Reflections On 2021

By Dr. Nancy Dickey, December 2021

2021 was a roller coaster of a year.

The country began implementing a high-speed fast vaccine rollout in its early months. And as vaccination rates climbed and COVID case counts fell, people began to breathe a sigh of relief. Elective surgeries returned. Intensive care units were no longer in short supply. Mask mandates loosened, concerts resumed, and travel picked up again. Many believed we had traversed the worst of the pandemic and that life would return to normal for the summer.

And it did, for a few weeks, but a lower-than-expected vaccine uptake and the emergence of the Delta variant cast doubt in July and August that we would ever be “done” with COVID-19.

As hospital capacity again reached critical limits, rural providers used what they learned in 2020 to snap into action. Ventilator and personal protective equipment shortages were a thing of the past, but a new challenge rose to the surface, one that has stymied the healthcare industry for years: a nursing shortage.

For years, other healthcare leaders and I have waved a red flag to signal the severity of this challenge, but it remains unsolved. Furthermore, when you pile extreme fatigue and burnout atop an already dwindling workforce, those numbers start to decrease even faster, making caring for patients during a deadly pandemic more of a challenge.

The story of the second half of 2021 became about finding the personnel resources to continue the battle.

Between December 14, 2020-May 22, 2021, only 57% of U.S. adults had received at least one COVID-19 vaccine dose. Hospitals began implementing new strategies to retain their workforce as state and federal offices rolled out vaccination mandates. COVID-19 vaccination efforts started among healthcare workers to illustrate trust in the science behind COVID vaccinations and standardize them as routine practice. In the past 12 months, nursing turnover rates exceeded 15%, a 4.7% increase from the beginning of 2021, partially due to these vaccine mandates. Many rural hospitals developed resources to encourage vaccination among their workforce and mitigate vaccine hesitancy with hopes of retaining their healthcare workers and keeping them safe while caring for their communities.

New variations of these programs unfolded throughout the communities surrounding rural hospitals. Through provider recommendations and financial incentives and home-delivered, workplace, and school-located vaccination opportunities, vaccination rates in the United States reached all-time highs. As of December 5, 2021, 71.5% of the United States population had received at least one dose of a COVID vaccination, 59.9% were fully vaccinated, and 14.0% had already received a booster shot.

When I think back to the challenges of 2021, I’m quite proud of the ways rural hospitals responded. They cared for higher-acuity patients, leveraged new partnerships, implemented new telehealth abilities, and more. It gave these institutions confidence to handle challenging cases and new crises that came their way.

Despite the challenges posed by the past year, CORH’s cohort 3 and 4 hospitals exhibited tremendous engagement in our programs and other available resources. Across all Cohort 3 hospitals, over 727 priorities were identified. The majority focused on the domains of Learning and Growth such as hospital board education, leadership training, recruitment and retention, and new service line implementation. Our exit interviews with Cohort 3 hospitals revealed nearly half (47%) added new service lines and that 50% of the 130 respondent priorities were identified as Completely Met.

We saw in interactions with our cohort hospitals that many challenges that rural hospitals faced in 2020 and 2021 were not new and could not be solved with short-term solutions. The rural health community must use experiences from the pandemic to motivate legislators and regulators to support rural health through long-term changes.

This includes finding workable solutions to staffing challenges. We need to think differently about how we recruit and retain hospital caregivers. It also means addressing the fatigue of the current workforce, one that is burned out from nearly two years of strenuous, sometimes chaotic, caregiving.

For instance, the recent expansion of broadband internet connection to more rural communities across the United States will promote the growth of telehealth services that were implemented at the peak of the COVID-19 pandemic. Applying these digital technologies was pivotal in patient quality of care during the pandemic. Telehealth Services allowed for safer clinic visits and a broader reach of services with lower staff numbers to areas facing healthcare disparities. Contact tracing and other public-health response tools were vital for healthcare providers to make rapid decisions in response to high COVID infection rates within their communities.

The steep highs and the deep lows of the year were, indeed, a roller coaster for rural health providers. As we head into 2022, we must learn from this pandemic and solidify rural health providers’ critical role in the health of our country.