A shortage of nurses at US hospitals hit West Virginia’s Charleston Area Medical Center at the worst possible time.

According to Reuters news, the non-profit healthcare system is one of the state’s largest employers and sits in the heart of economically depressed coal country.

It faces a $40 million deficit this year as it struggles with fewer privately insured patients, cuts in government reimbursement and higher labor costs to attract a shrinking pool of nurses.

To keep its operations intact, Charleston Medical is spending this year $12 million on visiting or “travel” nurses, twice as much as three years ago. It had no need for travel nurses a decade ago.

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