An ongoing staff shortage at Western State Hospital in Staunton continues to affect operations. WMRA's Randi B. Hagi has the latest.
This story is part of an occasional WMRA grant-funded series on mental health issues.
The state-run psychiatric facility Western State Hospital has been short-staffed for months on end. Last July, the Department of Behavioral Health and Developmental Services stepped in and halted civil admissions there and at four other public psych hospitals. And while they were able to resume taking in new patients by September of last year, they've had to keep a close eye on staff-to-patient ratios ever since.
JONATHAN ANDERSON: We discharge someone, we bring another person in, and we look at the ratios, and if we're able to push the census up, we'll keep taking admissions until we reach the capacity for those safe ratios.
That means their total patient capacity is a constantly moving target. Dr. Jonathan Anderson is the hospital director.
ANDERSON: If we look at the three types of positions that we're most interested in right now … which are psychiatric nursing assistants, the so-called PNAs, and then look at licensed practical nurses, LPNs, and RNs – all of those positions are running vacancies from 30 to 60%, so we have had to hire contract workers and have at least, I believe, over 40 contract positions to bring our vacancies down to between 25 and 50%, depending on the role.
They have agreements with two companies that bring in nurses and nursing assistants on three- to six-month contracts, as well as a longer-term, international nurse recruitment program.
Two nurses spoke with WMRA about the day-to-day conditions at Western State on the condition of anonymity, and I asked Anderson about some of the claims they made. He confirmed that one unit is completely closed because there aren't enough employees to staff it. I also heard that, sometimes when a patient has to be put in restraints and monitored individually, that will leave 20 or so patients on the floor under just one staff person's supervision.
ANDERSON: It's accurate that when somebody is so unsafe that they have to be restrained or secluded that you need dedicated staff for that one patient to make sure that that person's safe. We try to pull in extra staff to replace those people, so that we have, you know, appropriate numbers on the unit to monitor the rest of the patients.
Anderson said that other stressors include inclement weather, such as the recent snowstorms that prevented several employees from getting to work, and COVID surges.
ANDERSON: When you're in the midst of an outbreak, you lose staff to being quarantined and being sick, and the less that that happens, the more consistent staffing we'll have. So I'm optimistic that the numbers are coming down enough that we could expect that in the next month or two, that things will look much different.
One nurse told me that they regularly get mandated overtime to have enough hands on deck – but Anderson said that's just a long-standing reality of the industry.
ANDERSON: I mean, unfortunately, that always happens in a place that has to be staffed 24/7. So we try to avoid all of those things before we mandate people, and we try to cap the amount of time that people spend at the hospital, so, yeah, unfortunately it's necessary at times but we try to find ways to avoid it as much as possible.
He sees increasing salaries as their ticket out of the staffing crunch.
ANDERSON: We're hopeful of some of the initiatives in the General Assembly – the main one having to do with bringing nursing staff salaries up to be competitive. The hard part for us is just competing against the local private hospitals. Competing against this sort of runaway train of traveling nurse services that's out there, and once we can pay our nursing staff better, we're hoping that that will both retain people and recruit people moving forward.
Angela Harvell, deputy commissioner for facility services at the Department of Behavioral Health and Developmental Services, said they're trying a number of strategies to improve staffing levels at facilities across the state.
ANGELA HARVELL: … Changing the way that we advertise for positions, offering the retention bonuses, sign-on bonuses. We're even taking a look at shift differentials, critical pay for staff that are working in those areas identified as having the most need.
That includes directly lobbying for more funding from the legislature.
HARVELL: We have certainly advocated at every possible step with the General Assembly members to share with them our current situation and the need to become more competitive in this industry to be able to continue our mission, particularly for folks that are waiting in the EDs and in need of inpatient treatment … They have certainly been engaged in our conversation, and willing to listen.
Harvell said they've been asking good questions – and that gives her hope.
