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As California hospitals quickly approach capacity due to the unprecedented rise in coronavirus cases, there are growing concerns about the shortage of workers as the healthcare system struggles to keep up with growing demand.
Officials have contingency plans to open additional facilities if hospitals are overwhelmed, which was developed by the first wave of COVID-19 last spring. But conditions have changed significantly since then, which could pose a staffing problem.
On the one hand, the spring push was more limited in scope, with parts of California – and the country – being hit harder than others. This left more room to move resources and bring in health professionals from areas that could spare them. The current surge is not only larger than the spring surge, but also much more widespread, leaving fewer areas with nurses and doctors to spare.
In addition, some patients were avoiding emergency rooms and elective medical appointments in the spring, fearing they would be infected. Fewer people are staying away now, weighing on hospitals as they see an influx of COVID-19 patients.
“Know that these resources are not limitless,” said Dr Christina Ghaly, who heads the county agency that runs four public acute care hospitals and several clinics, in a press conference Wednesday. “The staff is tight, and it’s tighter than it would normally be in a hospital.”
Hospitals are filling up quickly, but so far they have been able to handle the surge. County health officials predict that within a week, LA County could see between 275 and 500 new COVID-19 admissions each day. Based on current modeling, if the rate of new cases continues to rise, LA County will suffer from a shortage of intensive care beds over the next four weeks, according to county officials.
There are options when conditions worsen.
Hospitals can limit non-essential outpatient care, cancel non-essential surgeries, and more quickly release patients who could be treated in rehab hospitals and care facilities. Hospitals can, and often do, open up overflowing patient areas.
To increase staffing in critical areas during the pandemic, hospitals have asked ambulatory staff with emergency and intensive care experience to work in emergency rooms and COVID units. The establishments have also signed contracts with itinerant nurses to strengthen their staff.
Some hospitals are also asking the state for waivers that would allow nurses to treat more patients than is permitted by state law.
Anxiety inside medical facilities is increasing as cases increase and workers feel they are entering uncharted territory during this pandemic.
Unlike the spring, LA County emergency rooms, in both public and private hospitals, are very busy.
“The number of COVID-19 cases and hospitalizations has been steadily increasing in recent weeks,” said Darlene Scafiddi, vice president of nursing at Pomona Valley Hospital Medical Center, at a recent meeting of the Supervisory Board. “Our staff at the hospital has doubled in the past three weeks. As the only trauma center in the eastern San Gabriel Valley and comprehensive stroke treatment center, all of our intensive care beds are currently full and we are booming.
A leader of the Greater El Monte Community Hospital echoed a similar sentiment, noting that the facility was seeing a “sharp increase.”
In the spring, during the first wave of the COVID-19 pandemic, people were avoiding the hospital for fear of contracting the virus, and the emergency room saw a decrease in its volume of patients due to fear of the virus. public to seek treatment, said Claude Stang, executive director of the emergency department at Cedars-Sinai Medical Center.
“This has changed. In this third wave, patients come to the hospital for various conditions, and they don’t seem so fearful of coming to the hospital, ”Stang said.
This is not a bad thing, because people need care and should not delay it, he said.
During the first wave, Cedars-Sinai, like most others, postponed elective surgeries and had an average daily count of only about 600 patients. In this third wave, Cedars-Sinai is one of several hospitals that continue to operate and has a census of around 900 patients.
Stang fears what will happen to his staff as cases continue to rise. He said he feared health workers would fall ill as more virus spreads in the community.
Since early November, cases among healthcare workers have increased by 71%, according to data presented by LA County officials on Wednesday.
As more and more people get sick, it becomes easier for others to contract the virus as the percentage of infected people in the community increases. These trends have recently caused an increase in the number of cases not only among healthcare workers, but also in skilled nursing facilities, schools and other workplaces.
A nurse at a Kaiser Hospital in LA County said he felt fatigued by the constant threat of COVID-19. When he goes to work, he never knows if he will receive a patient infected with the virus.
“It hurts because you want to help patients, but at the same time I’m so exhausted,” said the nurse, who asked not to be named because her hospital prevents medical staff from speaking to the media. “I just feel the stress of working right now, it’s just too much. I’m just done – I never hated my job again.
He said that sometimes after treating a patient they find out they actually have COVID-19. Their minds race to try to determine how long and how much they interact with them.
“Everyone’s panicking,” he said.
Unlike at the start of the year, his hospital has no shortage of PPE. Now, it seems the limiting factor is the beds, and projections show the hospital may run out soon.
“We are reaching a peak that we have never reached in the first round,” he said.
He said the hospital had started moving nurses and recruiting temporary staff to prepare for a bigger increase. Elective surgeries are canceled as of this week, he said. “Just a lot of changes are happening now,” he said.
A proposed remedy to ease the burden on hospitals has proven controversial.
At the onset of the pandemic, concerns over hospital staffing led Governor Gavin Newsom and the California Department of Public Health to begin allowing hospitals to seek waivers, only when they see an increase in COVID- 19 or a staff shortage due to the pandemic allow them to exceed prescribed nurse-patient ratios. (California is the only state in the country to have mandatory nurse-to-patient ratios in acute care hospitals.)
About 115 hospitals in California have been approved for waivers since the start of the pandemic – some on multiple occasions, as waivers last for 90 days – including about 31 facilities in LA County, according to an analysis of Department of Health data California Public. Most recently, Lancaster’s Antelope Valley Hospital received approval shortly after Thanksgiving.
Antelope Valley Hospital, which a hospital spokesperson says is the state’s second busiest emergency room, has been inundated in recent weeks not only with COVID-19 patients , but also trauma patients.
The hospital has received a waiver to temporarily change its staffing ratio on its telemetry floor, the unit for patients who need a heart monitor. Instead of 1 nurse for 4 patients, the staffing ratio is 1 to 5.
“This is a temporary measure until we can recover from the surge in patients and the staff shortage,” hospital spokeswoman Cynthia Frausto said, adding that several nurses were infected with COVID -19 and other ailments.
Earlier this week, registered nurses held a press conference to protest the staff change, which they say is stretching their exhausted staff too much.
Maria Altamirano, a registered nurse who has worked at the hospital for 13 years, said nurses do more than return patients on a regular basis, manage their medications, help them with the washroom and provide general health care. Because family members cannot visit loved ones with COVID-19, she said, nurses must also help patients with video calls.
During this time, they also wear a significant amount of protective gear and usually don’t have time to take a break. Sometimes Altamirano had to wait eight hours to use the toilet. Sometimes she did a non-stop shift. Two weeks ago, she was so tired that when she got home she couldn’t feel her feet anymore. She woke up on her sofa in her bathrobe, the chamomile tea and the dinner that her husband was still making her wait in the kitchen.
On a recent shift, she started at 7 a.m. and didn’t eat or drink anything until 11:30 a.m., when she swallowed tea and a donut and returned to work. Nurses no longer hug, talk or have time to support each other, despite the enormous mental toll the pandemic has put on them, she said. .
“You worry constantly [while on break] about “Who is looking after my patient? No one?’ So we are doing everything we can to help each other, ”she said. “We haven’t taken a break since March.”
On Thanksgiving night, the hospital saw a “huge surge” of COVID-19 and trauma patients, she said.
“Our intensive care unit is now also bombarded with COVID patients, and we still have to keep the beds open for our trauma and major surgery patients, and what will happen when those beds are occupied by COVID patients?” Altamirano said. “We are not going to be able to take care of [of them].… There will be no beds.
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