And some of the bed shortages that we have at the admission side and so, I wanted to speak on a story that is posted to the ACEP website. I'll link that as well if you guys want to take a look at it. But it is an amalgam of cases and testimonies that were collected from a lot of physicians throughout the state throughout the country. That spoke on some of the emergency department boarding stories and some of their experiences. z So the name of the story is not safe and it is written from the perspective of an ER doctor who has been working for many years in the emergency department and is seeing some changes that are affecting the care of the patients due to some of the boarding issues. So it goes, I'm a steady nighttime ED doc for many years now. I work in a 34 bed ED at night. We normally staff enough nurses, a PA or a nurse practitioner and myself for 20 patients. We calculate one nurse to four patients. Unfortunately, over the past year or more, we have had nights where we hold 20 or more patients in the ED waiting for beds. Some are ICU patients in the unit. They will normally have one nurse. To one or two patients. Our nurses will have one or more sick patients that take lots of work and at least three other patients, some nights, seven patients to one nurse, this is not safe. I wanted to highlight that story to sort of typify what is going on in real time emergency departments throughout the country and some ERs here in the state of Wisconsin as well, to give you a better understanding of some things that the emergency providers are up against, as well as to bring on the governor today to talk about some of the things that we are doing at the state level to try to remedy some of these issues. So rest assured that folks in the allied healthcare professional realm are working hard to try to come up with innovative ideas to. Help us with the throughput of patients in the emergency department to help reduce the amount of time that you have to wait and to make your condition safer while we are there. And while you are there, I should say and rest assured in knowing that the task force is working hard here in the state of Wisconsin and we should be hearing at the end of this year, I want to say and into 2025, what their findings are and their suggestions are for the state of Wisconsin so that we can again push forward to retain our much needed Nursing staff here in the state of Wisconsin. So with that being said, thank you so much again for joining us here today. I want to thank governor Evers for coming out and speaking to us as well. We are going to continue to press on the issues that are affecting your health here in the state of Wisconsin. And we're going to continue to report on that and to give you some insight into what we are experiencing as a state and some of the ways out of it as well. I want you to continue to reach out. You can feel free to reach out to us at the Pulse Check Wisconsin website. Like, and subscribe to us on YouTube as well as X and Instagram. Please, please, please continue to give me your feedback. It has been very helpful thus far. We're going to continue to do the shortened episodes as well as the longer episodes with cases as well. That should resume. So stay tuned for that. We got some good guests up that are going to talk about more social determinants of health, as well as how your vote can really help. Tailor your healthcare experience and how that contributes to some of the population health and public health as well. So stay tuned for that until that time again, as always, take care of yourselves, take care of each other. And if you need me, come and see me.

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Chris Ford, MD FACEP

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