CHI Health Good Samaritan

KEARNEY — Because of a nursing shortage, a unit offering rehabilitation services has been closed at CHI Health Good Samaritan.

The hospital has notified the state of the closure of the Transitional Care Unit. “It was a hard decision but allows our focus to remain on hospital-based, acute care,” Good Samaritan CEO Michael Schnieders said.

TCU, previously located on the fourth floor of the main hospital building, was a separate, skilled nursing facility that provided short-term, skilled nursing care to medically complex patients, rehab patients and end of life care patients. The unit was licensed for 22 beds and had 24 staff members. Because of staffing challenges, the hospital was limited to care for only 16 patients at a time.

“As a skilled nursing unit, TCU works very differently than any other unit of our hospital,” Schnieders said in an email to the Hub. “It is not an acute unit, but more like a nursing home. Unlike the other nursing homes here in town, it happens to be located inside the walls of the hospital.”

Now that the TCU has closed, the hospital will relocate the Inpatient Rehabilitation Unit from the second floor into the fourth floor.

The hospital CEO cites the national nursing shortage for the cutback.

“Our TCU provides exceptional care and the staff are amazing, however, we simply need more of them. ... For a while now we’ve been unable to fill open nursing positions,” Schnieders said.

According to the American Nurses Association, registered nursing positions are close to the top of the list when it comes to employment growth. Registered nurse is listed fifth by the Bureau of Labor Statistics of the U.S. Department of Labor as one of the occupations with the largest projected job openings because of growth and replacement needs.

The bureau listed the national number of registered nurses as 2,711,500 and the projected number by 2022 as 3,238,400. The agency projects there will be more than 1 million job openings from 2012-2022 as a result of the field’s expansion and the need to replace people leaving the workforce. The bureau lists about 21,240 registered nurses in Nebraska.

“The nursing shortage shines a light on the fact that health care is changing, and we need to look at new ways to provide care in the most efficient and high-quality manner possible,” Schnieders said.

Good Samaritan currently employs 530 nurses. There are 26 openings for nurses at Good Samaritan.

With the closure of TCU, some employees in that unit chose to leave. Those who remained were given the option to apply for open positions throughout the organization, Schnieders said.

No other units have closed, Schnieders said.

For those in need of the type of care provided by TCU, Good Samaritan began partnering with other skilled nursing facilities, such as some nursing homes, to provide care and service. The hospital did this by first limiting admissions to TCU then transferring the remaining patients to skilled facilities.

“Now, if there is a patient in our hospital who is ready to move to that level of care, our Care Management Department works with skilled nursing facilities close to the patient’s home to transition them there rather than TCU,” Schnieders said.

Staff has moved other units around the hospital as well. During flu season, the hospital’s Pediatric Unit remained steadily full but that’s not usually the case during the rest of the year, Schnieders said.

In early April, the pediatric rooms were moved adjacent to the Medical Surgical Unit to provide more staffing flexibility, he said.

“Nurses are cross-trained and can easily move between the combined unit. It utilizes our nursing workforce to the best advantage,” Schnieders said. “While there were a few kinks to work out in the beginning, this new model of care has been a success.”

This new model of care involves more cross training of nurses, ultimately creating more flexibility with a workforce that is in short supply, Schnieders explained.

Previously, pediatric nurses cared only for children and young adults. If there weren’t any of those patients in the hospital, the nurses went home. Now, with the department co-existing with the Medical Surgical Unit, the nurses can care for adults when there are no pediatric patients.

“At one time, hospitals across the nation provided skilled nursing care within their walls. Now, it’s rare to see that type of care offered in the hospital setting,” Schnieders said. “Other facilities in our community and region focus on this level of care, and that’s why we’re looking to partner with them to transition our patients to those facilities when there is a need.”

@AmandaPush