As the United States adds a new coronavirus case every second, hospitals from West Texas to Wisconsin are overwhelmed with the soaring number of critically ill Americans.
In many cases, it’s not a lack of hospital beds, therapies or equipment that worry managersamid the surge, with someone dying from COVID-19 in the U.S. nearly every two minutes. It’s the depleted and exhausted hospitals staffs needed to care for those who need life-sustaining therapies.
The head of the Utah Hospital Association this week warned the situation is getting so dire hospitals there might soon need to ration care. Hospitals in North and South Dakota are seeking staff reinforcements to care for patients in crowded intensive care units. And in Wisconsin, hospitals are opening makeshift ICU wings even as they desperately look for nurses and other clinicians to staff the facilities.
“We can keep converting ICU space,” said Jeffrey Pothof, an emergency room doctor in Madison, Wisconsin. “But the constraint will be the staffing … that’s the thing that worries us the most right now.”
More than 536,000 Americans tested positive for coronavirus over a 7-day period ending Thursday, a new one-week record. Another 46,000-plus were hospitalized as of Thursday. And perhaps more troubling, the share of positive cases is increasing in 41 states – a sign cases are on the upswing.
The worsening outbreak, fueled by Americans’ coronavirus fatigue and inconsistent mask wearing and distancing, means hospitals need more doctors, nurses and therapists to fill shifts. Not only do hospitals need extra workers to handle the surge, they also need to replace shifts when their own staffers are sick or quarantined.
But with the virus accelerating in so many states at the same time, hospitals nationwide are tapping the same limited pool of travel nurses, therapists and other clinicians who sign contracts to fill shifts on a temporary basis.
Rising cases in Phoenix, Arizona, in June and July made the nation’s fifth-largest city the epicenter of a summer surge that spilled over to other Sunbelt states. Because cases were largely under control elsewhere, Arizona recruited out-of-state travel nurses and respiratory therapists to temporarily fill shifts in crowded ICU units
With contract workers working side by side with full-time staffers, Arizona hospitals averted the deadly initial surge that overwhelmed New York hospitals during the early days of the pandemic.
Banner Health, Arizona’s largest health system, recruited more than 1,000 contract nurses and respiratory therapists from June through mid-July. Without those extra trained workers, the hospital might have used similar measures that Utah hospitals are now considering – rationing care.
Banner Health CEO Peter Fine worries hospitals can’t depend on stopgap staffing again.
“The real issue is staff burnout,” Fine said. “It’s a very real phenomenon and with a countrywide breakout we no longer can count on contracted staff to save us.”
‘More jobs than we could ever fill’
Staffing agencies that place travel nurses in hospitals and clinics say they’ve never been busier. In the past four weeks, RN Network, part of Salt Lake City-based CHG Healthcare, has fielded a 130% increase in staffing requests, said spokesman Chad Saley.
Hospitals in nearly every state are recruiting contract nurses to fill shifts. And those pandemic-driven jobs often pay “crisis rates” that swell compensation 20 to 30% above normal rates, especially for in-demand jobs like nurses with ICU experience.
Even full-time nurses are leaving hospital jobs to take lucrative gigs with travel companies, Saley said. They can earn extra pay and covet the adventure without the long-term commitment of a staff position.
“There are many more jobs than we could ever fill by ourselves,” Saley said.
Host Healthcare, a health care staffing agency based in La Jolla, Calif., said requests from hospitals have doubled from a year ago.
Not only do hospitals need to recruit workers to take care of the sickest patients, some are seeing demand in other areas of the hospital. Hospitals halted non-emergency operations during the early weeks of the pandemic. When those elective surgeries resumed as states relaxed restrictions, hospitals needed more workers.
In addition to ICU positions, Host is filling jobs at medical-surgical, post-operation recovery and telemetry units to remotely monitor patients vital signs.
All these extra requests mean travel nurses can command higher pay. Travelers can earn in five to six months what a staff nurse earns in a year, according to Gerald Cohen, Host’s executive director of training and development.
“I’ve never seen demand like this,” Cohen said.
Staffing limits care for sick patients
In North Dakota, where COVID-19 cases per capita are among the highest in the nation, the state directed $10 million in federal funds to the state’s six largest hospital systems. The purpose: aid hospitals that must pay lucrative travel nursing fees, as well as other staffing expenses, said Tim Blasl, president of the North Dakota Hospital Association.
Nearly one in five patients in North Dakota hospitals has COVID-19, the largest share of such patients in the nation. South Dakota has the second highest share of hospitalized coronavirus patients, followed by Montana and Wisconsin, according to U.S. Department of Health and Human Services data.
Because North Dakota was among the first states hit with the current surge, hospitals mobilized early to hire travel nurses, therapists and other contact workers. Existing hospital staffers took extra shifts and worked long hours to keep up with the demands.
This early jump on hiring contract workers means the state might have an advantage securing enough workforce, Blasl said.
Still, travelers have options, and will the extreme winter conditions of the Upper Plains states compel nurses and clinicians to look to other states?
“We do compete with other hospitals, other states, in terms of staff. It’s very, very expensive,” Blasl said. “When you get into the winter season, does it become maybe more of a challenge? It could. We are spending a lot of dollars on contracted labor. Probably no different than other hospitals across the country.”
Hospitals in Wisconsin are struggling to keep pace with the surge in cases there. The state opened a field hospital near Milwaukee to handle excess cases.
Pothof, an assistant professor of emergency medicine at the University of Wisconsin School of Medicine and Public Health and chief quality officer at UW Health in Madison, said his hospital is seeking to handle a growing number of sick patients. About one in three COVID-19 patients admitted to the hospital are “super sick” and need ICU care, he said.
The hospital planned to open a new ICU unit in November, but with cases mounting, the hospital began moving patients to the new unit this week. It also converted another medical unit into ICU space.
Beyond space and equipment, these units need workers. A nurse in a normal ICU unit can take care of two patients, but the sickest COVID-19 patients need round-the-clock attention. Some are hooked to heart and lung bypass machines and must be constantly monitored, so there is one nurse for every ICU patient with COVID.
The hospital has contacted travel nursing agencies and also looked within its own ranks. Some nurses who work in outpatient units have hospital experience and can fill some shifts.
Still, finding ICU nurses and other health workers limits the number of critically ill patients the hospital can handle.
“Pretty much every nurse who wants a job right now in the United States has a job,” Pothof said. “Staffing is the one that keeps me up the most at night.”
In El Paso, Texas, a judge sought to force the community’s hand by ordering a two-week shutdown of nonessential businesses. The city’s hospitals are at capacity and medical workers are exhausted as the county grapples with a record number of cases.
Infectious disease experts say the relentless pressure of new cases and fatigued hospital staffs represents a new phase of the pandemic. Unlike earlier days of COVID-19, fewer hospitals will be able to take patient transfers from hard-hit communities.
“It is something more widespread than the outbreaks that occurred in the Sunbelt episode in the summer or the Northeast in the spring,” said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security. “This just underscores the need to get control of this virus.”
Ken Alltucker is on Twitter as @kalltucker or can be emailed at email@example.com