SHORT STORY: Too few full-time nurses are causing severe service and financial problems at North Carolina's hospitals.

• Author: Martin, Edward

The addled 83-year-old woman repeatedly rips off her clothes in despair. The ambulance attendant had brought her last June to Wilmington's Novant Health New Hanover Regional Medical Center five hours earlier, citing confusion and stroke symptoms. Over that time period, her behavior spirals "from sweet to ugly."

The attendant refused to leave her unattended, though. Thirteen other ambulances idle outside, backed up on the arching driveway off 17th Street with its glowing "Emergency" sign. There were 164 other patients in the emergency department that evening, according to an inspector from the N.C. Department of Health and Human Services.

Ideally, 2,000 nurses would be on New Hanover Regional's payroll. Some of them would be in the emergency room, aiding triage and assigning patients to one of the hospitals 700 rooms. But last summer, the state inspector reported that 400 of the nursing jobs were unfilled.

Patient lives were in danger, he ruled, threatening the medical center's certification to treat patients covered by the federal Medicaid health program for the poor. Novant rushed to fill the gaps, cutting nursing vacancies to 100, a spokesperson says. By last fall, the hospital was restored to good standing by state officials.

Sadly, the case isn't unusual. In recent years, other Tar Heel hospitals including UNC Medical Center in Chapel Hill and Wilson Medical Center have faced similar critical orders from state officials--fix health and safety problems or else. It's no empty threat because many N.C. hospitals rely on Medicaid and Medicare for more than half of their revenue. Both UNC and Wilson Medical, which is owned by a partnership of for-profit LifePoint Health of Brentwood, Tennessee, and Duke University, resolved their issues with federal officials.

The Wilmington hospital's problems were exacerbated by unfortunate timing, when seasonal visitors swelled nearby beach towns, just as the coronavirus and flu were increasing patient loads. It had expected nursing shortages, but not as drastic as occurred, says John Gizdic, Novant Health's executive vice president for business developments.

Details of the Wilmington's patient's experience were verified by public officials, but it's unclear what happened to her because of privacy rules. But it's symbolic of the life-and-death consequences that nursing shortages are creating in many areas, a swath of industry observers say. Like much of modern medicine, it's clouded with paradoxes and complexities.

Nurses remain the nation's most admired professionals, modern Florence Nightingales in Skechers, according to repeated polls. Most became nurses for altruistic reasons.

"When I was a teenager, over the holidays, I went to a hospital with a group to sing Christmas carols for the patients," says a nurse at Asheville's Mission Hospital. "I decided then if I could bring maybe the tiniest bit of happiness to them, I wanted to be a nurse."

But now, more than one in four members of the 100,000-plus member North Carolina Nursing Association say they have been physically assaulted--punched, scratched, slapped, kicked--by patients and family members. U.S. Bureau of Labor Statistics numbers show health care workers are five times as likely to be victims of violence as others in the workforce.

A Durham nurse was stabbed to death by a patient last fall, and two Wilmington nurses were attacked by a patient now jailed in lieu of $7.5 million bail, awaiting trial on second-degree murder charges. Ben Davis, the Port City's district attorney, says he'll prosecute the 28-year-old man in the latter case, using a 2015 state law passed to combat such attacks with stiffer penalties for assaults on health care...