I think it's all of that. To add some context, we've added a number of things to nurses' work environment, some of which are related to their doing non-nursing-related tasks. We've seen examples of that. As some organizations have implemented new electronic health records that are more integrated, some of them have reduced clerical supports as physicians do more of their physician orders themselves, and yet there have been tasks left behind that those clerical people were doing that get downloaded onto nurses.
As an example, I hear of nurses needing to clean beds in some facilities at night for admissions because there are no cleaning staff in facilities. There are a couple of examples. Some of the others we're hearing about are that many hospitals across the country are over capacity, which adds to the workloads that nurses are experiencing. What makes it more challenging is that they are sometimes coming into work that day when the workplace is short-staffed already. That's part of the challenge when you have a system that has a significant increase in vacancies that you're not able to fill, yet you haven't adjusted the work with the workforce. We've continued to operate many of our facilities full blast, yet we have a workforce that's depleted and isn't at 100% capacity and are expecting them to continue to do the same work volume.
There needs to be some balance there. Part of that challenge is that it creates additional stress and more of those workers choose to leave because they don't want to come into work not knowing if they're going to have the five patients they should have, or 10, or if they're going to get to go home at the end of the day, or they're going to have to work 16 hours because there's no one coming in to relieve them. Those are the challenges. It's not just about needing to have more of a workforce; it's about needing to look at all of the issues and balancing them all out together.