MICHEL MARTIN, HOST:

We're going to start today by talking about some things that affect our health here in the U.S. and in the rest of the world. In a few minutes, we'll talk about the pros and cons of the Biden administration's plan to help vaccinate the world against COVID, but we're going to start with a problem closer to home. We're talking about a nationwide shortage of nurses. Hospital officials say they are reaching a crisis point as hospital ICUs fill up again because of the latest COVID variant even as they lose staff to burnout and to more lucrative temporary positions out of state. To talk about this, we decided to call someone we've been checking in with throughout the pandemic. That's the CEO of the Scotland County Hospital in Memphis, Mo., Dr. Randy Tobler. He's in a more rural part of the state, and he's back with us now. Dr. Tobler, welcome back. Thank you so much for joining us once again.

RANDY TOBLER: My pleasure. Great to reconnect, Michel.

MARTIN: Likewise. So how are things going? I mean, what have the last couple of months been like since we haven't chatted?

TOBLER: Right now, we're coming up for air after going down, maybe for the third time, during August and early September. Finally, things are moderating, but starting in August, the, you know, ground zero in Missouri was down in Springfield, in the southwest part of the state for the delta surge. And it gradually moved northeast, where we are, and really hit us harder than the winter surge did. And that, combined with the progressive nursing shortage that has just gotten worse and worse as the pandemic has gone on, really was a perfect storm to bring us to our knees.

MARTIN: And why is that? If nurses are leaving, what have they said about why, or have they told you why?

TOBLER: It's largely people are jumping for money. I've heard $10, 15, 20,000 signing bonuses, shift differentials that are just vastly out of our league. We've tried to combat that by increasing our scale for nurses, but even at that, it's loyalty to the hospital and the community and that neighborhood feel that is keeping some nurses. But we've lost five through the 18 months of the pandemic thus far.

MARTIN: In the first wave of this crisis, another issue was that - and this was before vaccines - hospital workers getting sick. Has that been an issue?

TOBLER: Yes. If you have someone who, either because of personal encounter with COVID or because of a family member and they have to care for them or quarantine, which has happened, then we're a nurse down. And when you're already having vacancies in your nursing staff, where do you pull the people from? It's been increasingly difficult, and I just am so thankful for the staff that keeps answering the bell to keep charging up the hill every time we ask them to. I'm so proud of them.

MARTIN: Well, now there are vaccines available. President Biden just this month issued a series of mandates, including one covering some 17 million health care workers at facilities that receive federal funding. Some administrators have been saying that they're worried that staff could quit over this. I understand that you don't actually have a vaccine mandate at your hospital right now. Is that accurate?

TOBLER: That's true. And actually, ironically, two days before the president's speech when he announced that mandate mandate that will be coming, we'd actually sent out mailers to nurses throughout the region and even the state saying, hey, come take a look at us because we don't have a mandate.

MARTIN: So you were hoping it would be a draw. You were hoping the fact that you don't have a vaccine mandate would be a draw for you.

TOBLER: Yeah.

MARTIN: But aren't you - you're not worried that your staff will get sick or that the patients will be exposed? That wasn't a concern?

TOBLER: It is a concern, but everyone wears N-95 masks, whether they're vaccinated or not, when they're giving patient care. And, again, we have to balance the risk of staff getting sick and maybe leaving us temporarily or not having staff at all because we make it a mandate and they jump off the ship - because that's the other thing. The fatigue and the burnout in the nursing realms when you're dealing with these incredibly sick patients and having to witness patients dying without their family nearby - the emotional, the physical, the professional toll on nursing is just tremendous.

MARTIN: Wow. Do you think - are you confident or at least are you hopeful that there won't be any more surges in your part of Missouri?

TOBLER: I am hopeful. I'm not confident because we're just not seeing the vaccination rate accelerate like I'd like to. In our four-county area that we serve, the maximum, the best rate of fully vaccinated folks is about 35%. There's just a lot of vaccine resistance. Usually, where I've seen people come to vaccinations, sadly, is when - it's not six degrees of separation - usually one or two degrees of separation from someone that - who gets gravely ill or dies, sadly. That's often when people will pull the trigger and get the vaccine who have been resistant previously.

MARTIN: You know, Dr. Tobler, I know it's hard watching people suffer like this and working so hard. If you don't mind my asking it this way, like, what's the worst thing about all this? What hurts the most?

TOBLER: What hurts the most is people that you work with and that people you've taken care of - you've delivered their babies. You've operated on them, for crying out loud. And in this particular instance, because of that gravitational pull of the viral videos on the social media and some people, sadly, with my credentials that are spreading false information, they believe that over someone that I thought we had a great relation, a trusting relationship. That hurts. That hurts docs, nurses, all who are trying to encourage people to do the right thing and get the vaccination.

MARTIN: Well, Dr. Tobler, we sure do appreciate your talking with us from time to time, and we certainly wish you the best as you continue to, you know, fight through this thing. That was Dr. Randy Tobler, CEO of the Scotland County Hospital in Memphis, Mo. Dr. Tobler, we thank you so much for your time.

TOBLER: Always my pleasure. Thank you, Michel. Transcript provided by NPR, Copyright NPR.