By Liz Carey for The Daily Yonder. Broadcast version by Nadia Ramlagan for North Carolina News Service, reporting for The Daily Yonder-Public News Service Collaboration.

Rural hospitals, already struggling with financial strains due to COVID-19, face an even more significant threat, experts say: the workforce shortage.

Hospitals say they are short on workers in all areas of the health-care system, not just the clinical ones. According to the American Hospital Association, about 20% of all hospitals across the country expect worker shortages to reach dire levels.

"It (the pandemic) has really stressed the workforce in ways that we're not going to recover from for decades," said Julia Harris, a senior policy analyst with the Bipartisan Policy Center. According to Haris, 2021 saw the biggest drop in the number of nurses in the workforce in history. Over 100,000 nurses disappeared from the hospitals' nursing supply, putting a lot of pressure on smaller facilities to hire nurses.

"But then, the smaller rural hospitals really can't compete dollar for dollar with other centers and so workforce is their number one expense," she said. "When we're talking about competition to keep the people needed to run a hospital, it's very scary to think about what they're going to do when the federal funds dry up."

The pandemic hasn't stopped causing workforce issues, said Dr. James Hoekstra, president of High Point Medical Center, during a webinar hosted by the North Carolina Healthcare Association.

"The stresses that were put on the health-care systems, especially the rural hospitals, during the pandemic are actually continuing," Hoekstra said during the webinar. "We have lost a lot of providers to retirement. We've lost a lot of providers to going to different areas of the country to travel and earn more money. We've lost a lot of providers and staff to burnout and what we've been left with is a situation where we've had to hire a lot of what we call travelers or contract labor."

That leaves the hospital with higher costs.

During the pandemic, thanks to federal Covid funding, rural hospitals were able to pay top dollar for travel nurses, sometimes paying as much as $200 per hour. Those salaries were subsidized with federal COVID relief funds. Now, all hospitals pay between $7,400 and $1,400 per week, according to Vivian Healthcare, a health-care labor placement company. And with COVID funding drying up, hospitals are responsible for all of those fees.

Whitfield Regional Hospital in Demopolis, Alabama, lists a travel nurse opening on Vivian for just under $1,700 a week - which includes a more than $900 a week salary, plus a nearly $700 a week tax-free stipend for a 13-week assignment. The hospital currently has 20 openings for full-time nurses.

According to a Vivian spokesperson, staff nurses traditionally make far less than travel nurses. Currently, the national average for a staff nurse is about $37 an hour, while travel nurses make on average $3,600 a week, the spokesman said in an interview.

"Rural hospitals pay more generally, especially factoring in cost of living (e.g. Houston average weekly is $2,761. Lubbock, Texas, is $2,831). During the pandemic, wages have shown the strongest correlation to COVID case counts rather than geography," the spokesman said.

At Northeastern Vermont Regional Hospital in St. Johnsbury, Vermont, nurse positions start around $30 an hour, CEO Shawn Tester told Kaiser Health News. At the height of the pandemic, the hospital paid staffing agencies around $175 per hour. Now that fee is down to over $100 an hour, he said, but the hospital is working to negotiate that rate down further.

According to the U.S. Bureau of Labor Statistics, U.S. health-care organizations will need to fill nearly 200,000 nursing positions every year from now until 2030. Some studies even project that the country will face a shortage of more than 29,000 nurse practitioners by 2025.

Vivian's research into nursing shows the outlook for clinical staffing doesn't look good. Nearly 65% of the 3,000 nurses they surveyed said they were looking to transition out of the profession in the next five years. Almost half (44%) said they felt like their unit is short-staffed "all the time."

National organizations hope Congress will step in to do something about it.

In a letter to U.S. Reps. Rosa DeLauro, D-Conn., and Tom Cole, R-Okla., chair and ranking member of the House Subcommittee on Labor, Health and Human Services, Education and Related Agencies, the AHA said that 781 hospitals across the country, or 18.9%, said they would face critical staffing shortages.

"While the nation may be rounding the corner in the battle against COVID-19, the health-care workforce continues to contend with many immediate challenges related to the pandemic, as well as a health-care landscape that has been deeply altered," the AHA wrote.

The AHA is asking Congress for $1.51 billion to fund health-care workforce development programs for the 2023 fiscal year's budget, including $374 million for rural health programs. The request represents an increase of $43 million over levels approved in 2022.

"Rural health programs... are vital to ensuring that needed services remain available in America's rural communities," the AHA said. "We also urge Congress to support funding to establish a Rural Emergency Hospital Technical Assistance Program, to support rural hospitals who are making the transition to maintain critical services for their communities."


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The U.S. Department of Agriculture will soon require electronic eartags for cattle and bison that cross state lines.

The USDA says its rule will affect some 11 million cattle, or about 12% of the nation's herd.

But the controversial eartag mandate is worrying some small ag producers, like Judith McGeary - a Texas rancher and executive director of the Farm and Ranch Freedom Alliance.

She said it's expensive and unnecessary.

"We have a system that works well right now," said McGeary. "And USDA's own tests of that system show that a cow that crosses state lines can be traced back, in most cases, within an hour. That is more than sufficient."

The USDA argues it will prevent future epidemics, cut down on paperwork errors, and protect international beef exports. The rule is set to go into effect in about six months.

McGeary, who supports the position of the National Family Farm Coalition on this issue, said it will be easy for large meat companies to implement but challenging for smaller family farms, which could lead to more consolidation in agriculture.

Right now, the USDA is giving away electronic tags through state veterinary offices.

But McGeary said there are other costs with this rule for an industry already on thin margins, including the fact that technology keeps changing.

"For instance, we've had reports of a sale barn that went and got an electronic reader to handle the cows that were coming through with electronic tags," said McGeary, "and within a couple of years, couldn't find batteries for those readers."

She added that the rule could be expanded to more domestic herds.

Other stockgrowing groups have supported transitioning to electronic tags, which could cut down on quarantine times during outbreaks.

Multiple bills in Congress seek to block the USDA's rule, but they've yet to build much support.




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An Iowa nonprofit group helps ag-related businesses grow to serve more farmers and get more cover crops planted in the state.

Cover crops like rye and wheat are typically planted to protect the soil in winter months - and in and between row crops like corn and soybeans to control weeds in the growing season.

Practical Farmers of Iowa is making up to $10,000 available to farmers who want to commercialize their cover crop practice through the Cover Crop Business Accelerator Program.

PFI's Senior Field Crops Viability Manager Lydia English said while cover crops are good for weed control and soil health, most farmers who use them have another goal.

"Ninety percent of the time, it's to combat erosion, either wind or water," said English. "So, I think seeing that soil loss is really real - and that's a lot of value that we're washing down the drain, literally, that we don't need to, with a practice like cover crops."

English said PFI wants to plant 12 million of Iowa's 30 million acres of farmland with cover crops and thinks the accelerator program will encourage farmers to help reach that goal.

Iowa corn and soybean Farmer Dan Bahe owns a business that plants cover crops for its clients on about 7,000 acres.

He and his brother were already experienced farmers who have used cover crops for more than a decade, but Bahe said they used PFI's accelerator program to scale up their operation - especially by taking advantage of a personalized business coaching program.

"Helping us put a business plan together," said Bahe. "Ideas on creating a legal entity, marketing, branding. Because we were already established, but we really didn't have a game plan. We were just taking orders, going out and seeding cover crops."

The 2022 Census of Agriculture reported nearly 1.3 million acres of cover crops in Iowa. That's a 32% increase since 2017.

PFI's accelerator program is in its fifth year.

A ruling from a federal judge will keep Washington state growers from depressing wages for farmworkers this harvest season.

Judge John Chun has temporarily reinstated piece-rate wages - the wages paid for the amount of fruit a worker can pick in an hour, which can be twice as high as the hourly wage. It's a victory for domestic farmworkers, who have to compete with H-2A workers - foreign farmworkers allowed temporary visas who typically work for less.

Andrea Schmitt, Columbia Legal Services staff attorney, said growers offering the lower hourly wage can dissuade local workers.

"The grower then goes to the government and says, 'Nobody wanted my job! There's a shortage of local workers.' But the shortage isn't a shortage of local workers. The shortage is a shortage of local workers who want to do the job for a significant pay cut," she said.

H-2A visas are allowed to be issued if it doesn't adversely affect domestic workers. Schmitt said that's exactly what was happening without proper wage setting from the U.S. Department of Labor. Growers who objected to the decision say it ignores the ever-changing market conditions on farms.

Schmitt said the timing of this preliminary decision is important because the court's final decision likely won't be ready until harvest is over this year. That means workers would have had another year of depressed wages - and that wouldn't just affect them this year.

"It will also depress wages for the future because growers will report those depressed wages on the wage survey for this year and prevailing wages are likely to be lower in the future if they're allowed to pay depressed wages now," she continued.

Edgar Franks, political director for the Familias Unidas por la Justicia, AFL-CIO in northwest Washington, which brought the case against the Labor Department, said this decision is important because farmworkers often don't have their voices heard.

"We just want to have that opportunity to be heard and have our case being taken as seriously as the industry," he continued.


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