New York felt the crunch first.
When COVID-19 case numbers started climbing in the early months of the pandemic, New York hospitals put out a call to arms. They needed more nursing staff, and hospitals were willing to dish out higher pay to get it. In some cases, they offered double or triple what nurses there had been making prior to the pandemic.
Nurses flocked into the health system in major cities, but that left many other places high and dry.
"That caused a shortage in other hospitals," said Carol Stefaniak, chief nursing officer at Self Regional Medical Center. "Their workloads were heavier and it took a toll on them, because nurses were with patients near 24/7."
There was an increase in pay for traveling nurses, which promised many of them twice the pay they'd earned working for a hospital. Some nurses who had vulnerabilities to infection left the profession, and many of those nurses didn't come back as case numbers rose.
"When we talk about a nursing shortage ... basically what we're saying, to really simplify it, is the demand is greater than the supply," said Lisa Bartanus, Self's director of talent acquisition, learning and development.
"It's a revolving cycle of not having enough nurses, hence hiring traveling nurses and having nurses leave because of the workload," Stefaniak added.
Before the pandemic began, Stefaniak said Self had adequate nursing staff to deal with its rate of patients, but at COVID's peak they were working long days short-staffed. A strong, resilient nursing team got them through the worst of it, she said, and now the hospital is in recovery mode after more than two years of stress, assuming no more case surges.
"We're building back the nursing teams," she said. "It's not always about numbers, it's about culture and environment."
That's also key for Greenwood's two nursing schools at Lander University and Piedmont Technical College. Both work with area hospitals to give students clinical experience outside of classroom instruction, so they can be familiar with the reality of the career they're pursuing.
"There's a whole gamut of things required of our students before they get out into the workforce," said Holly Davis, interim head of nursing at PTC.
Students take English classes to learn how to communicate and write effectively to document the care they give. Math helps them calculate dosages. They go through labs and simulations at the school, and clinical experience at Self, doctors' offices and dialysis clinics throughout the area.
"At first in their clinicals they're taking care of one patient, but as they gain experience that builds over time to caring for two or three," she said. "They're expected to do everything a nurse would do for them on that given day."
Lander's instructors mentor students about the realities of the nursing field and keep them tuned in to the opportunities available for work, said Paula Haynes, assistant dean of Lander's nursing college.
"Our faculty network with recruiters throughout the state of South Carolina, and recruiters from various health care institutions visit our campus regularly to talk to our students about career options," she said. "We also host career fairs on campus for the students."
Lander and PTC encourage students to participate in nurse extern programs that give them on-the-job experience and training. They partner with Self, and Bartanus said many of Self's nursing hires already had experience in the hospital through this program.
"We find that many more nursing students feel ready for a hospital setting one they've had that experience as an extern," Davis said. "We encourage students to find a home; a nice year in a medical-surgical unit is a good experience for a traveling nurse."
As for students who are starting to consider a career in nursing, Lander Nursing Dean Dr. Holisa Wharton borrows from Florence Nightingale to share that nursing is an art and science.
"Art is appreciated for its beauty and emotional power. How a nurse provides care to another human has profound emotional power," she said. "Likewise, nursing has the power to heal, power to comfort and even power to harm. The science of nursing supplements the art of nursing by allowing us to use research and proven practices to enhance healing, enhance comfort and minimize harm."
Stefaniak said the pandemic has highlighted how essential nursing staff are, and encouraged people to pursue this kind of caring career.
"We meet people at their most vulnerable — what an honor that is," she said. "We are privy to the most intimate information and moments of people's lives. The trust between a nurse and a patient is so strong, we see things that sometimes their families don't even see. That's an honor and responsibility."