‘It’s not ok’: Ballad chief discusses emergency room delays, labor shortage


JOHNSON CITY, Tenn. (WJHL) – COVID-19 caseloads are as low as they’ve been in a year, but Ballad Health faces another pressing problem as people stream back in for delayed care — labor shortages that are creating long waits for patients needing hospital rooms.

A recent surge of patients and staff shortages have combined to exacerbate wait times to get from emergency rooms to

“To the patient that’s in that emergency room, it’s perhaps the worst day of their life, and it’s not acceptable to us to have unnecessary wait times in the ER,” Alan Levine, the hospital system’s CEO, told News Channel 11.

“We are well aware of it,” he said. “It is not okay and everybody from our nursing staff all the way up to my office is concerned about it, and we are taking actions to try to deal with it.”

‘We’ve got to solve this problem and it’s going to cost us a lot of money.’

Ballad health ceo alan levine on the system’s nursing shortage

It won’t be an easy fix, though. Burnout from being in the trenches during COVID-19 seems to have exacerbated a national nursing shortage that’s most pronounced in the South.

“About two months ago, is when we started to really see it, and it was the combination of nurses that are burned out and saying, ‘I can’t do this anymore after a year of COVID,’ combined with … this influx of patients that have been putting off care,” Levine said.

Patients and their families notice long stays in the hospital system’s emergency rooms, but Levine said the treatment of emergencies and the staffing for those departments aren’t the actual cause.

Ballad Health CEO Alan Levine

Rather, the system doesn’t have enough people to adequately staff current demand for the “med/surg” floors where people go if they do wind up getting admitted after presenting at the ER.

Levine said most Ballad ERs are performing as well or better than state and national averages for wait times to treat the actual emergency.

“Where on a med-surg unit you have a nursing shortage, you don’t want to overload that nurse and create an unsafe situation for a patient,” Levine said. “And so at some point, you limit the number of patients that can go upstairs. They end up staying in a bed in the emergency department, and when that bed is occupied, then all of a sudden that creates the backlog.”

State lawmaker — Staffing is number one constituent complaint about Ballad

Tennessee State Representative David Hawk (R-Greeneville) said constituent complaints about Ballad are common — and that inadequate staffing levels creating long waits is by far the most frequent lament.

“I don’t know if that’s a function of how much our nurses are being paid or support staff are being paid, or if it’s just availability of nurses,” Hawk said of the shortage. “That’s the biggest issue that I’ve got and constituents have at this moment.”

The problem impacts Greene Countians in a couple ways, he said. The first is how fully staffed Ballad keeps “Greeneville Community Hospital East” (the former Laughlin Memorial).

State Representative David Hawk (R-Greeneville) discusses how Ballad hospital staffing shortages have been impacting patients in Greene County.

Staffing at that smaller hospital “will dictate whether you’re hospitalized in Greene County or whether you have to go to Johnson City or go to one of the other facilities.”

The bigger issue, Hawk said, are overall shortages that leave even patients who will be admitted in Greeneville waiting an awful long time after reaching the ER.

“You’ve got wait times that are going near to 24 hours in many instances, on a repeated basis,” Hawk said. “Week after week after week I’m getting concerns about redundant long stays in the ER.”

Turning to the front lines for advice

Levine said the system — which has increased bedside nursing pay several times over the past couple of years — currently finds itself in “a race to get ahead of the turnover.”

Late last month, Levine spent a couple of hours with a group of nurse managers at Johnson City Medical Center, one of the system’s flagship tertiary hospitals.

“Just to hear their concerns, their stories and their suggestions,” Levine said, adding that those suggestions “were really good.”

One young assistant manager, for instance, said she was willing to return to her alma mater and help recruit.

“We have thousands of nurses,” Levine said. “My guess is they came from probably all 50 states or close to it. What an amazing opportunity to have them be ambassadors for Ballad Health, to go back to their programs — and why not incentivize them to help bring nurses to this region from those communities?”

But Levine knows there isn’t a magic bullet, or even a six-shooter full of them, that will solve the problem.

“We’re competing with contract nursing agencies that are paying five times what we can pay,” he said.

A job fair at Ballad Health, where nursing shortages are driving long wait times in emergency departments as patients wait for beds to open up on regular floors.

And in fact, Ballad is having to rely on many of those travel nurses. The system’s contract labor cost through the first three quarters of its fiscal year — to March 31 — was $60.2 million, a 50 percent increase from the same point the previous year.

Levine said the last thing he wants is for new recruits to walk into an overwhelming situation.

“It’s about making sure that we have certified nursing assistants to support them, that there’s enough nurses so that they can have a patient load, they’re comfortable with and that’s safe,” Levine said.

What about the wait times now?

Levine admits the challenge is a long-term one. Drive-thru job fairs like one Ballad held June 1 and young nurses trying to convince people back at the alma mater to come work in the mountains don’t do anything for a chest pain patient who will end up needing a defibrillator and gets stuck in the ER for hours on end.

“Any ER wait to us is unacceptable,” Levine said. “We will get it solved. But it’s unfortunate for the patients who are having to deal with the discomfort of waiting, and it’s not okay.”

He hopes that problem will ebb somewhat when the glut of post-COVID patients slows down.

But the system will need to come up with money to keep salaries competitive and perhaps find even more help. Levine mentioned increasing the number of nurse educators so newly hired nurses have more support.

“It’s my biggest concern, and honestly the financial considerations come secondary,” he said. “We’ve got to solve this problem, and it’s going to cost us a lot of money. I think our board’s focus is do what we’ve got to do to take care of the community.”

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