TOMPKINS COUNTY, N.Y.—When the Alcohol and Drug Council of Tompkins County held the ribbon cutting ceremony for its new detox center in May, the facility was celebrated as a keystone that would soon fill a long-discussed gap in the region’s healthcare and addiction services.
But the nurses needed to run the detox center are nowhere to be found, Stacy Cangelosi, the Alcohol and Drug Council’s interim executive director, told The Ithaca Voice.
The detox center, as a result, cannot completely open, marking an acute local example of the impacts that a nationwide nursing shortage is having on the health and medical fields.
Cangelosi said that the Alcohol and Drug Council “might have one nurse” starting this week despite soliciting applications since April. The Alcohol and Drug Council has a total of 19 positions they’re hiring for, and needs to hire at least six registered nurses (RNs) and three licensed practical nurses in order to start providing detox services, Cangelosi said.
Until then, the brand new facility will operate at a partial capacity. The 40-bed detox center, located on N. Triphammer Road in the Village of Lansing, has only been open for about a week. Currently, Cangelosi said, the center is only able to provide stabilization services, like providing medication like suboxone or methadone to aid patients recovering from opiate dependence post detox.
The center was designed to be a 24/7 facility where individuals coping with addiction can enter a clinically supervised detoxification program. The experience of drug withdrawal can be intense and varied, depending on the substance someone is addicted tol. Common symptoms of withdrawal include nausea, vomiting, depression, fatigue, paranoia, trembling and tremors according to the Mayo Clinic.
“It’s a really tough position for us to be in — to have the facility to offer this level of care, but not have the staff to do it. It’s very frustrating,” Cangelosi said.
The New York State Office of Addiction Services and Supports has committed to providing $600,000 on an annual basis to the Alcohol and Drug Council to run the detox center. However, the state support that the Alcohol and Drug Council receives to run the detox center is also tied to the services that they are able to provide, adding pressure to the effort to fill the empty positions.
Evan Frost, a spokesperson for OASAS, said in a statement that funding for the detox center will remain “as long as the provider remains operational and in good standing. This program is currently receiving funding for the stabilization services, which are operational, and once the withdrawal part begins offering services they will receive funding for that program on a pro-rated basis per the terms of their contract.”
For now, the Alcohol and Drug Council are being forced to turn away patients seeking detox services and direct them to centers in the cities of Binghamton and Syracuse — both about an hour drive away from the Ithaca area.
“That’s the whole reason we built this facility — was so that we didn’t have to do that,” Cangelosi said.
New York State has over 350,000 nurses — including RNs and other nursing positions — according to the New York State Department of Health. Prior to the pandemic, a 2019 study from the American Journal of Medical Quality projected that New York State would experience a shortage of over 39,000 nurses by 2030.
That figure has become frequently cited by the state department of health and state lawmakers trying to express the urgency of the issue, such as when the state legislature passed and Governor Kathy Hochul signed a bill allowing nursing students to use simulations in lieu of clinical work to help expedite graduation timelines.
But the pandemic has likely exacerbated the projected nursing shortage. One study found that, nationwide, the number of RNs decreased by over 100,000 in 2021, primarily among younger people working in the profession. A 2021 survey from the Nurse.com 2022 Nurse Salary Research Report found that 29% of nurses considered leaving the profession, compared to just 11% in 2020, with burnout and fatigue fueling the departures among other occupational hazards nurses face.
Jessica Clark Manderville, a Community Health Nurse with the Tompkins County Whole Health department, said she knows of many people who left the nursing profession during the pandemic for some or all of the above reasons.
“We went through this huge global pandemic, and it uprooted everything in the world,” Clark Manderville said. “But we’re now on the other side, and we still need nurses. We need caring and compassionate nurses and we’ve just lost a lot.”
The most recent job listing for a nursing position on the Alcohol and Drug Council’s website advertises an hourly rate of $30-$40 an hour for an RN, but Cangelosi said the pay range that they’re preparing to offer is $40-$45. Multiple working nurses told The Ithaca Voice the latter pay range seemed competitive.
While the shortage is reportedly having a widespread effect on the medical field, small organizations like the Alcohol and Drug Council, a nonprofit of about 70 employees, are at a disadvantage in the tight labor market.
“[If] a nurse comes to us and says, ‘I’ll work for you, but I need this amount of money,’ and it’s way more than we offer, we can’t counter with anything,” Cangelosi said. “We’re not the hospital.”
The prospect of competing for workers with the likes of Cayuga Medical Center, the largest medical provider in Tompkins County as well as one of the county’s largest employers, is a tall order for any small or medium sized health nonprofit, Cangelosi said.
The Alcohol and Drug Council’s total expenditures were over $1.8 million in 2021, of which $1.1 million went to salaries and other employee compensation, according to the organization’s tax returns filed with the Internal Revenue Service.
Tax returns filed by Cayuga Medical Center, a non-profit hospital, show over $329 million in expenditures, of which over $138 million were related to salaries and other employee compensation.
Pay’s importance as a determinant of where nurses want to work is a trend that Clark Manderville, who has worked as a nurse for 12 years, said she has seen play out during her time in the profession.
“When I talk to fellow nurses or students that are going through the nursing program, a lot of what entices them is the pay, and not necessarily the care they’re providing or the specialty that they’re going into,” Clark Manderville said.
Lara Hamburger, an RN who has been working at Cayuga Medical Center for a year, told The Ithaca Voice that ancillary benefits like greater access to mentorship and training may be contributing to the detox center’s struggle to attract nurses.
She said that the pay for the RN positions at the detox center appeared to be competitive, but acknowledged that it is a demanding role, which may lead to some hesitancy for newer or early career nurses to consider applying.
“Most people are going into a hospital setting or a setting where there is mentorship,” Hamburger said. “So despite the fact that there may be licensed individuals who could take work, they’re not going to be able to just dive right into it.”
The need for the facility, though, is not in question for her.
“I really want it to open. I have patients who would benefit from it and I know people in the community who would benefit from it,” Hamburger said.
But the Alcohol and Drug Council’s leadership is ready to say they can’t get the detox center open by themselves.
“We need help,” said Cangelosi.
Correction (08/01/2023): This report originally stated that multiple requests to speak with a representative of Cayuga Medical Center went unanswered. The Ithaca Voice had reached out to someone no longer serving as the hospital’s spokesperson, thus Cayuga Medical Center never received the requests for comment.