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HHospitals in at least 25 states are critically short of nurses, doctors and other staff as coronavirus cases increase in the United States, according to the industry professional association and a tally by STAT . The situation got so bad that in some places critically ill patients were transferred hundreds of miles for an available bed – from Texas to Arizona and central Missouri to Iowa.
Many of these hospitals have spent months building up stocks of medical and protective equipment in response to Covid-19, but the supplies are of little use without adequate staff.
“Care is not limited to a room with a hospital bed. These are healthcare professionals who take care of patients, ”said John Henderson, executive director of the Texas Rural and Community Hospitals Organization (TORCH). “If you don’t have the staff to do this, people are going to die.”
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Staff shortages are a serious concern in several regions. Nurses in intensive care units, who typically don’t watch more than two patients at a time, are now being pushed to treat six to eight patients to make up for the deficit in parts of Texas, said Robert Hancock, president of the Texas College of Emergency. Doctors. In Ohio, about 20% of the 240 hospitals linked to the Ohio Hospital Association report staff shortages, according to spokesperson John Palmer.
American Hospital Association vice president of quality and patient safety Nancy Foster said she heard from two dozen hospital executives in the past two weeks, warning her of staff shortages in States such as Texas, North and South Dakota, Minnesota, Wisconsin and Illinois. . Healthcare providers in Kansas, Oklahoma, Arkansas, Ohio, Missouri, Michigan and Utah have said they are facing the same problem, as are local reports. from New Mexico, Nebraska, Colorado, Wyoming, Tennessee, Georgia, Alabama, Indiana and Montana. , California, Rhode Island and South Carolina.
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The shortages are mainly caused by an overwhelming number of patients as the coronavirus spreads, combined with a downsizing as nurses and doctors themselves fall ill or have to quarantine themselves after being exposed to people infected. Covid-19 is also prevalent in rural areas which have struggled with a shortage of healthcare professionals for years; hospitals in more remote areas do not have equipment such as ventilators and therefore have to transfer critically ill patients to already overwhelmed urban health systems. The magnitude of the problem makes it more difficult to solve: Systems designed to compensate for shortages by providing backup to other areas do not work when so many states are affected simultaneously.
States that sent doctors and nurses to New York City at the start of the pandemic now have no one to turn to as hospitals across the country are experiencing the same problem. “Right from the start, Texas was sending care teams to states like New York to help them cope with their surge,” Henderson said. “You can’t do this when 48 states are riding a wave in the wrong direction and they all need help. Where do you get from?
As the crisis proliferates, several health care systems struggle to transfer urgent patients to hospitals with adequate support. Hospitals in Lubbock, Texas have had to send patients with severe Covid-19 to Arizona, Henderson said. Missouri patient who urgently needed surgery to remove a mass in his brain was sent to an Iowa hospital, said Alex Garza, head of the St. Louis Regional Pandemic Task Force and responsible for community health at SSM Health in Saint-Louis.
“The mechanics of how you transport and expedite care is currently broken,” said Henderson. Even big cities in Texas, such as Houston, Dallas, and Austin, face their own staff limitations, and so many rural Texas hospitals are forced to try and treat patients that they would typically be transferred.
Covid-19 has so overwhelmed parts of Texas, including El Paso and Lubbock, that hospitals are running out of beds and staff. “I treated a clinical patient in a recliner chair, because it was the only thing near a bed we could find,” said Hancock, who works at Oklahoma hospitals, from Dallas-Fort Worth and Amarillo, Texas, but declined to say where the incident happened. “We knew the patient was sick and had nowhere to put them. You look at the resources you have and you get there. “
The lack of staff reflects the dramatic increase in the number of patients. There has been an average of 157,318 new cases per day over the past week, according to the STAT Covid-19 Tracker – 74% more than two weeks ago – and there are simply not enough nurses in the intensive care, in particular, to meet the needs. . Hospitals currently have 2,000 critical care nursing jobs open on Trusted Health, a company that connects traveling nurses, who move from job to job across the country, with hospitals.
The situation is exacerbated as staff themselves fall ill with the coronavirus or have to be quarantined after exposure. The need for staff is so dire that hospital workers who have tested positive for Covid-19 but are asymptomatic have been told to continue working in North Dakota.
A rural Texas hospital struggles with 30% of nurses off duty due to infection or exposure to Covid-19, TORCH’s Henderson said. At one point earlier this month, more than 1,000 Mayo Clinic staff were out of work due to Covid-19, said Amy Williams, executive dean of Mayo Clinic Practice.
“It could be taking care of a family member who has Covid, it could be in quarantine because it has been exposed in the community, or it could be because the staff member actually has Covid.” Williams said. More than 90% of possible exposures have occurred in the community when transmission accelerated, she said, not in hospital.
As health care systems compete for additional staff, wages are skyrocketing. Critical care nurses are a ‘hot commodity,’ said Dan Weberg, former emergency nurse and head of clinical innovation at Trusted Health, and their fees are currently twice as high as pre-Covid rates, between 5 000 and 6000 dollars per week.
“This is how PPE was at the start of the pandemic. When you compete with everyone else in town, in the state, and in the country, it creates a market that is not sustainable, ”said Garza of SSM Health.
In response to the staff shortage, several hospitals are postponing elective surgeries, as many did in the spring when the pandemic began. This decision carries risks: “They call them elective, but many are what I would call urgent cases,” said Hancock, the Texas emergency department. A surgeon recently had to cancel two bowel surgeries for patients who had difficulty eating, said Kencee Graves, assistant chief medical officer at the University of Utah Health. Patients waiting for knee surgery may have difficulty walking.
But there are few alternatives for health systems. “You can always add more beds. It’s much harder to add more workforce, ”said Alan Morgan, executive director of the National Rural Health Association. Some hospitals are turning to local dentists and Red Cross volunteers, as well as people with basic health experience to help them with tasks that require less training, said Foster of the American Hospital Association.
The only other option is to ask existing staff to work more hours. The University of Utah Health has been using extra intensive care beds for months, which means nurses and providers are working extra shifts. “Our numbers keep increasing but they are tired. Our nurses feel like there is no end in sight, ”said Graves. “They come in here, work 12-hour shifts in PPE, it’s just this turnover of seriously ill patients. Then you go into your community and you see spikes in footfall, and people keep going to bars and restaurants. “
Trusted Health tries to set a maximum of 60 hours per week in its nursing contracts. After working more than three shifts for 12 hours straight, error rates increase “exponentially,” Weberg said.
What worries hospital officials the most is that Covid-19 has not yet reached its peak. “What I’m afraid of before the holidays is what’s going to happen immediately after Thanksgiving,” Hancock said. “Then everyone goes into a crisis situation and there is no one who can help.”
Their only hope is that demand will decrease from people who reduce the transmission of Covid-19 through quarantine and wearing masks, they said. “A lot of us feel helpless because we feel people aren’t listening when we say not to get together for Thanksgiving or Christmas,” Graves said. After months of dealing with the crisis, she fears some nurses will be so exhausted that they will step down, further compounding the staff shortage.
Hospitalizations and deaths are lagging indicators, which means that it takes a few weeks for newly diagnosed cases to translate into more intensive care patients. “We’re having a very tough Thanksgiving and Christmas,” said Henderson.
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