Contribute Try STAT+ Today

Hospitals in at least 25 states are critically short of nurses, doctors, and other staff as coronavirus cases surge across the United States, according to the industry’s trade association and a tally conducted by STAT. The situation has gotten so bad that in some places, severely ill patients have been transferred hundreds of miles for an available bed — from Texas to Arizona, and from central Missouri to Iowa.

Many of these hospitals spent months building up stockpiles of medical equipment and protective gear in response to Covid-19, but the supplies are of little use without adequate staffing.

“Care is about more than a room with a hospital bed. It’s about medical professionals taking care of patients,” said John Henderson, chief executive of the Texas Organization of Rural & Community Hospitals (TORCH). “If you don’t have the staff to do that, people are going to die.”

advertisement

Staffing shortages are a serious concern in multiple regions. Intensive care unit nurses, who typically oversee no more than two patients at a time, are now being pushed to care for six to eight patients to make up for the shortfall in parts of Texas, said Robert Hancock, president of the Texas College of Emergency Physicians. In Ohio, some 20% of the 240 hospitals tied to the Ohio Hospital Association are reporting staffing shortages, according to spokesperson John Palmer.

The American Hospital Association’s vice president of quality and patient safety, Nancy Foster, said she’s heard from two dozen hospital leaders over the past two weeks, warning her of staffing shortages in states including Texas, North and South Dakota, Minnesota, Wisconsin, and Illinois. Health care providers in Kansas, Oklahoma, Arkansas, Ohio, Missouri, Michigan, and Utah said they’re facing the same problem, as do local reports from New Mexico, Nebraska, Colorado, Wyoming, Tennessee, Georgia, Alabama, Indiana, Montana, California, Rhode Island, and South Carolina.

advertisement

The shortages are primarily caused by overwhelming numbers of patients as coronavirus spreads, combined with decreasing staff levels as nurses and doctors themselves fall sick or have to quarantine after being exposed to infected people. Covid-19 is also prevalent in rural areas that have been struggling with a shortage of health professionals for years; hospitals in more remote regions don’t have equipment such as ventilators, and so must transfer severely ill patients to already-overwhelmed urban health care systems. The scale of the problem makes it harder to address: Systems designed to offset shortages by bringing in backup from other areas don’t work when so many states are affected simultaneously.

States that sent doctors and nurses to New York at the beginning of the pandemic now have no one to turn to as hospitals across the country experience the same problem. “Early on, Texas was sending teams of caregivers to states like New York to help with their surge,” said Henderson. “You can’t do that when 48 states are going through a surge in the wrong direction and they all need help. Where do you pull from?”

As the crisis proliferates, several health care systems are struggling to transfer urgent patients to hospitals with adequate support. Hospitals in Lubbock, Texas, had to send severe Covid-19 patients to Arizona, said Henderson. A Missouri patient who urgently needed surgery to remove a mass in his brain was sent to a hospital in Iowa, said Alex Garza, head of the St. Louis regional pandemic task force and community health officer at SSM Health in St. Louis.

“The mechanics of how you transport and accelerate care are broken at the moment,” said Henderson. Even major cities in Texas, such as Houston, Dallas, and Austin, are facing their own staff limitations, and so many rural hospitals in Texas are forced to try and treat patients that they would typically transfer out.

Covid-19 has so overwhelmed parts of Texas, including El Paso and Lubbock, that hospitals are running short of both beds and staff. “I treated a clinical patient in a recliner, because it was the only thing close to a bed we could find,” said Hancock, who works at hospitals in Oklahoma, 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 what resources you’ve got and make it happen.”

The lack of staff reflects the dramatic increase in 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 simply aren’t enough ICU nurses, in particular, to meet the need. Hospitals currently have 2,000 ICU nurse jobs open on Trusted Health, a company that connects travel nurses, who hop from job to job around the country, with hospitals.

The situation is exacerbated as staff get sick with coronavirus themselves, or else have to quarantine after exposure. The staffing need is so dire, hospital workers who have tested positive for Covid-19 but are asymptomatic have been told to continue working in North Dakota.

One rural hospital in Texas is struggling with 30% of staff nurses out of commission because of infection with or exposure to Covid-19, said TORCH’s Henderson. At one point earlier this month, more than 1,000 staff from the Mayo Clinic were out of work because of Covid-19, said Amy Williams, executive dean of Mayo Clinic Practice.

“It could be caring for a family member who has Covid, it could be on quarantine because of being exposed in the community, or it could be because the staff member actually has Covid,” Williams said. More than 90% of possible exposures occurred in the community as transmission picked up, she said, not in the hospital.

As health care systems compete for additional staff, salaries skyrocket. ICU nurses are a “hot commodity,” said Dan Weberg, a former emergency room nurse and head of clinical innovation at Trusted Health, and their fees are currently twice as much as pre-Covid rates, at around $5,000 to $6,000 per week.

“This is how PPE was in the beginning of the pandemic. When you’re competing with everyone else in town, and state, and the country, that creates a market that’s not sustainable,” said SSM Health’s Garza.

In response to the staffing shortage, several hospitals are postponing elective surgeries as many did in the spring at the start of the pandemic. This decision carries risks: “They call them elective but a lot are what I’d call urgent cases,” said Hancock, the Texas emergency physician. A surgeon recently had to cancel two intestinal surgeries for patients who were struggling to eat, said Kencee Graves, associate chief medical officer at University of Utah Health. Patients waiting for knee surgeries may well struggle to walk.

But there are few alternatives for health care systems. “You can always add more beds. It’s much more difficult to add more workforce,” said Alan Morgan, chief executive of the National Rural Health Association. Some hospitals are turning to local dentists and Red Cross volunteers, and people with basic health experience to help with tasks that require less training, said the American Hospital Association’s Foster.

The only other option is to ask existing staff to work more hours. University of Utah Health has been using additional ICU 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’s no end in sight,” said Graves. “They get here, work 12 hour shifts in PPE, it’s just this churn of seeing critically ill patients. And then you go to your community and see peak numbers, and having people continue to go to bars and restaurants.”

Trusted Health is trying to set a maximum of 60 hours per week in its nursing contracts. After working more than three 12-hour shifts in a row, error rates go up “exponentially,” said Weberg.

What most worries hospital officials is that Covid-19 has not yet reached its peak. “What I’m scared of, leading up to the holidays, is what’s going to happen immediately after Thanksgiving,” said Hancock. “Then everyone gets into a crisis situation and there’s nobody who can go help.”

Their only hope is for demand to decrease by people reducing Covid-19 transmission through quarantining and wearing masks, they said. “Many of us feel powerless because we feel people aren’t listening when we say don’t gather for Thanksgiving or Christmas,” said Graves. After months of dealing with the crisis, she worries that some nurses will be so burned out they’ll quit, making the staffing shortage even worse.

Both hospitalizations and deaths are lagging indicators, meaning it takes a couple of weeks for newly diagnosed cases to translate into more ICU patients. “We’re in for a very rough Thanksgiving and Christmas,” said Henderson.

  • It seems that the work and sacrifices by health care workers is just being expected, without being respected. If people expect to be taken care of in the health care system, then for sure in a pandemic they must make the efforts that the health care system is asking everyone for : small little sacrifices like mask, distance, hand washing, no travel, no big dumb thanksgiving gatherings. It is not right and not fair to expect health care workers to put themselves in the danger-line of Covid, while “future patients” just party on.

  • Dire staffing shortage in US hospitals was predictable months ago, as more and more people were ignoring rather small adaptations to curb the spread. It requires the commitment from all in a nation to minimize disease that locks up and kills the elder, forces hospitalization of young and old, causes long term effects for working people, and stresses the health care system to bursting. Major attitude adjustment needed !

    • Staffing for epidemics is near impossible as the training necessary to relieve the demand will not be useful following the taming or exit of the virus. Perhaps the medical and nursing schools could volunteer students to participate in the less critical tasks, freeing the professionals to those better suited to experienced staff.

  • 1. The military has health resources that should employed at this time to help civilians
    2. There are people who know how to build whole hospitals in a couple weeks they should be asked to help for cash payment
    3. There is a country with well-trained surplus medics personnel. They should be asked to help rather see our people die unnecessarily. Remember death is irreversible and the bitterness of death never passes completely for Lord one’s left. This is a global catastrophe and we should put aside ethnic an national hubris and tackle it as a species. NOBODY WANTS TO DIE !!!

  • They’re facing a staffing shortage because they keep sending staff home that are perfectly healthy but that test positive.

  • Ran over to the CDC for stats (lacking from this article). I work in healthcare – specifically with rural hospitals in the West – and the challenge reported to me has been managing a business with restrictions on elective surgeries – the main revenue source. There have been very few COVID cases managed in these rural facilities, generally. Check out data sources by county and you’ll see that. The source for the UT aspect of this article stood out to me. UT has reported 7k total hospitalizations for the past 9 months. That number doesn’t strike me on its face as something our healthcare community – over a span of time – is incapable of servicing. It should also be noted that over 75% of the reported deaths in UT were 65+, 90% of which were high risk. When you consider probability that some of these individuals may have been admitted to the hospital for other reasons, regardless of COVID, the COVID delta doesn’t suggest something outlandish. Again, I just went to UT because the comments from the UT source were inconsistent with what I understood to be true. I’m not calling this person incredible. But there’s more to the story, I think. Also, keep in mind that hospitals aren’t typically holding a lot of empty beds, even in non-COVID times. So when people see a shrinking number of available beds, it is concerning. But to be clear, it is by design to be efficient – that we come close to capacity needs to be viewed in this context.

  • They can take the opioids and benzos they took away from severely damaged pain sufferers especially the elderly,& for that reason they need to take a CDC reeducation course on killing our heroes and mentors,they lost all credibility, I’m 70 have horrible health issues and asked to be euthanized,its better than overdosing on aspirin & grain alcohol, uw Wisconsin health is worse than covid 19,unqualified to treat humans,I was a Guinea pig and assulted by a rogue, now deceased fake dr…. 1 down and just dont care……this is how we feel…..a senior with chronic pain is potentially more dangerous than uranium,when neglected….truth is a painful pill to swallow…..adhesive arachnoiditis sufferer left 4 dead because it was caused by medical procedures,,,,I have no sympathy left..$%&#÷_>&%>=÷÷&%_ greg

  • I don’t think most of those going to the hospital really need to be there.. I should think they would send them home and leave any space for that actually need to be there..

  • Alarmingly sad situation. Perhaps, because this is a pandemic, it may be appropriate to rely not only on the “limited” quantity of staff at any facility (establishment), but on additional staff, with suitable qualification and expertise, – (borrowed) – from some other, renown worldwide organization.

  • What I don’t see discussed is how much staff – OR staff, nurses and physicians – were abandoned and laid off by hospitals when revenues were down due to lack of patients and surgeries early on in the pandemic when admits and surgeries were restricted due to potential overrun of COVID admissions that often didn’t happen. Rehiring has been slow for a number of reasons and the remaining staff hours have been stretched to the maximum. Its going to take some reassuring to get staffing to come back and get levels back to where they should be.

    • I had the same thought. Early on, hospital staff were laid off. Some made more money on Covid relief payments than going back to work. Also, how much more training does it take for an RN to work ER, ICU, or Acute Care? It makes me think we are underestimating the value of staffing. In Phoenix, a recently closed hospital near downtown was refitted to deal with an influx of Covid patients which never materialized. Haven’t read anything more about the status of the hospital. If 90% of staff is exposed to Covid in the community, what if many of them remain asymptomatic and if not for a test which is often faulty, might be at work?

    • At a rate of $5,000-$6,000 a week, I am not sure how many laid off doctors and nurses you expect are currently living under a rock and have not yet realized that opportunities for rehiring are suddenly looking up. Perhaps the Spring experience was enough hardship to last a lifetime for some of them and they are not looking to be rehired. And honestly to see how so many people flaunt public health guidelines, it would be hard to not understand such a reaction

Comments are closed.

Your daily dose of news in health and medicine

Privacy Policy